The following questions and answers have been compiled following a discussion on the National Care Service, hosted by GCVS, on 30 September.

How will the scrutiny of the Bill work with four committees looking at it? And what committees are involved?

  • The Health, Social Care and Sport Committee has been designated as the lead committee for the National Care Service (Scotland) Bill.  The Education, Children and Young People Committee and the Local Government, Housing and Planning Committee,  have been formally designated as secondary committees, and the Social Justice and Social Security Committee and the Criminal Justice Committee are also taking evidence on the Bill.  The Finance and Public Administration Committee and the Delegated Powers and Law Reform Committee also take a part in scrutinising all bills.
  • All of these committees are in the process of taking oral evidence from various stakeholders. You can keep up with committee activity on the bill on the Scottish Parliament website (Stage 1 | Scottish Parliament Website) They will then send their findings to the lead committee (Health, Social Care and Sport) who will write the Stage 1 Report on the Bill for the whole Parliament to consider.
  • Parliament agreed that Stage 1 of the National Care Service (Scotland) Bill will be completed by 17 March 2023.

 

Will there be any protection or guarantee of not going out to the public as a main carer without proper training following the establishment of the NCS? Will there be a better way to monitor this?

  • The National Care Service will oversee the delivery of care, improve standards, ensure enhanced pay and conditions for workers, and provide better support for unpaid carers.
  • The Scottish Government’s National Workforce Strategy for Health and Social Care was published on 11 March. The Strategy looks at the whole workforce journey and how we can plan for, attract, train, employ and nurture our Health and Social Care Workforce. We have worked in partnership with our co-producers COSLA and extensively engaged with stakeholders from across Health and Social Care to develop the Strategy.  The Strategy outlines our shared vision for the workforce – a sustainable, skilled workforce with attractive career choices where all are respected and valued for the work they do.
  • We have been working at pace with Scottish Social Services Council (SSSC) and NHS Education for Scotland (NES) to develop an induction programme for social care staff. The National Induction Framework for new entrants into social care has been launched on Tuesday 1st February, and materials are available via the SSSC website. Further work is ongoing to develop and expand these materials to offer a robust induction framework for all social care staff, working in a variety of environments.  In the medium term we are working with schools, colleges and in partnership with SSSC and NES  a to develop career pathways and enhance learning and development for colleagues working in Adult Social Care. We are taking action to improve conditions and invest in up-skilling and training for the social care workforce. This includes the development of foundation and modern apprenticeships and resources for those providing careers advice.  In the medium term working with schools, colleges and partners we will develop career pathways within social services and between social services and health, through an integrated qualification that will increase the attractiveness of the sector and provide clear routes for career progression and skills development through to advanced practice.
  • The NCS consultation asked respondents: ‘What elements would be most important in a new system for complaints about social care services?’ The most popular of the 7 options provided was a ‘Charter of rights and responsibilities, so people know what they can expect’ (65%). We have therefore commenced early scoping work to develop a Charter of Rights and Responsibilities.
  • The creation of a Charter of Rights and Responsibilities for social care will set out what people can expect from the NCS. It will also provide a clear pathway to a complaints and redress process if these standards aren’t met. This will be developed as a priority and with input from those with lived or living experience.

 

How will the procurement changes introduced in Part 3 of the National Care Service (Scotland) Bill specifically help not-for-profit organisations to bid for social care services?

  • Ethical commissioning and ethical procurement will become a cornerstone that the NCS will use to shape all commissioning and procurement decision making. An ethical commissioning and procurement approach will ensure full engagement with those who access social care support, those who support people to access social care support, families and friends, unpaid carers, the workforce and providers.
  • The NCS approach to ethical commissioning will support the standardisation and implementation of fair work requirements and practices, ensuring these are agreed and set at a national level and delivered locally across the country.
  • Many third sector bodies make profits but require that those profits are reinvested into the organisation. The proposals in Section 41 of the National Care Service (Scotland) Bill are intended to allow the National Care Service to restrict some competitions to third sector organisations but not prohibit profit.
  • The power to reserve contracts for third sector organisations (which can and often do make profits) is a standard power in European public procurement regimes.  Third sector organisations have told us that they are often unable to compete with the private sector on the basis of cost.  These powers are included in the bill in order to ensure that, when a service is better provided by the third sector, the NCS is  able to ensure third sector organisations can compete effectively with one-another.
  • ‘Third Sector’ does not mean voluntary and nor does it mean unprofessional or amateur – there is no plan to reserve contracts for only voluntary organisations.  The mechanisms for determining which services will be reserved for third sector organisations is yet to be determined.  Third sector organisations delivering services will be bound by the same quality and workforce standards as private or public sector organisations.

 

How will proposed changes impact those who are currently involved with procurement in children’s residential services and the current decisions around this? How all this will work if when agreements are already in place with Local Authorities and how this will change if new boards and local commissioning services are introduced?

  • A decision has not yet been taken on whether children’s social work and related social care services will be included in the NCS.  The Bill provides for the transfer of local authority functions for social work and social care by regulations and for Ministers to designate health functions to the NCS. The Bill, furthermore, includes a requirement to consult on the transfer of local authority functions regarding children’s services to the NCS, before making regulations. The final decision on the inclusion of children’s services will be taken in 2024. If children’s services are included the following with apply.
  • The Care Boards will have responsibility for social care functions that currently are the responsibility of Local Authorities, and will also have responsibility for planning and commissioning community health services.
  • We will consider how best to ensure effective joint working with other services such as housing, education, and policing through co-design with those with lived experience and engagement with key stakeholders.
  • There are already provisions in the procurement rules to consider continuity of care.  Other than continuing with existing provisions in procurement legislation which grant public bodies the power to take account of previous poor performance or breaches of contract, there are no plans to prevent incumbent providers from re-contracting to deliver a service.
  • Local Authorities and their separate or ‘arms-length’ organisations will be welcome to deliver services under the National Care Service.
  • Ethical Commissioning and Procurement standards are yet to be determined through a process of co-design and collaboration with key stakeholders.

 

Is there going to be Local and National Care Boards, in addition to NHS Health Boards and Health and Social Care Partnerships (HSCP)? Is the proposal to have three different commissioning and governance functions locally?

  • The Independent Review of Adult Social Care and Audit Scotland have found the current ways of working have not fully delivered the improvements intended to be achieved by integration of health and social care and recommended the creation of a National Care Service.
  • The Bill provides for the transfer of social work and social care functions from Local Authorities to Care Boards through regulations. This means  Care Boards will have responsibility for the delivery of social care. Care Boards will also be responsible for  the strategic planning and ethical commissioning of community health services in addition to social care services. This means the role of planning and commissioning will transfer from Integration Authorities to Care Boards.  This will have implications for HSCPs that we will want to work through as part of the co-design process and consultation with partner organisations.
  • The Bill requires a further public consultation to be held in relation to children’s and justice social work and the results to be laid before Parliament alongside any regulations.
  • We are confident that care boards will build on the successful elements of integration while transferring accountability for social care to Scottish Ministers
  • We will consider how best to ensure effective joint working with other services such as housing, education, and policing through co-design with those with lived experience and with engagement with key stakeholders.
  • The NCS Bill makes some provision in relation to Care Boards, but provides for the Care Boards to be fully established via secondary legislation, which can only be brought forward once the Bill has been passed.

 

What will the Health and Social Care Partnerships (HSCP) role be in the new system with the NCS? Will HSCP be made defunct by NCS as HSCP usually provides care support provision?

  • The Bill provides for the transfer of social care functions from Local Authorities to Care Boards. This means   Care Boards will have responsibility for the delivery of social care. Care Boards will also be responsible   for the strategic planning and ethical commissioning of community health services in addition to social care services. This means the role of planning and commissioning will transfer from Integration Authorities to Care Boards.  This will have implications for HSCPs that we will want to work through as part of the co-design process and consultation with partner organisations.
  • The scope of the transfer of functions and the way in which future services are delivered will be developed during co-design and further stakeholder consultation.
  • In the process of proposing Care Boards, the Scottish Government considered a number of alternative options described in the policy memorandum. We are confident that care boards build on the successful elements of integration while shifting accountability for social care to Scottish Ministers at the request of the Scottish public.

 

Under the NCS, will the Care Inspectorate have powers to cancel care home registration without an improvement notice?

  • The provision referred to in the NCS Bill is designed to enhance and strengthen the Care Inspectorate’s powers under the Public Services Reform (Scotland) Act 2010.
  • The proposed changes will enable the regulator to speedily take action with poor performing services, better protect social care users, and drive up the consistency and quality of care expected across all social care services in Scotland. The new powers would allow the Care Inspectorate to act quicker and more effectively than at present to tackle consistently poorly performing and inadequate care services. This is particularly important where there may be a risk to life, health or wellbeing of residents.
  • The Care Inspectorate will have the power to forego the issue of an improvement notice where in their professional judgement the service is not in a position to meet the fit and proper person requirements.

 

Cost of carers has doubled in last 5 years. Attendance allowance goes up 10p a week. It’s becoming more expensive to employ carers. Is that being taking into consideration?

  • We want to change the system from one that supports people to survive, to one that empowers them to thrive, with human rights at the heart of it. That is why the National Care Service will have free service at the point of delivery, just like the NHS.
  • Attendance Allowance is awarded to help with extra costs if a person over State Pension age has a disability severe enough that they need someone to help look after them. Attendance Allowance is currently delivered by the Department for Work and Pensions, on the Scottish Government’s behalf, through an agency agreement. All disability benefits, including Attendance Allowance, increased by 3.1% in April 2022, in line with the Consumer Price Index (CPI) in September 2021. Pension Age Disability Payment will be the Scottish replacement for Attendance Allowance. Further information on Pension Age Disability Payment delivery will be provided in due course.
  • Meanwhile, we are progressing our commitment to increase spend in social care by at least 25% by the end of this Parliament, an increase of over £840 million, laying the groundwork for the establishment of a National Care Service.
  • Over £1.6 billion has been provided for social care and integration in 2022-23; this is out with the support for Covid.
  • We’ve invested an additional £20.4 million for local carer support in 2022-23, bringing total investment in the Carers Act to £88.4 million per year.

 

Regarding a National Health and Social Care Record, given the diversity of systems, data standards and huge variations in use cases, how will this single record operate? Isn’t there a major risk if this is a giant database? When will this be delivered by? How do we integrate all these frontline systems? The scale of that data is vast as it could include housing, policy, finance etc.

  • We will shortly be undertaking formal ‘discovery’ work for the integrated social care and health record. This means that we will be engaging with users to better understand their needs and ensure the integrated record is co-designed. Through the Independent Review of Adult Social Care people told us that having to share their stories multiple times to multiple providers is not only frustrating but can be traumatic. An integrated social care and health record will help to ensure safe, secure and efficient sharing of social care and health data across relevant care settings, critically including with the individual to help inform and empower their decisions around care.
  • We know there are lots of potential use cases for the integrated social care and health record so we will build, test and iterate the creation of the integrated health and social care record over the coming years. In choosing how data in the record is encrypted and secured; how access is controlled and monitored; and how systems are designed to be resilient, many options are being considered that do not involve a single large database. It is also important to note that the NCS Bill includes a provision for Scottish Ministers to create information (or data) standards to ensure consistency.
  • We recognise the scale of the challenge ahead and are working now to ensure we have a robust evidence base to inform decisions. This includes work to map the technology landscape across social care providers in the public sector, independent sector and third sector and a new project focussed on detailed mapping of data flows to inform the creation of the integrated social care and health record, and the associated information sharing regulations (there is a provision in the NCS Bill for the creation, through secondary legislation, of a scheme for information sharing).

 

What learning has been applied to the NCS Bill from the creation of a National Police Service in Scotland in 2013? Especially in terms of practical implementation. There is some significant learning there. So how has that informed the NCS Bill and Policy Memorandum?

  • We have been engaging with colleagues across the Scottish Government to learn from previous public sector reform programmes, including colleagues in Justice that were involved in the Policy Scotland Programme. Those engagements will continue, and be expanded to external bodies, throughout the co-design process and transition planning period to ensure that we capture learning and build on experience.

 

Will person-centred care first approach include British Sign Language (BSL) expertise support, especially for Deaf BSL users who may have hearing relatives who do not fully understand Deaf BSL culture?

  • The need for a person-centred approach for all those seeking care and support from the NCS is a core principle for our work, and choice around care and support is an extension of this. We expect it to be reflected in our co-design work, and this engagement will be critical to establishing, through work such as the Charter of Rights and Responsibilities, principles across all settings that enable all those seeking care and support to choose the most appropriate care and support for them.
  • We have enshrined in the NCS Bill principles our commitment to ensuring that the National Care Service – as well as those providing services on its behalf – communicate with people in an inclusive way. As such, we will co-design the NCS with a wide range of people with differing needs and life experiences, including people who have sensory impairments to ensure that they can receive information and express themselves in ways that best meet their individual needs.

 

Will the design school include people representing all various groups from Deaf BSL, Gaelic, other diverse and disability backgrounds?

  • The National Care Service is there for everyone, so it is important that the co-design process is accessible and inclusive, and that we have representation from a diverse range of people with different experiences.
  • We are seeking to recruit co-design participants representing Deaf BSL, Gaelic, other diverse and disability backgrounds through the Lived Experience Experts Panel and through other targeted direct recruitment routes such as working with stakeholder organisations who represent different groups.
  • People recruited to participate in co-design will be invited to participate in lived experience people’s design school sessions.

 

Is there a BSL lived experience user in the Lived Experience Experts Panel?

  • To date, one person who has registered for the Lived Experience Experts Panel have registered a requirement for BSL.
  • We are committed to ensuring that we have representation from BSL users in future NCS co-design and research activities. This will include using targeted direct recruitment routes for co-design and research activities such as working with stakeholder organisations who represent different groups.

 

Can we have more information about the Lived Experience Experts Panel?

  • The Lived Experience Experts Panel is a group of people who will help to design the NCS by taking part in different kinds of research and design activities.
  • Anyone living in Scotland will be able to register their interest in becoming involved in co-design work by becoming a member of the panel and registration will be advertised via the Scottish Government website.
  • The National Care Service is there for everyone, so it is important that the co-design process is accessible and inclusive, and that we have representation from a diverse range of people with different experiences.
  • We are consulting with stakeholder groups who have lived experience, to find out how best to support people joining the Lived Experience Experts Panel, to feel comfortable and confident to take part in design and research.
  • We will prioritise involving people who face additional barriers to engaging, whose needs are particularly complex, or who belong to protected groups as defined in the Equality Act.
  • We will develop a range of options to encourage people to contribute in a way that suits them, this may include face to face discussions, telephone discussions or correspondence by post.
  • We have established the Social Covenant Steering Group, made up of people who access and deliver social care support, to support the Scottish Government in ensuring that lived experience and the views of people with lived experience are central in the development of the National Care Service.
  • We have also established a Key Stakeholder Reference Group, to bring together a range of experts and practitioners to provide advice, scrutiny and challenge on proposed process, design and delivery plans, as well as providing best practice to inform those processes for design and delivery of the National Care Service.
  • More information and registration is available via the Scottish Government website.

 


GCVS Response to National Care Service Bill – Sep 5, 2022

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