Community engagement funding to ensure groups are heard
Third sector organisations are being awarded new funding to help ensure as many voices as possible are contributing to the design of the National Care Service.
The funding will facilitate contributions from minority ethnic communities, LGBTI people, children and young people and those with experience of homelessness or the justice system.
Organisations will each receive £5,000 to encourage the communities they work with to have their say on how future community healthcare and social work services should look.
Social Care Minister Maree Todd said: “As we build a National Care Service that best fits the needs of everyone in Scotland, we need to hear from people directly.
“The new National Care Service will set the standards and guidance to support the design and delivery of community healthcare and social work services locally.
“The complexities of getting this right should not be underestimated. People with experience of the current system, whether receiving health and care support or delivering it, are the experts. We need to hear those voices – and those of groups who are often overlooked.
“We know that minority ethnic communities, LGBTI people, children and young people and those with experience of homelessness or the justice system are under-represented in our co-design work to date. We also know that people affected by dementia are a key group we want to hear more from and we will benefit from partnering with an organisation with expertise in this area.
“I am confident the funding to support co-design activity with seldom heard communities will help us shape a system we can all benefit from and be proud of.”
The partner organisations are:
LGBT Health and Wellbeing
Minority Ethnic Carers of People Project (MECOPP)
The Simon Community
Scottish Association for the Care and Resettlement of offenders (SACRO)
Scottish Government, NHS and Councils to share accountability for services
The Scottish Government has reached an initial agreement with local government and the NHS about accountability arrangements for the National Care Service (NCS).
The agreement aims to establish who will be responsible for people’s care once the NCS is established. Overall legal accountability will be shared between Scottish Government, the NHS and local government.
Staff will continue to be employed by local authorities, and councils will still be responsible for assets like buildings and the delivery of services.
New governance arrangements will be introduced to ensure consistently high levels of service across the country, while building the flexibility to meet varying community needs at a local level.
Social Care Minister Maree Todd said: “The Scottish Government has been working closely with Local Government to find a consensus on the National Care Service (Scotland) Bill, which will allow us to deliver on the urgent improvements needed to strengthen the delivery of integrated health and social care for people.
“This partnership between the Scottish Government, Local Government and the NHS helps establish where responsibility for people’s care will sit under the National Care Service. The detail of how this will work at a local level will be developed in the coming months and we will continue to update parliament on this work, along with the results of our ongoing co-design events taking place across the country, after the summer recess.”
COSLA’s Health and Social Care Spokesperson, Councillor Paul Kelly, said: “Further improving the experiences of people accessing and working in social care and social work services must rest on an effective partnership between Scottish Government and Local Government.
“Combining shared national accountability with local expertise ensures the right balance of further improvement across Scotland, whilst rightly reflecting the diverse needs of local communities.
“We know too that successful change is driven by the valuable staff who deliver services. We hope by setting out the continued role of local authorities in delivering social care and social work functions, and staff remaining employed within councils, we offer comfort and stability to the Local Government workforce.
“In recognising this important first step, we know there is still more to do. As we progress forward, we are committed to continuing to work closely with people in receipt of support and partners to design a system that ensures individuals and communities always experience high quality care and support.”
The consensus follows the Verity House agreement on closer cooperation between Scottish Government and local government signed last month.
Social Care Minister Maree Todd will join the first of a series of events where people can co-design the new National Care Service.
Today’s event at Stirling’s Albert Halls will allow carers, people who access and deliver care, including the workforce, and anyone with an interest to contribute to how a new National Care Service could work.
Since the regional forums were announced last month, more than 600 have signed up to take part in-person and online, with additional capacity already being made for the Glasgow event next week.
Ms Todd said: “We want everyone to have access to consistently high-quality social care support across Scotland, whenever they might need it.
“There are unique demands across the country, which is why we’re going to different areas over the next 18 months, ensuring communities across Scotland can help design a National Care Service tailored to local needs.
“Having listened to people who access and deliver care support – both paid and unpaid – as well as care providers, unions and the third sector during the parliamentary process, these meetings will allow us to work with people who access care support, have a loved one that receives care, or works in the sector to think about how to meet the needs we have heard about. This will help us ensure the legislation reflects what people need and know as it progresses through Parliament.”
“I am pleased that there has been such interest in signing up, Spaces are still available, with online events providing another option for those who want to have their voices heard if they can’t make it in person.
People across Scotland are being invited to have a say on how a new National Care Service should work.
A programme of meetings will take place over the summer, stretching from Dumfries and Galloway to Shetland. There will also be online meetings for anyone who would prefer to join discussions remotely.
There are NO events in Edinburgh or the Lothians.
During a visit to the Allied Health Professionals in Bonnyrigg, which includes the 14 health professions that make up the third largest workforce in the NHS Scotland, Social Care Minister Maree Todd spoke with staff about what they want to see from the co-design of the new national approach.
Details for all events are now available on the online booking page. The first event will take place in Stirling on 20 June.
Ms Todd said: “There are unique demands across the country, which is why we’re going to different areas, ensuring communities the length and breadth of Scotland are represented in designing a National Care Service tailored to local needs.
“Having listened to care providers, unions and the third sector during the Bill scrutiny process, these meetings will allow anyone who uses care services, has a loved one that relies on care or has worked in the sector to have their say. This will help inform future stages of the Bill as it progresses through the Parliamentary process.
“There is general agreement that social care transformation will be of great benefit. This needs us all to have a shared understanding of what is working well and really focus on what’s needed to support people to thrive with the most suitable care for them. I would encourage everyone to be part of this conversation.
“To do this you can look to attend an event near you or join online, and be part of what will be the biggest social reform of our lifetimes.”
Alison Keir, Chair of the Allied Health Professions Federation Scotland said: “Rehabilitation is central to improving health and social care services in Scotland. Rehabilitation services are vital to people recovering from injury or supported through illness.
“When people get the rehabilitative care they need, they can be discharged from hospital sooner. Then they will need less health and social care, avoid being readmitted to hospital, and be able to regain their quality of life and their role as active citizens in Scotland.
“Allied Health Professionals, such as occupational therapists and physiotherapists, are experts in delivering rehabilitation. It is vital we improve community provision. We will fully engage with the national care service process to ensure we have the right services and systems in place.”
This week, the Chief Economist of the Bank of England, Huw Pill, generated many headlines when he said that “we’re all worse off” due to the stubbornly high inflation the economy is experiencing – and bluntly, that we all just need to accept that (write MARI SPOWAGE and EMMA CONGREVE) .
Given this follows on from Governor Andrew Bailey’s comments that people shouldn’t ask for pay rises, it adds a bit to the narrative that the Bank of England is a bit tin-eared to the way workers and households feel right now.
However, Pill’s comments are a reflection of the current outlook. Even with the more optimistic forecasts that we had from the OBR recently, meaning that a recession may be avoided, living standards are still projected to fall significantly over the course of 2023.
It is important though that we have a debate about who in society should bear the brunt of the costs we are experiencing, and whether indeed it is ever going to be possible to protect much of our society from these external shocks.
No sign of a recession… yet
On a more optimistic note, data published this week showed that the Scottish economy grew by 0.2% in February 2023, which follows on from growth of 0.5% in January. Services grew by 0.4%, and particularly encouraging was that consumer-facing services grew by 1.3%.
This means it looks like Q1 2023 is going to show some growth, rather than a contraction as many (including us) had feared.
It will be interesting to see how the economy evolves as we move past the end of March, when we know government support for energy bills started to wind down, particularly for businesses.
How does Scotland compare to other regions of the UK?
ONS have published their latest data on regional economic activity – which you can get split up by all sorts of levels of geography, including local authority and city region, and by industry.
This data allows us to compare the level and type of economic activity across the UK, for the year 1997-2021. Looking across the 12 regions of the UK, known as International Territorial Level (ITL) 1 Regions, we can see that economic activity in London far outstrips that of the other region of the UK. Scotland usually performs pretty well on these metrics, generally 3rd or 4th in the UK depending on the year.
Chart: GVA per head, ITL 1 Regions
Source: ONS
[As statto aside, this is “onshore” Scotland only. Aficionados of economic statistics in the UK will be aware that activity associated with the whole UK Continental Shelf is put into a 13th region called “extra-regio”, which also includes activities in embassies abroad.]
There are also significant differences between different local authorities within Scotland, with the main cities outperforming many other areas of the country. We have to remember of course that the economic activity data reflects where activity takes place – i.e. the location of the place of employment – rather than where people live, so there is a significant commuting effect associated with this data.
Chart: GVA per head, local authority
Source: ONS
Despite another instalment in the long running NCS saga, we still have no certainty over what, when or how much
Last week, it became clear that the National Care Service legislation (and by extension its delivery) will be pushed back (again). In a letter to the Health, Social Care and Sport Committee on the 17th April, the Minister stated that the Scottish Government would be seeking parliamentary approval to extend Stage 1 of the Bill till after the summer recess.
We have written before on some of the questions that remained following the introduction of the Bill and the accompanying Financial Memorandum. The Finance and Public Administration Committee shared many of our concerns (and had others) about the lack of detail in the Financial Memorandum and asked the Scottish Government for an updated version. The Convenor of that Committee, Kenny Gibson, wrote to the Minister this week noting that the Committee are becoming:
“increasingly concerned at the lack of information available on the financial implications of the Bill and frustrated that we have still not received the updated FM we requested back in December last year”
They have asked for a new Financial Memorandum no later than Friday 12 May along with a breakdown of spend to date on the NCS.
The importance of the NCS to those who work and draw on social care, and to wider society, is huge. Although there remains a difference of opinion on how reform should happen, all agree that reform is needed. The delays that we have seen with the programme to date have been concerning. Understanding the financial implications of what this all means has been nigh on impossible. This call for clarity is welcome.
Common Weal and STUC call for pause to National Care Service legislation
Scottish think tank Common Weal, along with the Scottish Trade Union Congress, has launched a joint letter to the First Minister calling for the National Care Service Bill to be paused (writes NICK KEMPE).
Since Common Weal supported calls from the Trade Unions to pause the bill at the beginning of December many other organisations have done the same. Until now, however, smaller organisations have had a limited opportunity to make their views known and there has been very little joint action. The idea behind the letter, which you can read here, is to change that and to show the Scottish Government the degree of concern across Scotland.
The NCS Bill has now been considered by various Committees of the Scottish Parliament and MSPs should now be aware that there is very little enthusiasm or support for it in its current form. The hearings of the Finance and Public Administration Committee received a large amount of media coverage, not least because SNP MSP Michelle Thomson broke ranks and made some scathing comments.
The Committee’s report on the Financial Memorandum accompanying the bill, published at the beginning of December, was highly critical about the absence of costings. It highlighted the absence of costs for the creation of the new service, including VAT liability, transfer of assets and staff and the creation of a health and social care record, as well as the proposal to introduce major policies “via secondary legislation or business cases which cannot be subject to the same in-depth and formal financial scrutiny as Financial Memorandums to bills”.
It called on the Scottish Government to provide the necessary financial details at least two weeks prior to the Stage 1 consideration of the bill in March – giving very little time for any outside organisation to comment/brief MSPs
The majority report published last Friday here from the Delegated Powers and Law Reform Committee – don’t be put off by the name – added to the concerns about the lack of information and that the Scottish Government is “setting a dangerous precedent, undermining the role of the parliament.” Its reason for concluding this (the two SNP MSPs on the Committee dissented) was:
“The Committee is concerned there is insufficient detail on the face of the Bill and within the Bill documents to allow for meaningful parliamentary scrutiny. Given the far-reaching nature of the proposed reforms the Committee is mindful there is a real risk of letting down those the Bill is intended to help by allowing Scottish Government ministers to use delegated powers instead of primary legislation to introduce core and as yet unknown provisions. The Committee believes the current approach significantly reduces the threshold for parliamentary approval and prevents MSPs from bringing forward detailed amendments”.
Far from increasing democratic control over care services, as we advocated in Caring for All, the NCS Bill is now threatening to undermine democracy, whether at the local level by removing control from local authorities, or at the national level by handing unprecedented powers to Scottish Ministers.
The Scottish Government needs to have a fundamental re-think about what it is proposing and how its engaging with civic society while at the same time secretly working with KPMG to design the Target Operating Model for the NCS. If you are part of an organisation which has a stake in the future of social work and social care in Scotland, please ask them to support the letter. As an individual, please also consider contacting your MSPs asking them to support the call for a pause.
Nick Kempe – Common Weal Care Reform Group
COSLA’s Health and Social Care Spokesperson, @cllrpaulkelly, commented following the release of the letter from @ScottishTUC and signed by a number of organisations which has called for Scottish Government to pause the National Care Service Bill:
Adults with first-hand experience of social care services in Scotland are being invited to help design the new National Care Service (NCS).
Applications are now open for both the Lived Experience Experts Panel (LEEP) and Stakeholder Register, which will bring together people from across the country to help develop a care system that puts people first, in one of the biggest co-design exercises the Scottish Government has ever undertaken.
The new National Care Service will provide the national oversight and guidance that ensures community healthcare and social work services can be delivered locally in a way which best meets the needs of those who use them.
The panels launched today will allow people with direct experience of community health and social care the opportunity to help design these future services.
Anyone over the age of 18 living in Scotland who has views on how the future NCS should look can apply to take part in the Lived Experience Experts Panel.
Over the next few years the design work will consider a number of themes, the first of which are:
Information sharing to improve health and social care support
Realising rights and recognising responsibilities
Keeping health and social care support local
Making sure my voice is heard
Valuing the workforce
Organisations in Scotland with an interest in health and social care can note their interest in specific themes by joining the Stakeholder Register.
In the future, there will be additional targeted ways for people get involved – for example children and young people under 18, care experienced people, and young carers.
Minister for Social Care Kevin Stewart said: “As we build a National Care Service that best fits the needs of everyone in Scotland, we need to hear from people directly.
“The new National Care Service will set the standards and guidance to support the design and delivery of community healthcare and social work services locally.
“The complexities of getting this right should not be underestimated. People with experience of the current system, whether in receipt of health and care support or delivering it, are the experts. We particularly need to hear those voices.
“These reforms are the biggest since the creation of the National Health Service almost 75 years ago and these Lived Experience Experts and Stakeholder Panels will make sure we deliver a service that puts people at its very heart. I encourage anyone with direct experience of social care to take part.”
The first NCS Forum on 3 October in Perth will be another opportunity for individuals to engage and shape the NCS co-design process. Register to join the event online
This is not the only opportunity to get involved in co-design work. In the future, there will be additional ways for specific groups to get involved – for example children, young people and families, care experienced people, and young carers.
For this reason, we’re not asking children (under the age of 18) to join the Lived Experience Experts Panel right now. Instead, we will work with organisations that represent different groups of young people to make sure we reach as many different groups as we can and undertake research work in a way that best suits their needs.
The UK Government urgently needs to come forward with additional funding this year to help the ravaged adult social care sector meet immediate pressures, including inflation and unmet care needs, says the cross-party Levelling Up, Housing and Communities (LUHC) Committee in a report published last week.
Examining the Government’s charging reforms and local government finance, unpaid carers and workforce challenges, the report says the “message rang clear throughout our inquiry: the adult social care sector does not have enough funding either in the here and now, or in the longer-term”.
The Committee’s report outlines that:
On adult social care, the Government currently has nothing more than a vision, with no roadmap, no timetable, no milestones, and no measures of success.
The Government should come forward with 10-year plans for how it will achieve its vision outlined in the People at the Heart of Care White Paper and for the adult social care workforce
The Government should provide a multi-year funding settlement to give local authorities what they need in terms of their own sustainability and their ability to help shape sustainable local care markets.
Clive Betts, Chair of Westminster’s Levelling Up, Housing and Communities Committee, said: “As Prime Minister, Boris Johnson said he would fix the crisis in social care once and for all.
“The Government deserves credit for attempting reform and for acting to try to prevent the unpredictable and catastrophic costs which can be inflicted upon people for their care. However, the Government should be under no illusions that it has come close to rescuing social care and it needs to be open with the public that there is a long way to go.
“Ultimately, whether it relates to immediate cost pressures or on wider structural issues in the sector, the fundamental problem is that there continues to be a large funding gap in adult social care which needs filling. Those who need care, their loved ones, and care workers deserve better.
“The NHS and adult social care provision should not be pit against one another. The two systems are interdependent and each needs to be adequately funded to reduce pressure on the other. Wherever the money comes from—from allocating a higher proportion of levy proceeds to social care, or from central government grants—the Government urgently needs to allocate more funding to adult social care in the order of several billions each year.”
The report notes the additional pressures of Covid-19 as having exacerbated the underlying structural challenges of rising demand, unmet need, and difficulties in recruiting and retaining staff.
It also notes severe current pressures arising from increases in the National Living Wage and the National Minimum Wage, and from rising inflation. That most of the funding from the Health and Social Care Levy Levy will go to the NHS, and the money that will go to adult social care is for reforms, not cost pressures, is also highlighted in the report.
Addressing the Government’s sector reforms, the report notes the positive stakeholder reception to the vision outlined in the Government’s White Paper on long-term reform of adult social care, titled People at the Heart of Care.
The report commends the Government for introducing many welcome initiatives such as those relating to housing and data which could make a significant difference in the long-term to people’s lives.
The report calls on the Government to publish a 10-year plan for how its vision in the People at the Heart of Care White Paper will be achieved, taking into account how the different policies interweave and affect one another. The Government should also publish a 10-year strategy for the adult social care workforce which includes a clear roadmap with core milestones, outcomes, and measures of success.
The report expresses concerns about the sheer number of reforms and new ways of working in respect of adult social care that involve and affect local authorities. To help local councils deliver the numerous social care reforms, it’s important the Government provides a multi-year funding settlement to give local authorities what they need in terms of their own sustainability and their ability to help shape sustainable local care markets.
The report also calls on the UK Government to publish a new burdens assessment by the end of the year to determine the level of resource needed by local government in terms of staff, expertise, and funding to deliver the full package of adult social care reforms.
The Scottish Government has committed to establishing a functioning National Care Service by the end of this parliamentary term in 2026:
STUC: WHY SCOTLAND CAN’T AFFORD PRIVATISED SOCIAL CARE
The Scottish Government’s approach to their new National Care Service has been declared “untenable” by Scotland’s largest trade union body.
Launching their report ‘Profiting from care: why Scotland can’t afford privatised social care’, the Scottish TUC (STUC) has accused the Scottish Government of “falling glaringly short” in their plans for a transformative National Care Service.
The trade union organisation, representing unions from across health and social care, is calling for the Scottish care home estate to be transferred out of private ownership in totality.
Research within the STUC report reveals that Scotland’s large private social care providers are associated with lower wages, more complaints about care quality, and higher levels of rent extraction than public and third sector care providers.
Under current Scottish Government plans, the proposed National Care Service would remain “ownership neutral”, embedding a role for the private sector in social care.
The research finds:
• Nearly 25% of care homes run by big private providers had at least one complaint upheld against them in 2019/20, compared to 6% of homes not run for profit.
• In older people’s care homes, staffing resources are 20% worse in the private sector compared to the not-for-profit sector. • Privately owned care homes only spend 58% of their revenue on staffing, compared to 75% in not-for-profit care homes.
• Over the last six years, the public sector has paid on average £1.60 more per hour to care workers.
• The most profitable privately owned care homes take out £13,600 per bed (or £28 of every £100 received in fees) in profits, rent, payments to the directors, and interest payments on loans. This compares to £3.43 in every £100 in fees for the largest not-for-profit care home operators.
The report argues that a truly transformative National Care Service must be based on a not-for-profit public service, delivered through local authorities with an ongoing role for the voluntary sector.
Roz Foyer, STUC General Secretary, said: “Our new STUC research clearly shows that large privately owned care homes perform worse than not-for-profit care homes at almost every level. They are worse for those receiving care, worse for the workers providing care and worse for the taxpayer.
“It simply isn’t the case that Scotland can’t afford to buy out private care homes, we can’t afford not to. As it stands, the Scottish Government are falling glaringly short in offering the transformative shake up to social care Scotland badly needs.
“As the National Care Service Bill makes its way through Parliament, politicians must focus their attention on the kind of organisations we want to provide care for our citizens, not as seems to be the case just now, the centralisation of commissioning and outsourcing procedures.”
The recommendations have been backed by Care Home Relatives Scotland. The influential group, set up during the pandemic, have been working to strengthen relatives rights as a result of care home visitation restrictions during COVID-19.
Catherine Russell, Care Home Relatives Scotland: “This report should be essential summer reading for every member of the Scottish Parliament.
“The research findings endorse everything Care Home Relatives Scotland said in our response to the NCS consultation. Our fear is that millions will be spent on upheaval and reorganisation when the priority must be to focus on improvements and with resources on the frontline where they are desperately needed.
“We also share the STUCs grave concerns about the further marketisation of social care and community health services.
“As the report demonstrates, private homes are not the most cost effective or highest quality. They are extremely costly for residents who need to pay and the profit motive tends to drive down staff conditions.
“Scotland can and should find a better, fairer way to do things and this research will be a very useful contribution to that debate.”
The Scottish Government must focus on transforming health and social care services to address the growing cost of the NHS and its recovery from Covid-19.
Improving the NHS will be very difficult against the competing demands of the pandemic and an increasing number of other policy initiatives, including plans for a National Care Service.
The health service in Scotland is on an emergency footing and remains under severe pressure. There is a growing backlog of patients waiting much longer for treatment because of the response needed to Covid-19. That has made workforce planning and delivering on ambitious recruitment plans all the more important. But the Scottish Government has historically struggled to recruit enough people with the right skills.
The NHS’s ability to plan remains hindered by a lack of robust and reliable data, including workforce, primary care, community, social care, and health inequalities data.
Meanwhile the pandemic has increased the fiscal pressures on the NHS, which remains financially unsustainable. This is despite the Scottish Government allocating £2.9 billion for pandemic-related costs in 2020/21 and committing more funding in 2021/22 and beyond.
Stephen Boyle, Auditor General for Scotland, said: “Reforming the NHS is key to the Scottish Government’s pandemic recovery plan and needs to remain a priority. Putting Covid costs to one side, health spending is rising every year, meaning less money for other public services.
“There’s now a clear opportunity to do things differently by building on the innovation and collaboration we’ve seen across the NHS in the last few years.
“For that to happen, our leaders must take the public with them and involve them in the shift from care being delivered in hospitals to much closer to people’s homes. But better-informed policy decisions and services won’t be possible without better collection and use of data.”
