Supplementary Agenda Document Pack - Integration Joint Board - 13/03/2026
North Ayrshire Council · 13 March 2026
Back to Integration Joint Board — 13 March 2026 and its agenda
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Integration Joint Board Supplementary Agenda for the consideration of the Integration Joint Boardon Friday, 13 March 2026 at 14:00 to consider the undernoted business. Business 7 Revenue Budget 2026-27 - Updated Report Submit report by Eleanor Currie, Chief Finance Officer and Section 95 Officer, on the financial position for the Partnership for 2026-27, including the proposed delegated funding, service budget pressures, plans developed to set a budget and the associated risks (copy enclosed). 8 Budget Consultation and Eligibility Criteria for Social Care Services Submit report by Scott Hunter, Chief Social Work Officer (NAHSCP) on the extensive consultation undertaken since December 2025 on “Delivering Social Care Services within Budget (copy enclosed). 1
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Integration Joint Board 13th March 2026 Subject: Revenue Budget 2026-27 Purpose: To update the IJB on the financial position for the Partnership for 2026-27, including the proposed delegated funding, service budget pressures, plans developed to set a budget and the associated risks. Recommendation: That the Board: (a) approves the budget for 2026-27 for the Partnership inclusive of all pressures, savings and reserves, noting that the funding position is subject to confirmation of the NHS Ayrshire and Arran budget (b) approves the new hourly rates for commissioned providers and Personal Assistants; and (c) notes the risks associated with this budget. Direction Required to Council, Health Board or Both Direction to:- 1. No Direction Required 2. North Ayrshire Council 3. NHS Ayrshire & Arran 4. North Ayrshire Council and NHS Ayrshire & Arran √ Glossary of Terms NHS AA NHS Ayrshire and Arran IJB Integration Joint Board NAHSCP North Ayrshire Health and Social Care Partnership NAC North Ayrshire Council CAMHS Child and Adolescent Mental Health Services FPC Free Personal Care PCIF Primary Care Improvement Fund ADP Alcohol and Drugs Partnership UnPACs UNPACS, (UNPlanned Activities) – Extra Contractual Referrals SLA Service Level Agreement AfC Agenda for Change 1. EXECUTIVE SUMMARY 1.1 The report outlines the funding allocations from North Ayrshire Council and NHS Ayrshire and Arran, the service pressures, resulting budget gap and the savings plan for 2026-27. The Council budget was set on 25th February and NHS AA will set their budget on 7th April 2026; if the funding assumption from NHS AA changes from the planning assumption set out, the plans for the IJB will require to be re-visited. 1.2 The Scottish Government finance settlement set out a number of conditions and requirements for Health Boards and Councils in relation to funding delegated to Agenda Item 7 3
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Integration Authorities. The delegated funding outlined in the report (indicative for NHS AA) meets those Scottish Government requirements. 1.3 The financial context for this budget is exceptionally challenging. Cost and demand pressures across both health and social care continue to grow at a pace that significantly exceeds available funding, and this is compounded by a recurring underlying deficit carried forward from 2025–26. Against that backdrop, the primary focus of this report is to ensure that the IJB is able to set a legally compliant, in-year balanced budget, while being transparent about the scale of risk, the level of reliance on savings and policy decisions, and the implications for future financial sustainability. 1.4 The table below summarises the overall financial position for 2026-27: Social Care (NAC) £m Health (NHS AA) £m Total £m Funding Increase 11.147 4.714 15.861 Service Pressures – Appendix B (17.152) (4.855) (22.007) Budget Gap (6.005) (0.141) (6.146) Funded by: - Savings – Appendix C 1.577 1.239 2.816 2026/27 Budget Position (4.428) 1.098 (3.330) Estimated Opening Gap from 2025-26 (1.400) (1.592) (2.992) 2026/27 Opening Budget Gap Position (5.828) (0.494) (6.322) Note that green highlighted line represents the new in-year budget gap for 2026-27 and the legal requirement to set an in-year balanced budget and in the case of the Health/NHS budget this is a surplus. Further savings are required in recognition that there will be an overspend from 2025- 26 carried into 2026-27 relating to a number of pressures areas regularly reported to the IJB. Approving additional savings at this stage is prudent and necessary to ensure early action is taken to minimise any overspend in 2026-27. 1.5 The Partnership has undertaken extensive community engagement which commenced early December 2025 on the challenges of delivering social care services within budget. There is a separate paper on the IJB agenda for consideration, it is recommended that the remainder of the Social Care/Council gap is met through the review of eligibility criteria for access to funded adult social work and social care services. The remaining budget gap for Health/NHS services is smaller in value and primarily reflects current year pressures recurring to an extent next financial year, rather than a significant pressure on core funding, therefore it is recommended that the remaining health services gap is monitored closely in-year during 2026-27 with further recovery actions identified as required. 1.6 A number of financial risk areas are highlighted in the report and the IJB are asked to note these at this stage; the IJB may be asked during 2026-27 to approve any appropriate action to mitigate or manage these areas. 4
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1.7 The IJB Finance Working Group (FWG) has supported the development of the proposals presented and the financial position and options have been discussed in more detail in that forum; this has supported the opportunity to bring forward some proposals earlier for approval such as the 2026-27 Charges for Services. The FWG will play a critical role as we move into next financial year to provide additional oversight, scrutiny, challenge and support to further monitor the position and develop the budget further. 1.8 The proposed integrated budget for the IJB is £343.390m (inclusive of the estimated Set Aside budget of £42.670m). A summary of the 2026-27 budget and net budget increase is detailed within Appendix A. 2. BACKGROUND 2.1 Key Budget Principles A number of key guiding principles were set out for the approach to developing the IJB budget for 2025-26. We have been guided by these principals in setting the budget for 2025-26, in managing in-year pressures and in developing the budget for 2026-27 and are able to provide examples of how these principals have been taken forward in practice – including the recent budget consultation, review of charging policy, our transformation plans, the roll out of digital solutions, our communications approach and escalations to parent bodies and Scottish Government of our funding challenges. It is recommended that these key principles remain in place, these are set out below: • Maximise income from charging for services to protect the delivery of frontline services, ensuring that only individuals who have the means should pay more for the services they receive directly. • Manage within available budget limits – including re-design to deliver service within available resource. • Maximise efficiencies in the way services are delivered through a structured service review process. • Maximise opportunities for shared service and lead partnership delivery across the Ayrshires. • Values-based health and care– eradicating effort that provides no benefit for the person and a focus on self-management and prevention. • Tighten the eligibility criteria for targeted services to prioritise delivery of services to those with the highest levels of need and risk. • Improve services through digital innovation and maximise the use of digitally enabled care technology, where appropriate • Be transparent and open in our challenges, having honest conversations with our staff and communities. • Advocate for a better funding deal for North Ayrshire for community-based health and care services & actively pursue opportunities for additional funding. 5
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2.2 The Integration Scheme outlines a process of planning for budgets in future years where the Chief Officer and the Chief Finance Officer develop the funding requirements for the Integrated Budget based on the Strategic Plan and present it to the Parties for consideration as part of the annual budget setting process. This includes consideration of pay awards, contractual uplifts, prescribing, resource transfer and ring-fenced funds. The Integration Scheme approved by Scottish Ministers states that following determination of the Council and NHS payments to the IJB, the IJB will refine its Strategic Plan to take account of the totality of resources available and there is an implicit requirement to set a balanced budget prior to the new financial year. In December 2025 the IJB approved a refreshed Strategic Plan to 2030 which updates the HSCPs priorities for delivery and long-term planning. The new vision in the plan is “To empower people in North Ayrshire to live safe, healthy and active lives with fair and equal access to sustainable health and care services”. The new plan will be in place for the new reporting period beginning on the 1st of April 2026. In recent years, the budget process has moved away from that outlined in the Integration Scheme, with Scottish Government directives and expectations in relation to funding levels to be passed on to IJBs. Whilst the IJB are required to engage with the partner bodies in relation to budget pressures and savings, the overall funding allocation reflects an element of ring fencing and settlement conditions in relation to funding for IJBs. This has to some extent in previous years driven or led the approach to local decision making for resource allocation for IJBs across Scotland with the Scottish Government minimum prescribed level of funding being the default. 2.3 The benefits of a delegated funding approach from both partners are: • The IJB can manage the budget process in terms of developing pressures and savings (including providing for those pressures not planned to be funded by partners), providing greater transparency and governance re decision making. • Allows resource to be allocated by the IJB in line with the priorities in the Strategic Plan. • Allows the SG directive to be followed, not only in terms of application of the uplift but also in terms of policy areas to be prioritised (e.g. Mental Health and Drug and Alcohol services). • Facilitates the ongoing in-year management of the IJB financial position in relation to the funding and budget being managed on an integrated way to deliver financial balance. • Supports future years planning and the development of a Medium-Term Financial Outlook, supporting an earlier approach to financial planning and an integrated approach to distribution of resource. • Aligns with the proposals in the review of integration for budget planning and resource delegation for IJBs. 2.4 Scottish Government Budget 2026/27 – Settlement for IJBs For 2026/27 the Health and Social Care Budget and directives to Councils and Health Boards included the following. Local Government: For 2026-27 there was no directive in the North Ayrshire funding settlement letter and instead it referred to: 6
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• Having listened carefully to the arguments set out in ‘Strong Councils, Strong Communities’, I have sought to balance the desire to ringfence additional funding towards social care with the Verity House Agreement commitment to maximise fully flexible funding. In conclusion, I have allocated as much as possible of the additional revenue funding as General Revenue Grant for Councils to allocate as they see fit. I do, however, recognise the importance of sustainable adult social care services and as I set out in my statement, the government is committed to working together with local authorities on the delivery and improvement of social care. • Following our engagement work over the autumn, I am confident that Local Government will pass more in total to IJBs than is provided as an in-year transfer by Scottish Government. However, I do acknowledge that partnership working will be even more critical this year to ensure that the technical changes applied to the Adult Social Care GAEs are appropriately reflected locally. Health Boards: For 2026-27 there was no directive in the NHS Ayrshire and Arran funding settlement letter: • NHS Boards will receive a 2% uplift on baseline funding in 2026-27. This will provide funding towards the costs of the 2026-27 pay deals and provides a 2% uplift for non-pay costs to support inflationary pressures. Additional funding will be provided to meet the costs of the 2026-27 pay deals where uplifts exceed 3% in line with public sector pay policy, and full funding has been included for the agreed Agenda for Change pay settlement. Pay funding should cover all staff including those delegated to Integration Authorities (IAs). • A further £150 million of recurring funding has been included to support territorial boards’ continued implementation of the reforms committed to as part of the 2023-24 Agenda for Change (AfC) pay deal, including the additional one- hour reduction from 1 April 2026. Together with the £150 million recurring funding issued in 2024-25, this increases total available recurring funding to £300 million for territorial boards. This funding covers all staff under AfC terms and conditions, including those staff working in functions delegated to IAs. • While funding for reform and improvement measures will be routed through NHS Boards, elements will support activity in the community and delivered via IAs. Part of this package will be used to directly support our shared ambition to alleviate pressure across the health and social care system. • There is a specific reference in the NHS Board funding letter to - The funding allocated to IAs should be additional and not substitutional to 2025-26 budgets for services which are delegated. Therefore, Local Authority social care budgets for allocation to IAs must be at least £167 million greater than 2025- 26 recurring budgets. However, this is not reflected in the Local Government settlement and contractility to the position communicated to Local Government directly. Full detail is included in the settlement letters in Appendix D. To ensure some stability in funding for future years, when there is no direction included in the funding circular, then the funding consideration by both partners should be aligned to the Integration Scheme. This includes consideration of pay awards, contractual uplifts, prescribing, resource transfer and ring-fenced funds. This will be considered for budget planning in 2027-28. 7
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2.3 PARTNER FUNDING 2.3.1 North Ayrshire Council North Ayrshire Council met on 25th February to set their budget for the coming year including the contribution to the IJB. There is no direct general investment in the Scottish Government budget for social care and no national directive about the level of resource for Councils to pass on and this will be locally determined. As noted, the settlement letter references “I am confident that Local Government will pass more in total to IJBs than is provided as an in-year transfer by Scottish Government. However, I do acknowledge that partnership working will be even more critical this year to ensure that the technical changes applied to the Adult Social Care GAEs are appropriately reflected locally.” The draft Scottish Government Budget included the transfer additional funding of £167million to Local Government to support social care and integration for 2026-27. This relates specifically funding for the following areas: • Real Living Wage for Adult Social Care • Free Personal and Nursing Care The allocation for the Real Living Wage was reviewed at the draft budget stage with Scottish Government allocating an additional £20m in total to make up the shortfall. This takes the national funding to: • £174.7m for adult social care workers in commissioned services. • An additional £13.4m to improve pay for early learning and childcare workers in commissioned services. • £13.9m to support development of people working in children’s social work. • £7m to support provision of Free Personal and Nursing care. The North Ayrshire share of the additional £20m has still to be confirmed but is included at an estimated £0.500m for the budget estimates. Additionally, in line with the agreed approach North Ayrshire Council have passed through all other funding or adjustments to Social Care allocations in the budget settlement, including: • Adjustments to allocations for Children’s Services, Disability Assistance administration and Justice Social Work • Funding received for the 2026-27 pay settlement difference between 3% and 3.5% - note the core pay settlement of 3% is not directly funded. • Additional funding approved at the Council budget setting meeting on 25th February which reflected North Ayrshire Council’s General Grant uplift and a Council Tax increase of 7% - £4.961m This has resulted in a net increased contribution to the Partnership of £13.759m through the NAC budget setting process. Some elements of this relate to previous years and were already assumed in the Partnership base budget and this is shown in the table below. Category £m Funding to meet new expenditure requirements: Childrens Services Additional Funding 0.651 Scottish Disability Assistance – reduction in grant (0.094) Health & Social Care Uplift – Real Living Wage 4.688 HSCP share of SG Funding to meet pay awards: 8
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SG Funding for 26-27 Pay Award 0.441 Baseline additional Uncommitted Funding to HSCP 4.961 Share of the additional £20m funding (estimate) 0.500 Per the HSCP budget plans 11.147 Reconciling Items to the Council Budget Paper Amounts already included in HSCP base budget: - SG Funding for 25-26 Pay Award 0.777 - Criminal Justice Social Work 2.335 Share of the additional £20m funding (estimate) still to be distributed (0.500) Per Council Budget paper 13.759 2.3.2 Adult Social Care GAE – Budget Context The Scottish Government’s Local Government Finance Settlement for 2026-27 includes technical changes to the Adult Social Care Grant Aided Expenditure (GAE) methodology, which underpins the distribution of core local government funding for adult social care across councils. The updating of Population Census variables has resulted in the revision of 3 indicators - Personal & Nursing Care of Older People, Residential Care for the Elderly and Services for Home-based Elderly. Together the indicators distributed about £2.33 billion in 2025-26. Much of the underlying data has not been updated since 2011 or 2001, and the current formulae, which have not been updated since 1997 or 2002, have been found to be either incorrect, or not using needs-based indicator methodology, and so not reflecting the expected numbers of clients in each authority. These changes affect the relative share of funding received by individual councils, representing a redistribution of existing resources rather than the introduction of new, ring-fenced funding for adult social care. Noting that these changes are exceptional in nature and may create volatility between councils, and to mitigate the impact of this the funding floor for 2026-27 has been increased to 0.5% below the average change, limiting the scale of any relative reduction in funding. The Scottish Government has stated an expectation that the technical changes to Adult Social Care GAEs are appropriately reflected locally and has emphasised the importance of partnership working between councils and Integration Joint Boards (IJBs) in this context. While the settlement provides councils with a high degree of flexibility over the use of General Revenue Grant, the policy intent is that revised assessments of adult social care need should inform local resourcing decisions for integrated services. North Ayrshire Position: • For North Ayrshire, the revised Adult Social Care GAE methodology will have influenced the Council’s overall settlement position for 2026-27, with implications for the resources available to support adult social care services. • The shift in Social Care based indicators is an increase of £3.3m based on the previous year. Other GAE indicators for funding have also been updated and have 9
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gone up and down in line with distribution. Despite this update for Social Care indicators and a greater relative share for North Ayrshire, what North Ayrshire Council gain through a more up to date assessment of need through the GAE indicators has been negated through less financial support through the floor mechanism in the local government funding settlement. • The extent to which this change is reflected in the Council’s contribution to the Integration Joint Board will be a matter for local agreement, taking account of: • the revised GAE distribution, • existing IJB financial commitments and demand pressures, and • the sustainability of integrated services. North Ayrshire Council has agreed to increase the IJB funding by £4.961m for 2026- 27 which reflects the increase in core revenue funding above the assumed 0% flat cash settlement for the Council overall. Financial Planning Considerations: • It should be noted that changes to the Adult Social Care GAE distribution do not remove underlying demand, cost, or workforce pressures facing adult social care services, however the updated distribution formula does highlight that appropriate funding reflecting demand for adult social care services through the Local Government Finance Settlement has fallen short for a number of years in North Ayrshire. • This increase in funding is not directly passed through to the IJB for the delivery of social care services and is instead part of the overall consideration of the funding allocation to the IJB by North Ayrshire Council. • There remains a risk that any future GAE driven changes to council funding do not fully align with the IJB’s assessed cost pressures, reinforcing the need for early and ongoing engagement between partners as part of budget setting and financial planning. 2.3.3 For years 2027-28 and 2028-29 the financial planning assumption of North Ayrshire Council is that, out with specific funding to be passed though by Scottish Government, that financial pressures facing the IJB will be fully met by savings, i.e. a flat cash financial settlement. This reflects the flat cash position predicted for Local Government in these years. 2.3.4 NHS Ayrshire and Arran NHS Boards will receive a 2% uplift on baseline funding to meet any anticipated pay deal, with pay fully funded and provides 2% inflation on non-pay lines. Additional funding will be provided to meet the costs of the 2026-27 pay deals where uplifts exceed 3% in line with public sector pay policy, and full funding has been included for the agreed Agenda for Change pay settlement. Pay funding should cover all staff including those delegated to Integration Authorities (IAs). NHS Ayrshire and Arran are required to passport the 2% through to IJBs (£2.890m to North Ayrshire) and furthermore the difference in the pay award for Agenda for Change staff from 2% and 3.75% (£1.824m for North Ayrshire delivered services). It is therefore anticipated that an additional £4.714m of funding contribution towards pay and inflation pressures will be allocated from NHS AA. NHS Ayrshire and Arran will meet on 7th April 2026 to set their budget for the coming year, the financial allocation for the IJB will be set at that meeting, however there is minimal risk of a deviation from the Scottish Government directive and allocation methodology from previous years. 10
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Additionally, there is funding of £150m nationally for Agenda for Change Pay Reform. A share of this funding will be allocated to the IJB towards the associated costs for NHS staff, this is being followed up for 2024-25 to ensure the correct roll-forward into 2025-26 and it is anticipated at this stage that the costs of the pay reform will be fully funded moving into 2026-27 including the implementation to the final hour reduction to the Reduced Working Week. While funding for reform and improvement measures will be routed through NHS Boards, elements will support activity in the community and delivered via IAs. Part of this package will be used to directly support our shared ambition to alleviate pressure across the health and social care system. Continuing from 2025-26, brokerage will not be available to support overspends, and NHS Boards must work towards a break-even position which remains the statutory responsibility of the Accountable Officer. Historic brokerage remains repayable and has not been written off. Non-recurring sustainability funding of £150 million will be provided to territorial boards on an NRAC basis. This funding must be used in full to reduce pressures and the reported deficit. NHS Boards at stage two and above on 2 the NHS Scotland Support and Intervention Framework for finance will receive additional support in 2026-27 to improve financial sustainability, including non- recurring deficit support funding as notified in early September 2025. The NHS AA financial position for 2026-27 is very challenging, on 13th February 2026 NHS AA Board was escalated to Stage Four of the NHS Scotland Support and Intervention Framework. This applies across three areas financial sustainability, financial control and financial governance and leadership. It is noted that the Board has been at Stage Three on the Framework since 2018 and the financial position remains unsustainable over the short to medium term. NHS AA has the highest level of outstanding brokerage of any Board in Scotland at over £130 million. The Board has also recently had a Section 22 report published by Audit Scotland and are not forecasting to meet their targeted deficit funding in 2025-26. 2.4 2025-26 FINANCIAL POSITION The overall projected outturn position for 2025-26, as at month 10, is a projected year- end overspend of £2.802m (0.85% of the annual budget). This excludes the Reduced Working Week funding request of £0.551m which if awarded in full would reduce the overspend to £2.251m. Since the initial recovery plan was agreed in June 2025 there has been a £2.833m reduction in the projected overspend. Whilst the full-year benefit of the financial recovery plan has not been realised in-year in the bottom-line outturn, it has supported the delivery of mitigating a further deterioration to the position introduced through other in-year unexpected financial pressures and supported addressing or reducing overspends in core services moving into the new financial year. The main areas of budget and demand pressure are: care at home, residential placements for children, physical and learning disability care packages, supplementary staff in wards, staff costs in Montrose House and Unplanned Activities (UnPACs) within the lead partnership for mental health. Demand for services, particularly for social care support is volatile and there are significant costs and risks associated with responding to the requirement for low volume high-cost placements. 11
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The graph below illustrates the volatility over the year in the projected outturn position, and the significant improvement made during the year, noting that for 2025-26 financial balance will not be achieved. Many of the underlying overspend areas will continue into 2026-27 and services require to address these or there will continue to be a reliance on other budgets underspending and short-term high-risk measures to cease or delay spend. 2.4.1 2026-27 Opening Position The 2025-26 projected outturn of £2.802m has been reviewed to establish the anticipated impact on the 2026-27 position and any element of recurring over and underspends. Following a robust review by the Finance Team and budget holders the adjusted opening projection for 2026-27 is a predicted £2.992m overspend. This is higher than 2025-26 as the in-year position includes one off underspends due to a draw on reserves as part of the recovery plan. This reflects the full year impact of part year cost reductions achieved in 2024-25, including - care at home, Brighter Pathways, care packages, vacancy management and supplementary staffing – targeted improvement in other areas. Further information is contained in the Financial Monitoring Report for Period 10 which is also on the IJB agenda. It assumes all mitigations and controls established in 2024-25 and 2025-26 continue throughout 2026-27 as it is recognised that the same uncertainty and risks remain into 2026-27 and there needs to be tight grip and control over expenditure overall. The opening projected overspend for 2026-27 is predicated on maintaining Financial Recovery Plan Controls, and: • Removing the care home overspend and manging the number of placements in line with the budgeted level. • Reducing agency costs at Montrose House on Arran • The Brighter Pathways programme of work bringing children’s placement budgets into line across different settings including residential, fostering, kinship – recognising the impact of the change programme and new supports in place for 2026-27. 12
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• Significant reduction or removal of overspends on supplementary staffing across wards through focussed improvement work supported by the General Manager, Lead Nurse and responsible Senior Managers The main areas of continued risk and where overspends are anticipated as part of the £2.992m are: • Physical Disability Care Packages • Integrated Island Services • Learning Disability Care Packages • Section Payments • Inpatient Ward Staffing – for Community Rehab and Mental Health Wards • UnPACs • Psychiatry There are inherent risks in moving into 2026-27 with the level of overspends across a range of service areas and focus will remain across services to manage these, the IJB will receive regular updates through the financial monitoring report for 2026-27 on progress and on the final outturn position for 2025-26. 3. PROPOSALS 3.1 2026-27 REVENUE BUDGET PLANS The NA HSCP 2026-27 integrated budget is expected to be £300.720m (excluding Set aside) and £343.390m (including Set Aside budget of £42.670m). A summary of the 2026-27 total budget and net funding increase is detailed within Appendix A. The pressures and savings are detailed separately in Appendices B and C respectively. Sections 3.1.1 to 3.1.5 provide an overview of the pressures and savings. 3.1.1 BUDGET PRESSURES Service cost and demand pressures are detailed within Appendix B. Total net budget pressures for health and social care services total £22.007m. These have been developed in partnership, with Finance supporting front line services to identify current and emerging financial pressures, considering historic demand and costs and potential future variations. The provision of funding for pressures has the impact of increasing the budget gap to be addressed through savings, therefore the pressures are only included in budget plans where these are assessed as being absolutely unavoidable. The pressures are noted below with full detail in Appendix B: Category Social Care (NAC) Health (NHS A&A) TOTAL £m £m £m Pay pressures 10.325 4.262 14.587 Demographic Pressures 0.420 0.420 Transition Pressures 1.056 1.056 Contract Inflation 4.902 0.025 4.927 Lead Partnership Pressures: 13
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Pan Ayrshire Pressures 0.077 0.077 Other Pressures 0.449 0.491 0.940 Total New 2026-27 Pressures 17.152 4.855 22.007 Note that this excludes any expectation or plan for any debt repayment to North Ayrshire Council or NHS AA for the 2025-26 overspend, the Council and NHS Board would require to consider on what basis they would plan to fund any year-end overspend, i.e. through an additional contribution or repayment basis. Provision has been made for Health pan-Ayrshire pressures recognising the North Ayrshire contribution towards pressures faced for services led by East or South. These pressures were agreed with the Chief Officers and Chief Finance Officers with an agreement that the IJBs have a shared responsibility to fund. These will be monitored during the financial year. 3.1.2 LIVING WAGE The Living Wage will increase from £12.60 per hour to £13.45 per hour from April 2026. This uplift will be applied in the same way as the £10.90, £12 and £12.60 uplifts in the last three financial years. This will mean an uplift will be applied to a set percentage (national weighting) of contract values, in line with the average full workforce costs for residential and non-residential services. A separate agreed weighted percentage has been set for Personal Assistants who are paid directly through SDS Option 1 budgets. After the weightings are applied and the national insurance increase is taken into account the hourly rates being paid to providers and personal assistants as follows: *The 2026-27 rates continue to align with those which are proposed by East Ayrshire and South Ayrshire, ensuring a consistent pan-Ayrshire funding approach for our commissioned providers. 2025-26 Rate Per Hour 2026-27 Rate Per Hour Care at Home and Housing Support £23.08* £24.44* Sleepovers £15.45 £16.50 Personal Assistant Day Time Hourly Rate £16.94 £18.02 Personal Assistant Sleepover Hourly Rate £15.83 £16.89 3.1.3 NEW FUNDING GAP FOR 2026-27 The table below summarises the overall new funding gap for 2026-27: Social Care (NAC) £m Health (NHS AA) £m Total £m Funding Increase 11.147 4.714 15.861 Service Pressures – Appendix B (17.152) (4.855) (22.007) Budget Gap (6.005) (0.141) (6.146) 14
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£6.146m is the new budget gap for 2026-27 only and does not include the £2.992m underlying deficit from 2025-26 which also requires to be addressed through savings plans, the table below demonstrates the full budget gap which requires to be met through savings. Social Care (NAC) £m Health (NHS AA) £m Total £m Funding Increase 11.147 4.714 15.861 Service Pressures – Appendix B (17.152) (4.855) (22.007) Budget Gap (6.005) (0.141) (6.146) Estimated Opening Gap from 2025-26 (1.400) (1.592) (2.992) Total 2026/27 Opening Budget Gap (7.405) (1.733) (9.138) 3.1.4 BUDGET SAVINGS Savings in relation to NAC and NHS commissioned services are detailed within Appendix C. The savings are RAG rated informed by an overall assessment of the ease of delivery and the impact on services, indicating an overall risk of deliverability. The savings are split into: • Previously agreed savings • Adjustments (payroll turnover and recharges) • Operational savings • Policy – Models of care or efficiency • Policy – Service reduction or cessation • Eligibility Criteria – Subject to a separate report The IJB are recommended to approve the savings proposals. Approval will allow: 1. The IJB to work towards a balanced budget – with all savings being recurring. 2. Give the maximum time to implement the savings. 3. Reduce the risk around financial sustainability. 4. Reduce the risk to our funding partners. These savings proposals do not fully address the funding gap, as illustrated below: Social Care (NAC) £m Health (NHS AA) £m Total £m Budget Gap (6.005) (0.141) (6.146) RAG Deliverability Status Social Care (NAC) £m Health (NHS A&A) £m Total £m Red - - - Amber 0.100 0.041 0.141 Green 1.477 1.198 2.675 TOTAL 1.577 1.239 2.816 15
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Funded by: - Savings – Appendix C 1.577 1.239 2.816 2026/27 Budget Position (4.428) 1.098 (3.330) Estimated Opening Gap from 2025-26 (1.400) (1.592) (2.992) 2026/27 Opening Budget Gap Position (5.828) (0.494) (6.322) The Partnership has undertaken extensive community engagement which commenced early December 2025 on the challenges of delivering social care services within budget. There is a separate paper on the IJB agenda for consideration, it is recommended that the remainder of the Social Care/Council gap is met through the review of eligibility criteria for access to funded adult social work and social care services. The remaining budget gap for Health/NHS services is smaller in value and primarily reflects current year pressures recurring to an extent next financial year, rather than a significant pressure on core funding, therefore it is recommended that the remaining health services gap is monitored closely in-year during 2026-27 with further recovery actions identified as required. 3.1.5 LEAD PARTNERSHIP MENTAL HEALTH SERVICES The North partnership lead on acute and specialist Mental Health services across Ayrshire and therefore require to ensure that the services have plans to balance the budget moving into 2026-27. We have developed plans to ensure that lead partnership Mental Health services are sustainable and are not impacted by pressures elsewhere in services. The overall position for the lead partnership element of the North managed budget is summarised below: £m 2026-27 Baseline Increase 2.550 Pay Pressures (2.557) Demand Pressures (0.029) Budget Gap/Savings Requirement (0.036) Previously agreed savings - Adjustments (payroll turnover and recharges) 0.090 Operational savings 0.016 Policy – Models of care or efficiency 0.272 Policy – Service reduction or cessation 0.511 Net position – surplus 0.853 Estimated Opening Gap from 25/26 (0.892) Net position – deficit (0.039) 3.2 ACUTE SET ASIDE BUDGET Each Health Board, in partnership with the Local Authority and IJB, must fully implement the delegated hospital budget and set aside budget requirements of the legislation, in line with the statutory guidance published. 16
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The full implementation of the set aside arrangements is key to delivering a commitment to planning across the whole unplanned care pathway and partnerships must ensure that set aside arrangements are fit for purpose and enable this approach. Work has been ongoing with partnerships to progress and develop set aside arrangements to fully implement the legislative requirement. This includes arrangements in relation to the use of Directions, Joint Commissioning Plans and overall progression towards fair share allocations of resources. Further work has been undertaken through the Ayrshire Finance Leads group to establish baseline resources for each partnership and how these compare to the NRAC “fair share” of resources. Ayrshire Finance Leads have now agreed a baseline methodology for set aside budgets which involves using the four full years prior to the pandemic, 2016/17 – 2019/20 inclusive. The HSCPs require to agree their final share of the baseline with each other, however the aggregate will remain unchanged. The table below shows the cost of the 2024- 25 activity at 2025-26 prices inflated by 2% for 2026-27 prices. Note that this is estimate pending final information being available. IJB 2024-25 Activity at 2025- 26 prices inflated by 2% for 2026-27 East 34,003 North 42,670 South 34,844 Total 111,517 The NHS AA Chief Executive had previously requested the development of a joint strategic commissioning plan to enable the setting of directions to provide to NHS Ayrshire and Arran for Unscheduled Care, aligned with the Set Aside resources. The NHS AA Chief Executive had previously requested the development of a joint strategic commissioning plan to enable the setting of directions to provide to NHS Ayrshire and Arran for Unscheduled Care, aligned with the Set Aside resources. Furthermore, seeking the support from the 3 IJBs in the review, and onward approving and monitoring of the delivery of a Strategic Commissioning Plan in line with the provisions laid out in the Integration Schemes, as outlined below: The NHS Board will consult with the Ayrshire Integration Joint Boards to ensure that any overarching Strategic Plan for Acute Services and any plan setting out the capacity and resource levels required for the Set Aside budget for such Acute Services is appropriately coordinated with the delivery of Services across the Ayrshire and Arran area. The parties shall ensure that a group including the Director for Acute Services and Chief Officers of the three Ayrshire Integration Joint Boards will meet regularly to discuss such issues. The initial Set Aside base budget for each Integration Joint Board will be based on their historic use of Acute Services. The actual unit cost which would apply as part of any change to activity or service redesign is dependent on the scale of change planned and requires agreement in advance by all Parties. Any redesign of service requires to be agreed across the three Integration Joint Boards and be reflected in the Strategic Plans. 17
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In year pressures in respect of Set Aside budgets will be managed in year by the Health Board, with any recurring over or underspend being considered as part of the annual budget setting process. In any joint strategic commissioning plan each IJB will consider and outline a clear framework for commissioning, at a strategic level, the urgent and unscheduled care service funded from the ‘set aside’ budget. There is an ambition that the commissioning plan will indicate an expectation of service delivery that will see sustained and affordable improvement in relation to performance outcomes for the citizens of Ayrshire and assure best value to support the financial balance of urgent and unscheduled care provision through a review and system wide redesign of the preferred models of care. This work remains ongoing and there is an opportunity to refresh this alongside the national focus on NHS Renewal for Unscheduled Care. There have been recent discussions on a Pan Ayrshire and the recent establishment of an Ayrshire Transformation Board with representation from the 3 HSCPs, 3 Councils and Health Board to progress this work during 2026-27. 3.3 NHS RENEWAL – Operational Improvement Plan – Unscheduled Care In January 2025, the First Minister described plans to renew the health service and deliver the change that people in Scotland need. This Operational Improvement Plan is the first component, to be followed by publication of a population health framework and a health and social care service renewal framework. Together these plans will progress reform to ensure long-term sustainability, reduce health inequalities, further harness the benefits of digital technology, and improve population health outcomes in Scotland. They will set out how we will plan our services for our whole population over the short, medium and longer term. This Operational Improvement Plan describes a number of commitments and actions across NHS Scotland that are needed to improve the experience of patients. The plan brings focus to four critical areas that the Government is committed to delivering: • improving access to treatment • shifting the balance of care • improving access to health and social care services through digital and technological innovation • prevention – ensuring we work with people to prevent illness and more proactively meet their need NHS Boards, in collaboration with Health and Social Care Partnerships, were asked to evidence how they would deliver whole-system and sustainable improvement through the £100 million to deliver the Operational Improvement Plan. In 2025-26 the level of funding requested from Boards across Scotland exceeded the total additional funding available and the Scottish Government were unable to approve the entirety of each NHS Boards plan. In June 2025, the Scottish Government confirmed £10.079 million additional funding for NHS Ayrshire & Arran for 2025/26. This allocation is designed to support whole- system transformation and is broken down as follows: 18
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• £1.681m – Hospital at Home (H@H) expansion, including virtual capacity and care closer to home. • £6m – Discharge without Delay (DwD) and Frailty Services, embedding early discharge planning and front-door frailty models. • £2.399 million – Core Unscheduled Care funding to maintain essential flow and resilience. North Ayrshire HSCP has £1.081 million ring-fenced within this allocation as follows: • £746k – Enhanced hospital-based multi-disciplinary team (MDT) to deliver seven-day working, front-door frailty, and discharge-to-assess. • £335k – Mental Health Officer (MHO) capacity to address statutory compliance and reduce Adults with Incapacity (AWI)-related delays. The NHS Renewal allocation of £10.079m for Ayrshire & Arran, including £1.081m ring-fenced for North Ayrshire, has enabled progress on enhanced hospital-based MDTs and MHO capacity. However, delays in approval and recruitment have limited impact to date, and the non-recurring nature of funding poses significant risks to sustainability. Revised improvement trajectories show slower progress than originally planned, with delayed discharge numbers projected to remain high into mid-2026 unless additional interventions are implemented. Community unmet need is also escalating, with average waiting times for care packages for those who experience a delay in the community exceeding 120 days. Funding is conditional on achieving agreed outcomes such as embedding DwD principles, implementing front-door frailty services, and expanding virtual capacity, with robust monitoring and trajectory reporting required to secure future recurrent funding. The Scottish Government budget for 2026-27 includes £100m across Scotland, the individual allocations to Health Boards and IJBs have not been received to date. There remains a risk of recurring funding to meet the existing financial commitment in North Ayrshire of over £1m in addition to the further release of funds to take forward investment in other areas which would support hospital demand and flow. 3.3 FINANCIAL RISKS There are a number of ongoing financial risk areas that may impact on the 2026-27 budget during the year, these include: • Growing demand for services. • Staff recruitment and retention challenges across a number of service areas. • The expectation that performance will continue to be maintained or improved despite the significant resource challenges. • Ongoing delivery costs of Scottish Government policy directives, particularly where these are not fully funded or inflation proofed. • Unearmarked reserves are depleted, there is no scope to absorb in-year variances, with any overspends requiring additional funding from partners. • The ongoing review of the Integration Schemes, where there is a focus on financial arrangements and risk share. • The wider system financial challenges and impact across the whole system, for example the financial position of NHS AA and the decisions taken to reduce the Board’s deficit may have impacts on other parts of the health and care system. 19
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• The ability to re-pay funding partners in-year for previous year overspends given continued financial challenges. • The overall sustainability of commissioned care providers • Progress with the work to develop set aside arrangements and the risk sharing arrangements agreed as part of this. • The recurring underlying levels of overspend which may impact on the Partnership’s ability to continue to sustain service levels in the future. • The use of supplementary staffing for enhanced observations across a number of service areas and the use of high-cost agency staff to support frontline service delivery in areas where there are recruitment challenges. • Agenda for Change Pay Reform programme – including Nursing Band 5-6 re- grade, protected learning time and reduction to the working week. • Risk related to NHS Reform investment being allocated by Scottish Government on a payment by results basis and in arrears. • A risk of meeting legal obligations to deliver a balanced budget set against continued increased demand for services, inflationary impacts on the cost of care and the more difficult decisions which are required to reduce spend. These risks will be monitored during 2026-27 and any financial impact reported through the financial monitoring report. 3.4 IJB RESERVES The IJB is established as a Local Government body therefore has the ability to hold reserve balances. Reserve balances are held as part of an approach to good financial management, the purpose of reserves is as follows: a) As a working balance to help cushion the impact of uneven cash flows. b) As a contingency to manage the impact of unexpected events or emergencies; and c) As a means of building up funds, often referred to as earmarked reserves, to meet known or predicted liabilities. The balance of reserves should be considered as part of the budget setting process. The IJB has a reserves policy in place which outlines an optimum value of reserves to be held uncommitted in contingency, this is currently set as 2% to 4% of net expenditure, based on the lower value this would be around £6.014m of the 2026-27 budget (exc set aside). The IJB reserves position projected to 31st March 2026 is summarised in the table below. This reflects a significant in-year draw on both earmarked and unearmarked reserves. General Fund Reserve Earmarked Reserves Total Unearmarked External Funding HSCP £m £m £m £m Balance – 1 April 2025 - 2.381 0.780 3.161 Anticipated Drawdown - (2.381) (0.780) (3.161) Projected Balance – 31 March 2026 - - - - The final position for reserves will be outlined in the year-end outturn report in June 2026 and in the Annual Accounts, however at this stage it is anticipated that the IJB will not carry any reserves moving into the new financial year. 20
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Whilst the ambition would be to plan to replenish the contingency reserves for the IJB in future years, the reality is in the current financial operating environment there is not the ability or scope to plan for this in the short term. 3.5 2027-28 and 2028-29 3.5.1 A detailed Medium-Term Financial Outlook was presented to the IJB in December 2025. At that time the projected position for 2027-28 and 2028-29 was as follows: 3.5.2 The MTFO uses three possible scenarios to estimate what our additional funding could look like across the financial years 2027-28 and 2028-29. These are as follows: • Best Case – an annual uplift of 2% for social care and health. The funding assumptions have been scaled back based on the Scottish Govt Medium Term Financial Strategy 2025. This includes a forecast 3.3 per cent real-term average growth per annum, however, this is before required savings and efficiencies. • Medium Case – this allows for 1% uplift in 2027-28 and 2028-29. This is linked to the midpoint between Best- and Worst-case scenario. • Worse Case – flat cash from both Council and NHS Board. The MTFO sets out a range of cost pressures across each of the financial years. These cover pay inflation, demand and demographic pressures across health and social care services, and the possible costs of delivering national priorities. As Scottish Government budgets continue to be for one year only, assumptions are made for future years. Cost pressures are currently estimated at £11.536m for 2027-28 and £11.592m for 2028-29. 3.5.3 The modelling from December 2025 has been updated to reflect updated pressures and savings (full year impact of 2026-27 savings). This has been carried out across best, medium and worst-case scenarios has identified the following potential positions for 2027-28 and 2028-29: 21
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3.5.4 Our budget position for 2026-27 has proven to be closest to the medium and the worst- case scenario which was previously projected for that year and it would be prudent to assume a similar position for the following years. • For 2027-28 this would mean identifying savings between £7.971m and £10.761m • For 2028-29 this would mean identifying savings between £5.842m and £11.592m. Cost pressures have continued to be assumed on a consistent basis with 2026-27 excluding the impact of the increased to employers’ superannuation contributions in 2026-27. 3.5.5 On that basis, it is highly likely that the IJB will continue to face significant budget gaps which will require to be addressed in order to set a balanced budget. The IJB Finance Working Group will continue to meet regularly and will be presented with opportunities and options to work towards a sustainable financial position for future years. 3.6 NATIONAL FINANCIAL POSITION OF IJBs AUDIT SCOTLAND FINANCE BULLETIN 2024-25 (published 26-02-26) Local government in Scotland: Financial bulletin 2024/25 | Audit Scotland Key Messages for IJB Members: 22
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• Despite a 2.3% real-terms increase in funding, IJB finances continue to deteriorate as cost pressures outstrip available resources. • Total IJB reserves are now lower than the forecast 2025/26 budget gap, reducing financial resilience. • Audit Scotland is explicit that difficult decisions are unavoidable, including potential changes to service models, eligibility criteria, charging, or withdrawal of non-essential services. National Financial Position (2024/25) • Net cost of IJB services: £12.5 billion • Savings delivery: 78% of planned savings achieved nationally • 22 of 30 IJBs reported an in-year deficit • Increasing reliance on additional in-year partner contributions, which Audit Scotland considers unsustainable Reserves and Financial Resilience • Total reserves at year-end: £404 million (of which £316 million is earmarked) • Reserves fell by 12% compared to 2023/24 • Almost half of IJBs hold no contingency reserves • Only two IJBs meet the commonly referenced 2% contingency reserve threshold Savings and Transparency • Savings targets increased to £364 million in 2024/25 • Public reporting remains inconsistent, particularly on recurring versus non- recurring savings • Reliance on non-recurring savings (e.g. vacancies) presents significant financial risk 2025/26 Financial Outlook • Forecast national budget gap: £449 million • Average gap: 3.6% of net service costs • Gap-bridging plans include unidentified savings (10%) and use of reserves (5%), which is not sustainable Governance and Leadership • 86% of IJB audits raised financial sustainability risks • Over 50% of IJBs experienced senior leadership turnover in 2024/25 • Leadership instability undermines long-term financial planning and transformation Implications for IJB Decision-Making Audit Scotland concludes that maintaining current service levels within existing resources is not feasible. IJBs will need to lead strategic service redesign, review eligibility thresholds, consider charging and prioritisation, and engage transparently with communities about the impact of change. 3.6.1 Presentation of position There is regular reporting by IJBs of the individual and collective financial position thorough internal governance mechanisms but also through audit and directly through returns to Scottish Government Health Finance directorate. Chief Officers met with the Cabinet Secretary on 5th March 2025 to present an overview of the national picture for IJBs, some of the context around the rising pressures and cost of services, and to bring to life the impact of a critically challenging financial position for service delivery, risks and performance expectations in the coming year. North Ayrshire IJB is not alone in facing these challenges and whilst there is variation around the scale of the gap for IJBs, there are many similarities in the pressures facing us across Scotland. The Cabinet Secretary received a presentation which highlighted: 23
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• 2025-26 projected budget gap, including the worsening position for reserves. • Historical funding settlements for IJBs • Trends in health and adult social care spend. • Risks to the financial position, service provision and performance • Scale of the impact in terms of service provision levels • Social Care provider sustainability risks • A case study from an area illustrating the link between financial resources and delayed discharge performance. • Priority of need and risk management • Links to national priorities and policy directives Chief Officers set out a number of asks in relation to: • appreciated the opportunity to share the scale of the collective challenge and have this understood and heard – and want the opportunity to build in more regular visibility of this • recognise there is limited resource available which has not already been committed on other priorities – however would seek to influence decision making around priorities for future resources. Currently working within local systems on the whole system plans to inform the NHS Renewal submissions. Chief Officers would ask that consideration is given to the priority for investment in community services and that any resource asks from IJBs are prioritised • Would ask that there is a greater appreciation that there is local variation and complex reasons for this, the solutions and decisions required across areas may therefore be different • Lastly, seek that our positions are understood and appreciated at a national and local level, and that there is a level of understanding and honest reflection of the reality of the financial pressures and difficult decisions required. Would ask for support to manage public and political expectations around the scale of change, service impacts and implications for performance. COSLA highlighted a significant gap for social care services moving into 2026-27 and called for an urgent £750million investment to stabilise the sector and prevent service crisis. Raising concerns of a structural financial crisis facing social care, warning that failure to invest results in reduced care packages and increased pressures on families. This investment is not reflected in the Scottish Government budget for 2026-27. The North Ayrshire IJB Chief Officer met together with Craig Hatton, Chief Executive of North Ayrshire Council on Thursday 12th February with the Cabinet Secretary and Minister to discuss the financial position of the IJB. This was following a request in December 2025 for the Chief Officer to write to set out our challenges and request consideration of further funding for North Ayrshire IJB particularly to meet demands and needs for social care services. The Cabinet Secretary and Minister acknowledged the difficulties we face and referred to opportunities to work with NHS Ayrshire and Arran on shifting the balance of care and risk-share and hospital at home service developments and confirmed there is no further funding available from Scottish Government. 3.7 Strategic Risk Register 24
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The Strategic Risk Register (SRR) is normally made available on the same agenda as budget setting, with the IJB last reviewing this is in June 2025. The SRR helps to ensure the IJB are proactive in identifying and managing the risks to the successful delivery of our Strategic Plan. The scoring of risks on the SRR are informed by the severity of risk multiplied by the likelihood of it happening. Given the significant budget challenge and significant recommendations to balance the financial position the SRR will be reviewed following the budget meeting and presented to the next IJB. The current risks on the SRR are: SRR01 Financial Sustainability SRR02 Infrastructure (ICT Integration) SRR05 Transformational Change Programme SRR06 Governance SRR07 Demography and Inequality Pressures SRR08 Workforce SRR09 Local Impact of Scottish Government Policies SRR12 Clinical and Care Governance SRR13 Provider Failure (commissioned services) SRR14 Asylum Arrivals SRR15 Risk of Harm SRR16 Growth and expansion of specialist complex care developments 3.8 Anticipated Outcomes There are a number of outcomes anticipated in relation to the 2026-27 Budget: • The proposed plans will work towards a balanced budget for 2026-27. • Transformational Change for financial and service sustainability will feature at the forefront of the IJB and NAHSCP agenda throughout 2026-27 and beyond. • The remaining financial gap will require further decisions to be considered in relation to eligibility criteria for social care services, this will overall lead to a reduction in the level of care delivered next year. 3.8 Measuring Impact • Full year financial outturn forecasts will be compiled monthly with variance analysis and relevant explanations. • Regular financial review sessions will be undertaken with the Director, all Heads of Service and relevant senior managers in NAHSCP to ensure timely action is being taken where needed to stay within budgets. • Regular financial performance reports will be presented to the IJB to ensure it is kept fully informed of performance and importantly any major areas of concern requiring corrective action. • The Transformation Board will meet regularly to review progress with savings and any corrective action required to bring any plans back online. 4. IMPLICATIONS 4.1 Financial It is essential that the IJB and NAHSCP operate within the 2026-27 delegated budget, this is supported by approving a balanced budget before the new financial year. The report outlines estimated delegated funding and the pressures required to be met from within the overall integrated budget. It is estimated there is a requirement to deliver £9.138m of planned savings during 2026-27 alongside dealing with a number 25
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of other known pressures and the risk of managing fluctuating demand for services. There remains a balance of £6.322m of savings to be approved, with most of this aligned to the requirement to re-set eligibility criteria for access to social care. The estimates are based on a robust understanding of the additional resources available, the risks and challenges faced by the Partnership and the anticipated budget pressures. Appendix A shows the total 2026-27 IJB Budget Appendix B shows the proposed service pressures. Appendix C shows the proposed savings. Appendix D shows the Scottish Government Finance Settlement letters. 4.2 Human Resources There will be full consultation with the Trade Unions as appropriate. 4.3 Legal The IJB has an implicit obligation to funding partners to set a balanced budget prior to the start of the new financial year. The financial position and funding as detailed out would result in both partners complying with the Scottish Government directives re delegated funding for Integration Authorities. Legal advice has been sought on proposals aligned to the budget, to ensure alignment with the Council and Health Board continuing to meet their statutory duties and obligations. 4.4 Equality/Socio-Economic All budget proposals are assessed for any potential impacts using Equalities and Children’s Rights Impact Assessment (ECRIA) Screenings. If any potential impacts are identified, a full assessment is carried out. The previously agreed savings were assessed as part of the 2025-26 budget. A copy of all the relevant assessments across the budget savings categories is available. 4.5 Risk Failure to operate within the delegated budget would impact on the overall financial sustainability and reputation of the partnership and would expose both funding partners, North Ayrshire Council and NHS Ayrshire and Arran to additional financial risk. The IJB has no reserves available to mitigate the risk to partner bodies. 4.6 Community Wealth Building Effective delivery of services as per the 2026-27 budget and associated plans should allow key strategic priorities to be met which should maximise benefits for the North Ayrshire community as a whole but also benefit those areas of the community most in need, with a focus on ensuring HSCP resources are directed to those most in need in our communities. 4.7 Key Priorities The IJB approved a refreshed Strategic Plan in December 2025, this plan highlighted the fiscal constraints and impact and risk on achieving outcomes and ambitions. Whilst the HSCP Strategic Plan Priorities would remain unchanged a follow up assessment will be carried out to review the performance and service delivery ambitions in light of the significant financial saving requirement and impact on service delivery. 26
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5. CONSULTATION 5.1 The budget plans detailed in this report have been produced in consultation with relevant budget holders, the Partnership Senior Management Team, the Finance Working Group and IJB members. The funding assumptions align with information shared and agreed with the Head of Finance at North Ayrshire Council and the NHS AA Director of Finance. The financial position, outline savings proposals and approach to reviewing and budget consultation was shared with NHS Ayrshire and Arran and North Ayrshire Council. Engagement has been undertaken with all Elected Members as part of North Ayrshire Council’s budget planning process including an HSCP hosting an all members session in January 2026. Extensive public engagement has been undertaken on proposals relating to social care eligibility criteria with further details included in the separate report on the agenda. For more information please contact: Eleanor Currie, Chief Finance Officer at eleanorcurrie@north-ayrshire.gov.uk Appendix A North Ayrshire Health and Social Care Partnership 2026-27 Total Budget 27
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NAC £m NHS AA £m Total £m Baseline Budget 140.359 144.500 284.859 Baseline Funding Increase 11.147 4.714 15.861 2026-27 Budget excluding set aside 151.506 149.214 300.720 Draft set aside budget - 42.670 42.670 2026-27 Budget including set aside 151.506 191.884 343.390 2026/27 Budget 28
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DIRECTION Reference No. 260313-07 Title 26-27 Budget From Caroline Cameron, Integration Joint Board/Chief Officer To NHS Ayrshire Arran Name/Contact Details Local Authority Name/Contact Details Both Name/Contact Details 1. IJB Report Reference No. 260313-07 2. Date Direction Issued/Approved by IJB 13th March 2026 3. Report Author/Contact Details Eleanor Currie (eleanorcurrie@north-ayrshire.gov.uk) 4. Date Direction takes effect 13th March 2026 5. Does this direction supercede, amend or revoke a previous direction – if yes, include the reference numbers(s) Yes This Direction supersedes all previous budget-related Directions issued for: • 2025/26 Revenue Budget Direction • Any in-year Directions issued during 2025/26 relating to financial recovery, savings, eligibility criteria, or service redesign • Any previous Directions concerning delegated budget allocation that are replaced by decisions taken for 2026/27 No 6. Description of services/functions covered by the direction This Direction covers all delegated health and social care functions under the North Ayrshire Integration Scheme, including: • Delivery of all services within the 2026/27 integrated budget of £343.390m, including Set Aside (£42.670m). • All social care functions delegated by North Ayrshire Council, including adult and children’s social work and social care services. • All delegated community health services and hosted/lead partnership services delegated by NHS Ayrshire & Arran. • Lead Partnership responsibility for acute and specialist Mental Health services across Ayrshire. • Delivery of statutory duties (community care, mental health, SDS, Carers Act, public protection, clinical & care governance). 29
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• Delivery of all approved savings, eligibility policy changes, and operational and service redesign measures required to balance the 2026/27 budget. 7. Full text of direction North Ayrshire Council is directed to: • Deliver all delegated social care functions within an approved 2026/27 budget of £151.506m (excl. set aside). • Implement the approved Real Living Wage uplift to £13.45 per hour and apply contract uplifts accordingly. • Implement social care savings totalling £1.577m and support further savings through service redesign, charging uplifts, workforce restructuring, and operational efficiencies. • Consider alongside the recommendation and outcome of the review and resetting of eligibility criteria for adult social care, as identified in the 2026/27 budget. • Continue tight financial controls, vacancy management, and demand-management actions required to respond to demographic pressures, high-cost placements, and volatile demand. • Ensure all delegated functions operate within allocated resources and provide required monitoring returns to the IJB. NHS Ayrshire & Arran is directed to: • Deliver all delegated health services within an approved 2026/27 budget of £149.214m (excl. set aside). • Apply the required 2% uplift to delegated services and implement pay settlement requirements (including AfC pay reform and reduced working week). • Deliver NHS-related savings totalling £1.239m, including workforce redesign, reduced supplementary staffing, and service efficiencies. • Support IJB oversight of recruitment risks, supplementary staffing controls, and operational recovery actions across Mental Health, UnPACs, inpatient wards, and integrated island services. • Provide all required information for in-year monitoring, including progress against statutory performance requirements. The IJB directs both partners to: • Deliver all delegated functions within the total 2026/27 integrated budget of £343.390m (incl. set aside). 30
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• Take all necessary steps to deliver the £9.138m savings requirement, including £6.322m still to be formally approved (primarily through eligibility changes). • Implement all financial controls required to ensure a legally compliant, in-year balanced budget. • Participate in joint improvement work in support of the NHS Operational Improvement Plan, Discharge Without Delay, Frailty Pathways, and community capacity improvements. • Provide monitoring information required by the IJB in line with statutory guidance (Sections 5.1–5.7). • Work collaboratively to deliver the IJB’s refreshed Strategic Plan 2026– 2030. 8. Specification of those impacted by direction. • North Ayrshire Council: Adult social work, children’s services, justice services, commissioning, finance, business support, digital telecare, and community services. • NHS Ayrshire & Arran: Primary care, community health teams, Mental Health services, specialist hosted services, inpatient wards, and pan-Ayrshire functions. • Commissioned Providers: Care at home, residential care, supported living, SDS, third sector services, mental health providers, ALD services, and children’s care placements. • Service Users and Carers: Individuals receiving adult social care, children’s services, mental health services, LD/PD services, and unpaid carers through Carers Act supports. • HSCP Workforce: All HSCP-managed and delegated staff, including community health teams, Mental Health teams, social work, and integrated services. 31
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9. Budget allocated by Integration Joint Board to carry out direction Component Budget 2026/27 NAC-delegated Social Care £151.506m NHS-delegated Health £149.214m Set Aside Budget £42.670m Total Integrated Budget £343.390m New 2026/27 Budget Gap £6.146m Opening Recurring Deficit from 2025/26 £2.992m Total Savings Requirement £9.138m Approved Savings £2.816m Further Savings Required £6.322m 10. Outcomes/Link to Strategic Priorities This Direction supports delivery of the IJB’s refreshed Strategic Plan (2026–2030), including: • Prevention and early intervention • Shifting the balance of care toward community-based models • Improving outcomes and experience for people with complex needs • Supporting unpaid carers and community capacity • Ensuring sustainability of integrated health and social care services • Transformational change aligned with the Operational Improvement Plan and national reform agenda • Targeting resources to those most in need, in the context of tightening eligibility and prioritisation Audit Scotland’s 2024/25 findings further reinforce the necessity to prioritise sustainable models of care. 11. Timescales/Review/Monitoring Arrangements This Direction takes effect on 13 March 2026 and remains in force until 31 March 2027, unless superseded, varied, or revoked. The IJB will monitor delivery through: • Regular financial monitoring and performance reports • Oversight by the Finance Working Group • Quarterly Strategic Plan delivery reporting • Transformation Board oversight of savings and service redesign 32
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Partner bodies must report promptly on any risks to delivery of functions or achievement of financial balance. Revised Directions will be issued if material changes arise (e.g., funding changes, national policy directives, service redesign decisions). 12. Lead Partnership Arrangements North Ayrshire IJB, as Lead Partnership for Acute & Specialist Mental Health Services, directs NHS Ayrshire & Arran to: • Deliver the Mental Health Transformation savings plan for 2026/27, ensuring a sustainable net position. • Address overspends in UnPACs, Psychiatry, and inpatient ward staffing through operational redesign and supplementary staffing reductions. • Report on performance, financial risk and service impact to all three Ayrshire IJBs. • Support pan-Ayrshire planning for Set Aside budgets, including engagement with the Ayrshire Transformation Board and development of a joint Strategic Commissioning Plan for unscheduled care. • Ensure that redesign proposals are agreed by all IJBs in line with statutory governance requirements. 33
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Appendix B North Ayrshire Health and Social Care Partnership 2026-27 Budget Pressures Council NHS (non lead) NHS (lead) TOTAL Basis of Budget Pressure £m £m £m £m Pay: Pay awards 3,067,090 1,604,007 2,406,010 7,077,107 Council 3.5% NHS 3.75% Superann increase impact 7,243,087 7,243,087 Reflects the increased rate of 17.5% employer contributions Apprenticeship Levy 15,335 8,020 12,030 35,385 0.5% of the payroll increase NHS ENICs shortfall 92,800 139,200 232,000 This is the shortfall carried forward from 25-/26 TOTAL PAY PRESSURES 10,325,512 1,704,827 2,557,240 14,587,579 Non Pay: Demand Pressure Mental Health 139,747 139,747 Reflects historic demand Transition Pressure Mental Health 162,113 162,113 Reflects historic demand Demand Pressure Learning Disabilities 280,000 280,000 Reflects historic demand Transition Pressure Learning Disability 893,874 893,874 Reflects historic demand NCHC Pressure 1,579,373 1,579,373 Estimated increase (final increase TBC when the 2026-27 rate is confirmed ) Contract Inflation outwith the NCHC 3,322,721 25,000 3,347,721 Reflects the increase in the Living Wage Care at Home Management System 75,000 75,000 Additional annual contract cost (full year) Analogue to Digital 80,000 80,000 Additional hardware costs Brighter Pathways Programme 785,313 785,313 Net cost of Boyle Street, new foster scheme and achieving an online position Resource Transfer inflation 490,960- 490,960 - 2% applied TOTAL NON PAY PRESSURES 6,827,181 515,960 - 7,343,141 Pan Ayrshire Pressures : Palliative Care Service 18,000 18,000 : Mattress Replacement 25,000 25,000 50,000 : Office 365 increased costs 4,263 4,263 8,526 TOTAL PAN AYRSHIRE PRESSURES - 29,263 47,263 76,526 TOTAL 2026/27 PRESSURES 17,152,693 2,250,050 2,604,503 22,007,246 Agreed on a pan Ayrshire basis with East and South 2026/27 34
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Appendix C North Ayrshire Health and Social Care Partnership 2026-27 Savings Council NHS (non lead) NHS (lead) TOTAL RAG Deliverability Status Description Adjustments and Previously Agreed Savings: Inflate Payroll Turnover 107,348 60,150 90,225 257,723 Green Increased target to reflect the pay award Recharge to East for Ward 2 beds - 25,000 - 25,000 Green Increased charge to reflect the pay award Financial Inclusion Review 32,500 - - 32,500 Green Full year impact of the 2024/25 saving Social Care Model at Trindlemoss House - 175,000 - 175,000 Green Moving from a nursing led model to a social care led model 139,848 260,150 90,225 490,223 Operational Council NHS (non lead) NHS (lead) TOTAL RAG Deliverability Status Description Social Care Fees and Charges 5% increase 100% included 120,000 - - 120,000 Green Increased income to reflect the 2026/27 charges LES Payment - Buckreddan Care Home 43,000 - - 43,000 Green Service will be ither cease or be funded by the care home LES Payment - Toddhill 22,000 - - 22,000 Green Service will cease Third Sector Capacity Building 34,000 - - 34,000 Green Reduction of a post Business Admin - Phase 1 - Quick wins 251,979 - - 251,979 Green Reduction in 6.8 WTE posts Moving and Handling post 55,000 - - 55,000 Green Reduction of a post Business Admin Team - senior structure - 40,000 - 40,000 Green Saving following a retiral and resultant revised structure Carers UK Annual Subscription 3,500 - - 3,500 Green Cease the subscription NADARS NHS non staffing budget - 26,771 - 26,771 Green Saving in non staffing costs Pan Ayrshire Alcohol & Drug Services Management Team - 16,478 16,478 32,956 Green Saving in staffing costs Removal of SW Trainee Post 54,000 - - 54,000 Green Removal of a SW trainee post Child Health Assessment - Charge for Out of Authority cases - 6,000 - 6,000 Green New charge for Out of Authority health assessments Children and Families Throughcare Review 87,000 - - 87,000 Green Reduction in staffing (WTE TBC) Support Services outwith business support 100,000 - - 100,000 Amber Reduction in staffing (WTE TBC as it is a target) 770,479 89,249 16,478 876,206 35
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Policy - Model of Care or Efficiency Council NHS (non lead) NHS (lead) TOTAL RAG Deliverability Status Description Roslin House - shared respite/residential model 300,000 - - 300,000 Green Moved to respite and residential model. Assumes 4 external placements will move to Roslin House Trindlemoss - review of care delivery model 116,989 - - 116,989 Green Review of care delivery model. Budget reduction regarding the Pan Ayrshire Prevention & Service Support Team - - 40,817 40,817 Green Saving in non staffing costs Phase 1 - Children and Families -quick wins re: retirements, WLB and vacant posts 250,000 - - 250,000 Green Reduction in staffing (7 WTE) Phase 1 - Psychology - - 231,138 231,138 Green Reduction in staffing (2.5 WTE and a reduction in grade for 1 post) 666,989 271,955 938,944 Policy - Service Reduction/Cessation (all agreed with East and South HSCP) Council NHS (non lead) NHS (lead) TOTAL RAG Deliverability Status Description DBI - Distress Brief Intervention service - - 157,500 157,500 Green Cessation of the Distress Brief Intervention service (7mths assumed) MH Innovation Fund (reduction of posts) - - 41,331 41,331 Amber Reduction of Innovation Funded posts. 3mths of savings assumed as the posts will be redeployed. (2.7 WTE) RISE Team - Resilience in Stressful Events - - 192,131 192,131 Green Reduction in the RISE service Mental Health Practitioners (MHPs) in GP practices - - 120,000 120,000 Green Reduction in the MHPs ( est 3 WTE posts) - - 510,962 510,962 TOTAL DRAFT SAVINGS PROPOSALS 1,577,316 349,399 889,620 2,816,335 36
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Appendix D SCOTTISH GOVERNMENT FUNDING LETTERS 2026-27 LGF - Correspondence - 202 2026-27 - Scottish Government Budget L 37
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Integration Joint Board 13th March 2026 Subject : Budget Consultation and Eligibility Criteria for Social Care Services Purpose : This report: a) Provides an update and feedback on the extensive consultation undertaken since December 2025 on “Delivering Social Care Services within Budget” b) Seeks approval for the implementation of a revised Eligibility Policy for adult social work and social care services, establishing a Critical Only funding threshold for ongoing, commissioned supports. The policy clarifies the Partnership’s approach to statutory assessment, risk management, governance, and financial sustainability. Recommendation : It is recommended that the IJB: 1. Note and consider the extensive engagement with and feedback from our communities on how we Deliver Social Care Services within budget 2. Approve the Eligibility Policy – Critical Only Access to Funded Adult Social Work and Social Care Services (Appendix 3). 3. Note that the policy does not alter the HSCP’s statutory duties to assess need, make inquiries, provide protection, or offer SDS options where an eligible need is being met. 4. Note that the HSCP will monitor implementation and impact and will provide an evaluation report which will include data on demand, risk patterns, unmet need, and impact on service sustainability. A formal review of the policy will be undertaken alongside budget planning for 2027-28. Direction Required to Council, Health Board or Both Direction to :- 1. No Direction Required 2. North Ayrshire Council X 3. NHS Ayrshire & Arran 4. North Ayrshire Council and NHS Ayrshire & Arran Glossary of Terms NHS AA NHS Ayrshire and Arran HSCP Health and Social Care Partnership IJB Integration Joint Board CSWO Chief Social Work Officer Agenda Item 8 39
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1. EXECUTIVE SUMMARY 1.1 The IJB faces significant challenges in continuing to deliver delegated Health and Social Care services within the available resource. The separate report on the agenda “Revenue Budget 2026-27” set out the delegated funding for services, service budget pressures and savings plans developed to set a budget for next financial year. The budget report sets out the scale of the financial gap for next year alongside an inability to deliver financial balance during 2025-26. Whilst the gap for 2026-27 has improved from the £12.6million from early estimates in December 2025, the financial pressures and the gap for delegated Social Care services for 2026-27 remains significant at £7.405m for the coming year, reduced to £5.828m after identified savings. This report recommends the remaining budget gap for Social Care Services delegated by North Ayrshire Council is met through the review of eligibility criteria for access to funded adult social work and social care services. The IJB requires to set a balanced budget and further savings of £5.828m require to be delivered in Social Care services to achieve this in 2026-27. The IJB must: • Plan and deliver services within the integrated budget delegated by partners. • Issue Directions that specify the budget associated with each delegated function. • Ensure financial governance arrangements are in place to ensure expenditure does not exceed available resources. The budget outlook beyond 2026-27 remains challenging with a Medium Term Financial Outlook that estimates a gap in Social Care services between a best and worst case scenario range of between £3.6m to £6.4m for 2027-28 and between £4.1m and £7.0m for 2028-29. It is clear that without a fundamental shift in future funding for social care that significant pressures will continue to escalate. Approximately 75% of the budget for Social Care Services in North Ayrshire is committed to fund individual social care packages of care which are accessed by individuals following an assessment of need in line with current eligibility criteria set at Critical and Substantial levels. The position in North Ayrshire has reached a point where the financial and operational demands placed on services are not sustainable and there requires to be a fundamental change and re-set on the level of care we can provide. The mechanism for controlling access to and demand for social care services is through eligibility criteria. 40
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1.2 North Ayrshire Health and Social Care Partnership continues to face unprecedented pressures across adult social work and social care services, driven by rising levels of complexity and risk in the population, sustained workforce and market fragility, and the growing financial challenge within the Integration Joint Board (IJB). The IJB has received previous updates that these pressures are being experienced by IJBs across Scotland, with shared challenge areas and each area impacted by the financial position to a greater or lesser extent based on local context, demand and resource availability. In the context of the North Ayrshire position, the Partnership has undertaken extensive public and stakeholder engagement since December 2025 to explore options for delivering social care services within its financial envelope and ensuring resources are prioritised for those with the greatest need. This report presents the proposed implementation of a revised Eligibility Policy that introduces a Critical‑Only threshold for funded ongoing adult social work and social care services. While statutory duties to assess need, safeguard individuals, uphold human rights, support unpaid carers, and provide Self‑Directed Support options remain fully unchanged, the policy sets a clear, transparent, and defensible framework for the allocation of limited resources. The evidence indicates that transitioning to Critical‑Only eligibility will have significant consequences. Individuals with substantial needs will no longer routinely receive funded ongoing support, increasing risks of social isolation, deterioration in physical and mental health, loss of independence, and crisis‑driven presentations. There is likely to be a substantial increase in reliance on unpaid carers, raising the risk of carer strain and breakdown and increasing emergency demand within the wider system. Short‑term financial savings may be achieved within adult social care budgets, but these is a greater risk of cost‑shifting pressures elsewhere, including unplanned hospital admissions, delayed discharges, primary care, mental health services, and higher‑intensity interventions when individuals re‑enter services at crisis point. Public engagement demonstrated strong concern about the potential impacts of reducing access to preventative support. Respondents emphasised the importance of dignity, equity, transparency in decision‑making, and the need to retain early intervention wherever possible to prevent crisis escalation. Equality and socio‑economic impact assessments indicate disproportionate effects for older people, disabled people, those living in poverty, women—as unpaid carers—and people with limited support networks. While mitigation measures are proposed, not all adverse impacts can be eliminated. 41
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Despite these risks, the absence of a revised eligibility framework would result in rapidly growing waiting lists, which carry their own significant dangers: unmanaged deterioration, increased safeguarding concerns, moral and ethical distress among the workforce, regulatory scrutiny, and escalating long‑term cost. A Critical‑Only threshold provides a clearer, fairer, and more consistent allocation method, supports financial sustainability, and ensures that the most at‑risk residents receive priority access to support. The report therefore recommends that the Integration Joint Board approve the revised Eligibility Policy, recognising both the necessity of this decision within the current financial climate and the requirement for a robust post-implementation evaluation to monitor impacts on unmet need, risk patterns, Adult Support and Protection activity, carer support demand, and system‑wide sustainability. 1.3 The report sets out the anticipated impact of moving adult social work and social care eligibility criteria to critical need only, in the context of current financial pressures. It outlines the likely consequences for individuals, carers, the wider health and social care system. The IJB are asked to consider all of the information in the round including the extensive public engagement feedback, the policy including safeguards and alignment with continuing to meet statutory duties and the risks and mitigations set out in the equalities impact assessment. Professional advisors recognise the challenges in moving to this position and risks associated with the Policy, however in the absence of any further funding to stabilise and fund services for future years, there is an acceptance that spend must reduce and a focus on supporting and managing the risk of our most vulnerable residents must take precedence. The Policy is recommended to the IJB as this will allow for the reductions in care provision to be implemented in a carefully managed basis which - protects statutory duties, ensures those most vulnerable and with the most critical needs are prioritised to access services, preserves options for individual choice, will be underpinned by an individual assessment of risk and need and supports a fair and equitable implementation of changes to funded care arrangements. The Policy will take effect from 1st April 2026 and would apply to all new community care assessments commenced after that date. In respect of existing service users, the Policy will apply at the next review undertaken in respect of the service user’s care package, occurring after 1st April 2026. To ensure alignment with the financial position a programme of individual reviews will be planned. 2. BACKGROUND 2.1 North Ayrshire HSCP continues to face significant and increasing pressure across adult services, driven by: • rising levels of complexity and risk in the local population; • sustained workforce and market fragility; • national legislative duties which remain unchanged despite resource constraints; 42
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• growth in demand for community-based supports; and • increasing financial challenge within the IJB underpinned by the lack of investment in social care and social work services to deliver national policy objectives. The IJB considered a report in November 2024 on Social Work Duties, Available Resource and Ethical consideration, this highlighted the breadth of Social Work duties and impact of the current and future financial context. At that time the paper identified risks in relation to the continued ability of North Ayrshire to continue to meet its statutory Social Work duties in light of the financial situation. Alongside this, the impact of the current years budget and emergence of waiting lists was noted along with the impact of this on residents and their loved ones. Since the adoption of substantial and critical assessed need as the threshold for accessing services in North Ayrshire there have been a number of significant changes in relation to the operating context and the financial context along with the emergence of a more progressive approach to service design and delivery based around people and place. There has been considerable demographic change with an ageing local population, greater numbers of people living with multiple long-term conditions, increasing numbers of children with an identified disability along with an increased complexity of need across all age groups. This is further exacerbated by the broader societal impact of public sector fiscal constraints, covid and the broader effects of poverty which has compounded the range of difficulties society is facing. Despite focussed best efforts and robust financial management – including strict spending controls and accelerating efficiency measures – the scale of demand and cost pressures upon us has grown beyond the resource available. Many of these pressures and demands are systemic and largely out with the direct control or influence of the IJB, as outlined below: • Increasing demand for social care services. We are experiencing unprecedented demand for services, notably in care at home services and in children’s care placements. This is compounded by national shortfalls in foster carers and suitable care providers, meaning the IJB must fund high-cost placements to ensure vulnerable children and young people are supported. We have also focussed on significant investment to increase the capacity of our care at home service to a level which is now unsustainable financially. • Meeting the health and care needs of our local demographic profile. This includes an increasingly elderly population, with a 15% increase in the number of pension- aged residents in the last 10 years and a prediction that this will reach 30% of all residents by 2040. The levels of poverty and deprivation in North Ayrshire with over 40% of residents living in the most deprived areas in Scotland. 43
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• North Ayrshire has the lowest healthy life expectancy in Scotland being only 52 years old. These factors drive the level of demand to meet the health and care needs and outcomes for our local residents and with a greater complexity and intensity of support required. • High-Cost specialist care services. A number of unavoidable, high-cost care packages are required to meet the needs of individuals with complex needs, for example complex learning disability support and mental health placements. These essential services, while affecting relatively smaller number of patients and service users, incur very large costs that significantly impact on our resource availability. • Local implementation of nationally set policy. Several national policy changes have introduced additional financial burdens without full funding. These include the National Care Home Contract uplift, increases in National Insurance contributions, and the Agenda for Change reduction in the working week, which will have a further impact in April 2026. • Workforce and capacity challenges. Like many areas, North Ayrshire faces health and social care staffing challenges, with these being compounded in specialist services and in remote and rural areas including providing services to the islands we serve. To maintain safe services, we have relied on overtime and agency staffing which is unsustainable. • The inflationary increase to the cost of delivering care is far outstripping any additional resource available leading to real-terms reductions and limited investment in supporting demographic and demand pressures. Over the last 7 years, the North Ayrshire IJB budget has increased by 29% - the equivalent of 3.6% per year. However, nationally agreed staff pay increases averaged 3% to 4% each year, as well as an increase in commissioned social care costs of over 5% per year, meaning overall funding increases are insufficient to meet cost inflation. The IJB has exhausted all available reserves and one-off sources of funding. Each year we identify savings plans to deliver efficiencies and service reductions and apply stringent cost controls. These measures have been in place for some time, reflecting our determination to live within our means. However, these actions alone cannot fully mitigate the financial shortfall without directly impacting front-line care and outcomes for our most vulnerable citizens. The IJB has a focus on robust financial management and in delivering efficiencies and transformational change, and each year we have delivered on significant programmes of work to transform and modernise our care services and will continue to have a focus on this approach. However, the scale of the financial challenge, both in-year and projected for future years is far beyond the level to which efficiencies and longer-term transformation can address in the short-term. 44
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Independent oversight and scrutiny supports our assessment. Audit Scotland’s recent audit of the IJB acknowledged that North Ayrshire IJB has effective financial management and governance arrangements in place and has successfully delivered on required savings. This gives assurance that the current funding gap is not due to any lack of financial discipline, but rather due to rising levels of need and external cost pressures that outstrip the growth in our funding. The financial pressures and limitations are having a visible impact on vulnerable people in North Ayrshire who require support from social care services and there is a demonstrable impact on service performance across the wider health and care system. Our delayed discharge performance has deteriorated as care at home services are scaled back and we have moved to a 2 out 1 in basis for care home admissions, whilst this has a visible impact on hospital delays there is a broader concerning level of unmet need in our communities where individuals are delayed or denied support, placing individuals at risk of harm and a greater burden on families and unpaid carers. The continued growth of waiting lists for services is not sustainable, transparent, safe or a defensible position. In North Ayrshire waiting lists are currently in place to access services based on Substantial and Critical criteria with over 200 residents waiting Care at Home Services and 50 for funding for admission to a care home. This position would significantly increase if eligibility criteria remains unchanged. Given these pressures, a clear and transparent framework for the allocation of funded social care support is essential. The proposed policy establishes Critical Only eligibility for funded, ongoing adult social care services, while ensuring full compliance with all statutory assessment and protection duties. The policy aligns with the Scottish Government eligibility framework. 3. PROPOSALS CONSULTATION – DELIVERING SOCIAL CARE SERVICES WITHIN BUDGET 3.1 The Health and Social Care Partnership has undertaken public consultation with residents, staff, service users and providers on the scale of the budget challenge for next year with a focus on the impact on social care and care packages. With 75% of our Social Care budget committed to individual care packages the scale of the budget gap cannot be addressed without impacting on the level of care commissioned, delivered and future eligibility criteria and thresholds for support. The programme of engagement set out to understand how social care services could be delivered sustainably in the face of rising demand, rising costs and a significant budget gap. The purpose of the engagement was twofold: firstly, to inform the public, community groups, staff and providers of the challenges currently being faced by the Health and Social Care Partnership and, secondly, to seek views and feedback on a range of areas including proposals. 45
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A number of Key Engagement Principles were agreed: ∗ Explain the “why” clearly: Share the financial pressures, policy changes, and demographic shifts driving the demand and costs ∗ Frame the Issue Clearly and Urgently ∗ Use plain language to explain what services are being reduced, why, and who will be affected. ∗ Highlight local impact: people care more when they see how cuts affect their neighbours, families, or themselves. ∗ Avoid jargon like “efficiency savings” or “budget realignment”—these obscure the real consequences. ∗ Make engagement accessible through different platforms and forums, maximising on existing networks (digital and in person) The approach taken forward since December 2025 has been aligned to these principles. The “Delivering Social Care Services within Budget” engagement programme was carried out over two phases as outlined below: • Phase 1 – launched 5th December and closed on 16th January – focussed on sharing information and gathering feedback and views on: • Understanding Needs and Priorities • Eligibility and Access • Choice and Cost • Equality and Impact There were no specific policy proposals consulted on for Phase 1 with a focus on instead seeking views. • Phase 2 – launched 10th February and closed 25th February – focussed on seeking views on 3 specific proposal areas: • Proposal 1 - Changing Eligibility – Support Only for People at Critical Risk • Proposal 2 - Best Value Care Funding Framework • Proposal 3 - Prioritising Personal Care Both phases of engagement were open to every resident in North Ayrshire to participate and have supported the gathering of feedback and views from our staff, residents, service users and community groups. The full reports and outputs from each phase of engagement are included in Phase 1 (Appendix 1) and Phase 2 (Appendix). The IJB are advised to give due regard and consideration to the views and feedback gathered through this consultation. 46
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3.2 High level information on the approach and outputs are summarised below for each phase. PHASE 1 (5th December 2025 to 16th January 2026) Across North Ayrshire, residents, service users, unpaid carers, families, staff, commissioned providers, and wider partners were invited to share their views through a range of accessible engagement activities. This included digital and in person engagement, targeted discussions with groups most likely to be impacted, and opportunities for frontline staff to contribute insight from practice. The illustration below provides an overview of the approach taken over a 6 week period which was designed to ensure opportunities to participate and share views were maximised. Across all engagement channels for Phase 1, a combined 1,538 people took part in the consultation, including 134 people attending the drop-in sessions. The final report from Phase 1 is provided in Appendix 1. The engagement asked people their opinions and requested feedback on issues surrounding social care delivery in North Ayrshire. The report reflects this feedback and the comments that were received through the various channels of those who took part in the survey and the other engagement activities. The feedback is extensive and detailed, however, some key themes emerged from responses: 47
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• Strong concern about the impact of reductions: While participants understood the financial pressures facing the HSCP, there was widespread concern that tightening eligibility, reducing care packages, or introducing cost limits could undermine safety, dignity, independence and long-term wellbeing, particularly for the most vulnerable. • Care and support are interdependent: Respondents consistently stressed that personal care, practical support, emotional wellbeing and social connection cannot be separated. Reducing “lower-level” or preventative support was seen as likely to accelerate deterioration, increase crisis demand and ultimately raise system-wide costs. • Clarity and fairness in eligibility are critical: The consultation highlighted significant frustration with unclear, inaccessible and inconsistently applied eligibility criteria. Participants called for clearer communication, greater transparency, and a more consistent, rights-based approach to assessment and decision-making. • Cautious and divided views on charging and limits: Views on charging and cost controls were mixed. Some accepted limited contributions in principle, but there was strong consensus that any charging framework must protect people on low incomes and recognise disability-related costs. Limiting choice was widely seen as risky and potentially harmful to autonomy and quality of life. • Future decisions must be fair, transparent and preventative: Overall, respondents emphasised the importance of dignity, equity, prevention and openness in decision making. There was a clear expectation that decisions should safeguard rights, support those with the highest and most complex needs, and take account of local circumstances. PHASE 2 (10th February 2026 to 25th February 2026) The timescales for the second phase of engagement were impacted by the need for the IJB to receive feedback alongside consideration of the requirement to balance the budget moving into 2026-27, in recognition of this a letter-drop was sent to every household in North Ayrshire to inform all residents of the consultation signposting to the online survey, to support from the Carers Centre, to Libraries to access paper copies and our Strategic Planning Team for any other support. In this critical phase of engagement views were sought on 3 specific proposals these being – changing eligibility to support only those at critical risk, a best value care funding framework and prioritising personal care needs. The final report from Phase 2 is provided in Appendix 2. 48
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All residents in North Ayrshire received a letter outlining the 3 proposals and what this might mean. Residents were invited to provide their views and feedback on each of the three proposals in an online survey. For each policy proposal, the survey asked respondents if the policy was an acceptable measure in light of the current financial position, and how might the HSCP lessen the impact of the proposal, this being to ensure any appropriate mitigations could be considered. For Phase 2 a total of 2,285 responses were received. The feedback is extensive and detailed, however, some key themes emerged from responses with feedback captured separately for the 3 proposals: • Proposal 1 has the lowest level of support – 61% were against this proposal; 25% were in favour; 7% neutral and 7% unsure • Proposal 2 responses were mixed: agreement was the single largest response category at 42%, people selected an option which was not in favour: No 38% and Neutral 12% and Unsure 8% • Proposal 3 received the highest level of overall support at 47%, a number of respondents opposed the proposal (36%), and with 11% neutral and 6% unsure As with Phase 1 engagement, the purpose of Phase 2 was to ask individuals their views and opinions. The full feedback report is provided in Appendix 2. Respondents were asked how the HSCP might lessen the impact of each proposal. The main mitigations, suggested from the public engagement, are provided below: • Protect early intervention and prevention – retain targeted preventative support, reablement, community hubs and low-level services to reduce deterioration, crisis demand and higher long-term costs. • Ensure holistic, fair and timely assessments – apply case-by-case, person-centred assessments and regular reviews that consider health, wellbeing, carers, family capacity and changing risk, with clear routes for rapid reassessment. • Strengthen support for unpaid carers – protect access to carer support plans, respite and early identification of carer strain, recognising carer breakdown as a major driver of crisis and cost. • Expand reablement, technology-enabled care and medication aids – increase use of short-term reablement, telecare, sensors and medication support as cost-effective alternatives to ongoing care, with safeguards and review. • Improve communication, signposting and transparency – provide clear, honest information on eligibility, costs, alternatives and appeals, with meaningful person-to-person signposting and consistent messaging to avoid people falling through gaps. • Strengthen community, third-sector and system capacity – invest in and align statutory, third-sector and community provision before relying on alternatives, 49
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ensure equity across rural/island areas, and pursue system-wide efficiency and funding alignment. The full reports from each Engagement Phase are available at Appendix 1 and Appendix 2. ELIGIBILTY POLICY - CRITICAL ONLY ACCESS TO FUNDED ADULT SOCIAL WORK AND SOCIAL CARE SERVICES 3.3 The Eligibility Policy, included as Appendix 3, sets out that from 1st April 2026 the HSCP eligibility criteria will be aligned to Critical Only Access to Funded Adult Social Work and Social Care Services, this includes the incorporation of a Best Value Care Funding Framework. This approach directs finite resources to those at immediate or imminent risk, while maintaining all statutory duties to assess, protect and offer SDS options when eligible need is being met. The IJB are asked to approve this Policy as a means to balance the IJB budget moving into 2026-27 and to align the demand for social care services to the available resources. 3.4 Policy Framework: The policy confirms that North Ayrshire HSCP retains full statutory duties to: • Receive referrals and provide information/advice • Undertake needs assessments under the Social Work (Scotland) Act 1968; • Conduct Adult Support and Protection inquiries under the ASP (Scotland) Act 2007; • Offer and prepare Adult Carer Support Plans under the Carers (Scotland) Act 2016; • Uphold Self-Directed Support rights, including offering all four options when eligible need is met; • Provide emergency and interim interventions where immediate risk requires this. The Critical-Only threshold applies only to decisions about funding ongoing social care services, not to whether an assessment or inquiry is undertaken. Eligibility Threshold: Critical Risk Funded support will be provided when a person’s needs meet the Critical risk descriptor, defined as: • immediate or imminent danger to life or severe deterioration in health; • serious self-neglect where no safe alternative exists; • risk of abuse, exploitation or harm requiring urgent protective action; 50
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• breakdown of essential care arrangements leading to unsafe circumstances; • risk of hospital or care home admission avoidable only through urgent support. Where these criteria are met, SDS options must be offered and recorded. Where needs to do not meet the Critical threshold For people whose risks fall within the Substantial, Moderate or Low categories, the HSCP will provide: • Information, advice, and signposting; • Access to prevention, community, and third-sector supports; • Time-limited interventions where required to prevent imminent escalation; • Safety planning and risk management. Adult Protection duties override eligibility at all times. Best Value Care Funding Framework Aligned to resource limitations, the Framework ensures publicly funded care is delivered fairly, consistently and sustainably. Under this approach: • The HSCP will fund the most cost-effective option that still meets the person’s assessed outcomes. • Individuals may choose a more expensive option if they self-fund the difference. • Examples include: o Care home placement offered where high Care at Home hours exceed best-value thresholds o Provider choice above the approved rate requiring self-funding This maintains choice while ensuring public funding is used fairly. Governance and Recording The policy sets out governance arrangements, including: • Completion of the Single Shared Assessment on Eclipse; • Transparent recording of decision-making, including risk rationale; • Oversight of cases where required services are unavailable; • Robust audit of “below critical” decisions and repeat referrals; 51
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• Integration with HSCP governance pathways (Duty of Candour, CSWO Notifiable Incidents, Care Inspectorate notifications). Implementation The Policy will take effect from 1st April 2026 and: • Applies to all new assessments from 1 April 2026. • Applies to existing service users at their next scheduled review after that date. • The HSCP reserves discretion to depart from the policy in exceptional circumstances, ensuring flexibility in complex or high-risk cases. Key implementation actions include: • development of staff guidance and practice notes; • integration of policy into assessment templates and Eclipse workflows; • training sessions for assessment staff, team managers, and partners; • supported transition arrangements for existing service users; • public-facing communications to ensure transparency; • to ensure alignment with the financial position, a programme of individual reviews will be planned. The Policy implementation will in effect implement the three Proposal areas included in the Phase 2 consultation, those being: • Proposal 1 - Changing Eligibility – Support Only for People at Critical Risk • Proposal 2 - Best Value Care Funding Framework • Proposal 3 - Prioritising Personal Care Whilst there is no direct policy or references in the policy to altering access to non- personal care supports a move to Critical eligibility criteria would likely result in a reduction in the level of non-personal care supports offered during assessments as only those which are required to meet Critical needs would be funded. A full Equality and Children’s Rights Impact Assessment has been completed and is included at Appendix 4. 3.5 The rationale for recommending this policy implementation include: • Ensuring Fairness and Consistency - A clearly defined eligibility threshold ensures that residents with the highest level of risk receive priority access to limited resources. It promotes transparency and defensible decision-making. • Financial Sustainability - The modelled projections indicate that without changes to eligibility practice, demand will outstrip the IJB’s financial capacity. This policy 52
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supports the Board’s statutory duty to deliver services within allocated resources while protecting those at greatest risk. • Workforce and Market Stability - A more focused allocation framework reduces unmanageable caseload pressures, supports professional autonomy, and stabilises commissioned services by ensuring they are utilised for individuals with the highest level of need. • Mitigates Risk of Waiting Lists – Growing waiting lists undermine the preventative intent of social work and shift services toward crisis response rather than early intervention, persistent waiting lists can in some cases create false hope or optimism as well as having the real potential to attract further negative attention from our regulatory bodies. • Compliance and Risk Management - The policy formalises practice already emerging within teams and ensures compliance with: • Social Work (Scotland) Act 1968 • SDS (Scotland) Act 2013 • ASP (Scotland) Act 2007 • Carers (Scotland) Act 2016 • Human Rights Act 1998 and Equalities duties The Policy aligns resource allocation to statutory purpose and critical risk, without reducing statutory duties. A review period is built into the Policy to allow for reflections and a more detailed understanding of impact to emerge. Given the policy position is recommended in line with resources if there are any significant changes to resourcing in the future this would also prompt a review. 3.6 Health and Social Care Partnerships (HSCP’s) in Scotland are required to operate within a policy framework that prioritises prevention, early intervention, human rights, and community-based support, as set out in national legislation and policy. A move to Critical need only eligibility represents a significant departure from this approach and carries material strategic, operational and reputational risks. Restricting eligibility to Critical need will result in individuals with substantial needs no longer receiving funded social care support. The evidence and professional advice to board indicates this is likely to lead to: • Increased social isolation and deterioration in physical and mental health; • Reduced independence and ability to live safely at home; • Increased risk of crisis presentation and safeguarding concerns; • Increased risk undermining the principles of Self-directed Support, particularly choice, control and proportionality. 53
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The withdrawal of formal support at lower levels of need will significantly increase reliance on unpaid carers. While a move to Critical only eligibility may deliver short-term savings within adult social care budgets, it may generate additional cost pressures elsewhere in the system, including: • Increased unplanned hospital admissions and delayed discharges; • Greater demand on primary care, mental health services and acute services; • Higher long-term costs as individuals re-enter the system with escalated, Critical needs requiring intensive support. In the longer term, the overall financial impact is therefore likely to be cost-shifting rather than cost-avoidance, with increased demand across health and social care. Reducing eligibility will impact the stability of the commissioned care market, particularly for providers supporting people with lower-level needs. Potential consequences include: • Reduced provider capacity and increased market fragility; • Loss of skilled workforce due to reduced demand and uncertainty; • Increased pressure on social work staff managing higher-risk caseloads with fewer preventative options. This may limit the Partnership’s ability to respond flexibly as needs escalate. The proposed change is likely to disproportionately affect vulnerable groups, including people living in poverty, those with disabilities, people in rural areas, and individuals without informal support networks. Increased pressure is also anticipated on third sector and community organisations. Moving to Critical only eligibility introduces significant strategic and operational risks, including: • Increased likelihood of adverse outcomes and safeguarding concerns; • Reduced alignment with national policy and public service reform principles, including the Population Health Framework; • Potential reputational risk for the IJB if outcomes deteriorate. A full Equality and Children’s Rights Impact Assessment has been completed and is included at Appendix 4. 54
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The IJB require to have “due regard” to the public sector equality duty and relevant equalities assessments. Equalities duties do not dictate a particular outcome. It may not be possible to remove all prejudice to protected groups taking account of the resources available, nor is it legally necessary to do so. The duty should however be applied proportionately to the decision proposed. The IJB require to be satisfied that the impact of the proposal has been appropriately assessed, including in relation to its impact on those with protected characteristics. 3.7 The mechanism for controlling access to and demand for social care services is through eligibility criteria. Noting the points above it is important to be clear that without this change in eligibility criteria the Partnership will merely find itself in a position of having lengthy waiting lists. These waiting lists require to be actively managed as such drawing further resource into risk management as opposed to direct service delivery. There are a number of significant risks associated with a growing waiting list including physical deterioration, falls, malnutrition and unmanaged long-term conditions, worsening mental health, including anxiety, depression and social isolation and increased safeguarding risks, particularly for adults at risk of harm, people may be on a waiting list and pass away before care is arranged. Waiting lists undermine the preventative intent of social work and shift services toward crisis response rather than early intervention. Growing waiting lists, also contribute to: • Moral distress among social workers and care managers – managing large waiting lists instead of delivering care; • Increased staff turnover and sickness absence; • A lack of consistency, transparency and public accountability; • Reduced professional autonomy and increased proceduralising. This weakens professional judgement and undermines the relational basis of social work. Most importantly, persistent waiting lists can in some cases create false hope or optimism as well as having the real potential to attract further negative attention from our regulatory bodies. The continued growth of waiting lists for services is not sustainable, transparent, safe or a defensible position. In North Ayrshire waiting lists are currently in place to access services based on Substantial and Critical criteria with over 200 residents waiting Care at Home Services and 50 for funding for admission to a care home. This position would significantly increase if a further £5.8m of resources were not available, to illustrate this based on the average cost of a care home placement this could result in a further 188 people on a waiting list for access to a care home. 55
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3.8 Anticipated Outcomes The intended anticipated outcomes of this policy are: a) The reduction in social care packages of care to meet the financial envelope b) The use of eligibility criteria as a lever to manage demand and the provision of social care services c) The prioritisation of care to those most in need and at risk first d) To ensure Policy and implementation aligns with the Statutory duties of the HSCP and North Ayrshire Council e) An approach which strengthens consistency, transparency and public accountability 3.9 Measuring Impact The impact of this policy shall be measured through the demands on • Levels of demand and unmet need • Adult support and protection activity • Carer support services demand • The financial impact of assessment and review in line with new criteria • The policy will be formally reviewed by January 2027 with ongoing monitoring throughout implementation 4. IMPLICATIONS 4.1 Financial The policy supports the IJB’s Financial Plan by ensuring a plan is in place to approve a balanced budget for 2026-27. Without this Policy a £5.8m gap would remain for the delivery of Social Care services from 1st April 2026 leading to significant financial risks for the IJB and North Ayrshire Council. The re-set of eligibility criteria would support the Medium Term Financial Outlook through a recurring reduction to core service delivery which would be sustained moving into future years. 4.2 Human Resources There will be an impact on the workforce to implement the revised Policy. Practice guidance has been developed that has a focus on support and well being. Regardless of implementation approach there will require to be a reduction to the social care workforce. This is a high turnover area and it is anticipated any reduction would be met through natural turnover and a reduction in the use of bank and casual staff hours. The reduction in care packages will impact on our commissioned care providers and their own workforce. 56
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4.3 Legal Legal duties relating to assessment, adult protection, and self-directed support remain unchanged. There are key pieces of legislation and statutory duties that fall on North Ayrshire Council and onwards to the Health and Social Care Partnership. When taking relevant policy decisions such as the one proposed, decision-makers require to have “due regard” to the public sector equality duty and relevant equalities assessment(s) (s.149 of the Equality Act 2010 and the Equality Act 2010 (Specific Duties) (Scotland) Regulations 2012). Equalities duties do not dictate a particular outcome. It may not be possible to remove all prejudice to protected groups taking account of the resources available, nor is it legally necessary to do so. The duty should however be applied proportionately to the decision proposed. You require to be satisfied that the impact of the proposal has been appropriately assessed, including in relation to its impact on those with protected characteristics. Thereafter, as decision-makers, the duty requires the robust consideration of all relevant matters and potential impacts by you before a decision is taken. Consideration should be given as to how to balance, prevent or mitigate the effects of any decision. Full information is provided to IJB members through this report, accompanying draft policy document and the ECRIA in particular, to assist members in that consideration. Given the potential impacts of the proposal, this assessment has been informed by consultation, as outlined. 4.4 Equality/Socio-Economic. An Equality and Children’s Rights Impact Assessment (ECRIA) has been completed and is attached at Appendix 4. The ECRIA is completed to capture the combined effects of the implementation of the Critical Only Access to Funded Adult Social Work and Social Care proposal, with an assessment aligned to the distinct aspects and impacts of this as per the community consultation Phase 2. The ECRIA highlights a number of impacts of the policy proposal and how it will affect protected groups. Key impacts include the reduction of access to preventative support as criteria threshold is changed, the disproportionate impact on older people and disabled people, increased pressure on unpaid carers (particularly women), widening socio-economic inequality and potential indirect effects on children and families. Included in the ECRIA are steps that the HSCP will take to lessen the impact of the proposals. This includes creating robust assessment, review and escalation processes, creating clear guidance and providing information on any changes, clear signposting and pathways for support and guidance, maintaining key preventative supports where possible and ensuring robust monitoring of the policy and its impact. The assessment also recognises that not all negative impacts can be fully mitigated, given the scale of financial pressures and the statutory requirement to prioritise resources for those at the highest levels of risk. The HSCP will monitor the impact of the proposals through existing governance structures, using a broad range of performance indicators and data. 57
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4.5 Risk The risks of adopting the Policy are highlighted within the report. Risks associated with not adopting the policy includes: • inability to meet statutory financial duties; • increased service instability; • inconsistent practice and inequity of access; • unmanaged risk exposure for the IJB. • Increased risk within the regulatory environment Implementing the policy reduces organisational risk by ensuring transparent, risk assessed based allocation of resources to those most in need. 4.6 Community Wealth Building Although the policy itself focuses on social care eligibility, there are ways it may affect Community Wealth Building, directly and indirectly: • Reduced Preventative Support → Lower Local Economic Participation with impacts on staying in work, participating in local economy and engaging in volunteering or training • Increased Carer Burden → Constrained Local Wealth Retention – could see reduced household income, less local spending and lower economic resilience • Reduced access to statutory services → pressures on community capacity building and increased strain on community structures, those with lower capacity may struggle to absorb the impact • Impact on Local Businesses and Local Procurement – reduced service availability and funding leading to potential provider fragility 4.7 Key Priorities The IJB approved a refreshed Strategic Plan in December 2025, this plan highlighted the fiscal constraints and impact and risk on achieving outcomes and ambitions. Whilst the HSCP Strategic Plan Priorities would remain unchanged a follow up assessment will be carried out to review the performance and service delivery ambitions in light of the significant financial saving requirement and impact on service delivery. 5. CONSULTATION Extensive consultation has been undertaken since early December 2025, the full outputs from the consultation are appended to the report to allow IJB members to consider the views and feedback from the public consultation. 58
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The budget position and proposals to consider eligibility criteria as a mechanism to manage demand and the financial position have also been shared with the IJB Finance Working Group, Partnership Extended Senior Management Team and a range of key internal and external stakeholders. Caroline Cameron, Director Scott Hunter, Chief Social Work Officer, scotthunter@north-ayrshire.gov.uk Appendices • Appendix 1 – Phase 1 Consultation Report • Appendix 2 – Phase 2 Consultation Report • Appendix 3 - Eligibility Policy - Critical Only Access to Funded Adult Social Work and Social Care Services (including Best Value Care Funding Framework) • Appendix 4 - Equality and Children’s Rights Impact Assessment Background papers: • IJB 14th November 2024 – Social Work Duties, Available Resource and Ethical Considerations - 130307nachppaper4 59
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DIRECTION Reference No. 260313-08 Title Eligibility Criteria From Caroline Cameron, Chief Officer To NHS Ayrshire Arran Name/Contact Details Local Authority Name/Contact Details Both Name/Contact Details 1. IJB Report Reference No. 260313-08 2. Date Direction Issued/Approved by IJB 13th March 2026 3. Report Author/Contact Details Caroline Cameron, Director 4. Date Direction takes effect 13th March 2026 5. Does this direction supercede, amend or revoke a previous direction – if yes, include the reference numbers(s) Yes This direction supersedes all previous directions relating to eligibility criteria and access to funded adult social work and social care services issued prior to 1 April 2026. No 6. Description of services/functions covered by the direction • Implementation of the revised Eligibility Policy – Critical Only Access to Funded Adult Social Work and Social Care Services. • Application of the Best Value Care Funding Framework for all funded adult social care services. • Alignment of assessment, risk management, governance and service allocation processes with the new Critical-Only funding threshold. • Delivery of statutory duties including assessment, Adult Support and Protection, Self-Directed Support, and carer support planning. 7. Full text of direction North Ayrshire Council is directed to implement the revised Eligibility Policy and Best Value Care Funding Framework with effect from 1 April 2026. This includes: • Applying the Critical-Only threshold for the allocation of all ongoing funded adult social care services. • Ensuring all assessments, reviews and resource allocation decisions follow the risk-based criteria set out in the Policy. 60
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• Offering Self-Directed Support options to individuals meeting the Critical threshold. • Providing information, advice, signposting, short-term interventions and safety planning for individuals assessed as Substantial, Moderate or Low risk. • Ensuring that Adult Support and Protection duties are discharged regardless of eligibility. • Applying the Best Value Care Funding Framework when determining the most cost-effective option that meets assessed outcomes. • Recording all assessments, decision-making rationales and eligibility outcomes on Eclipse in line with governance requirements. • Implementing a programme of reviews for existing service users to transition to the new criteria. • Embedding practice guidance, staff training and communication processes to support consistent application. 8. Specification of those impacted by direction. North Ayrshire Council is directed to implement the revised Eligibility Policy and Best Value Care Funding Framework with effect from 1 April 2026. This includes: • Applying the Critical-Only threshold for the allocation of all ongoing funded adult social care services. • Ensuring all assessments, reviews and resource allocation decisions follow the risk-based criteria set out in the Policy. • Offering Self-Directed Support options to individuals meeting the Critical threshold. • Providing information, advice, signposting, short-term interventions and safety planning for individuals assessed as Substantial, Moderate or Low risk. • Ensuring that Adult Support and Protection duties are discharged regardless of eligibility. • Applying the Best Value Care Funding Framework when determining the most cost-effective option that meets assessed outcomes. • Recording all assessments, decision-making rationales and eligibility outcomes on Eclipse in line with governance requirements. • Implementing a programme of reviews for existing service users to transition to the new criteria. 61
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• Embedding practice guidance, staff training and communication processes to support consistent application. 9. Budget allocated by Integration Joint Board to carry out direction The direction supports delivery of a balanced budget for 2026-27 by implementing a revised eligibility framework that maintains expenditure within the IJB’s available financial envelope. This includes achieving savings of £5.828m required to balance the Social Care budget. The budget to which the Policy applies are all Adult Social Care packages of support, circa £112m of current budget. 10. Outcomes/Link to Strategic Priorities • Prioritisation of care for those at highest risk and in greatest need. • Improved consistency, transparency and defensible decision-making aligned to statutory duties. • Strengthening of financial sustainability and long-term service viability. • Compliance with national eligibility frameworks and statutory obligations. • Reduced waiting lists and improved ability to manage system demand. • Support delivery of IJB strategic priorities including safety, prevention, sustainability, equity, and rights-based approaches. 11. Timescales/Review/Monitoring Arrangements • Policy implementation begins 1 April 2026. • Applies to all new assessments from this date. • Applies to existing service users at their next scheduled review. • Formal review by January 2027, with ongoing monitoring through: demand and unmet need patterns Adult Support and Protection activity financial impact carer support service demand • Ongoing oversight through IJB governance structures and performance reports. 12. Lead Partnership Arrangements • North Ayrshire Council is the lead delivery partner for the implementation of this direction. • The HSCP will provide professional, operational and governance oversight. • Joint working will be maintained with NHS Ayrshire & Arran where relevant to assessment, protection and system impacts. 62
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DELIVERING SOCIAL CARE SERVICES WITHIN BUDGET PHASE 1 Final Report February 2026 Appendix 1 63
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2 Table of Contents Executive Summary ................................................................................................................................. 3 Introduction ............................................................................................................................................ 5 Methodology ........................................................................................................................................... 6 Public Online Survey ........................................................................................................................... 6 Staff and Service Provider Surveys ..................................................................................................... 7 Community Group Facilitated Surveys ............................................................................................... 7 In‑Person Locality Events .................................................................................................................... 8 Persona‑Based Engagement ............................................................................................................... 8 Data Management and Analysis ......................................................................................................... 9 Ethical Considerations ........................................................................................................................ 9 Sample................................................................................................................................................... 10 Online Survey, Facilitation Packs and Paper Responses ................................................................... 10 Drop In Events .................................................................................................................................. 10 Limitations of the Data ......................................................................................................................... 10 Findings ................................................................................................................................................. 12 General Public Consultation ............................................................................................................. 12 Staff and Provider Consultation ....................................................................................................... 40 Community Group Consultation ..................................................................................................... 102 Drop-in Events Analysis .................................................................................................................. 144 Combined Analysis .......................................................................................................................... 154 Conclusion ........................................................................................................................................... 171 Appendices .......................................................................................................................................... 173 Appendix 1 – Completed persona sheets ....................................................................................... 173 Appendix 2 – In person event Posters ............................................................................................ 195 64
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3 Executive Summary North Ayrshire Health and Social Care Partnership undertook a programme of engagement to understand how social care services could be delivered sustainably in the face of rising demand, workforce pressures and a significant projected budget gap. Participants across all engagement routes recognised the difficult financial climate but expressed deep concern about the potential effects of changes to eligibility criteria, care thresholds, charging policies and service levels and highlighted the risks these changes could pose to people’s safety, independence, dignity and long-term wellbeing. Across public responses, staff and provider insights, community group submissions and locality events, there were several strong themes: • Strong emphasis on the importance of essential daily living support, including personal care, safety, and the help required for people to remain well at home. • Personal and nonpersonal supports were felt to be interdependent, such that reductions in “lower level” or practical assistance could result in deterioration, crisis, avoidable hospital admission and greater system pressures. • Prevention and early intervention were repeatedly identified as crucial for protecting both individuals and the wider health and social care system. • Current eligibility criteria are difficult to understand, inconsistently applied and not easily accessible. There was a clear desire for greater transparency, clearer communication, and more equitable decision making. This was echoed across all the engagement. • Views on charging and financial contributions were mixed. While some felt it was reasonable for those who can afford it, many others raised serious concerns about affordability, the cost of living, and the risk of pushing vulnerable people into hardship. • There was strong agreement across all engagement that any charging arrangements must protect people on low incomes and recognise the additional living costs associated with disability. • Choice and control over how care is organised were widely viewed as essential to dignity, autonomy and rights, particularly within the framework of Self-Directed 65
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4 Support. Participants warned that restricting choice could diminish quality of life, increase distress and undermine people’s independence. Community groups strongly emphasised that choice is not optional but a legal and ethical foundation of social care practice. • Island communities, especially Arran, expressed significant concern about the disproportionate impact of any reductions in service availability, travel challenges, or changes to local provision. These concerns reflected broader themes of equity, fairness and the importance of considering local context in decision making. Overall, participants called for a balanced and rights-based approach that protects essential care, maintains a focus on prevention, strengthens communication, supports unpaid carers, and ensures transparency and fairness in how decisions are made. The feedback emphasises the need for a sustainable social care model that continues to uphold dignity, independence and equity, even in times of financial constraint. The combined analysis shows strong consensus that personal care and essential daily living supports are central to people’s wellbeing and should be prioritised when resources are constrained. Respondents broadly support the principle of promoting independence and recognise the importance of personal hygiene, eating and drinking, continence care and mobility. Choice over how care is organised is viewed as important by most respondents, although opinions differ on whether limits should be placed on choice to ensure sustainability. While there is majority support for charging or contributions for non-personal care, there is notable opposition to applying cost limits to individual care packages. Differences between respondent groups underline the need for proportionate, case-by-case approaches that balance consistency with flexibility, ensuring future decisions are equitable, transparent and informed by lived experience. 66
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5 Introduction North Ayrshire Health and Social Care Partnership (NAHSCP) has undertaken a significant programme of engagement to gather views on how health and social care services should evolve in the face of growing financial, workforce and operational pressures. With demand for support rising sharply, costs increasing, and the Partnership facing a significant budget deficit in 2026–27, it is vital that future decisions about care provision are informed by the people and communities most affected. The consultation sought to understand community, workforce and wider stakeholder perspectives on a range of potential changes to care packages, including eligibility criteria, prioritisation of personal and non-personal care, limits on choice or levels of provision based on cost, and whether people who can afford should contribute financially to certain aspects of care. These topics were deliberately presented openly and transparently, acknowledging that difficult decisions lie ahead and that changes may affect the level, type, and flexibility of care that can be provided across children’s, adult, mental health, learning disability, and community services. Across North Ayrshire, residents, service users, unpaid carers, families, staff, commissioned providers, and wider partners were invited to share their views through a range of accessible engagement activities. This included digital and in person engagement, targeted discussions with groups most likely to be impacted, and opportunities for frontline staff to contribute insight from practice. The approach was designed to support meaningful participation, aligned with the principles set out in Planning with People and the national standards for community engagement. This report summarises what we heard. It brings together the themes, concerns, priorities, and suggestions offered by participants, highlighting both areas of broad agreement and issues where perspectives diverge. The findings presented here reflect lived experience across a diverse range of stakeholders, encompassing those who access support, those who deliver it, and those who care for family members or friends. By presenting this summary, the Partnership aims to provide a clear and honest account of the feedback received to inform decision making by the Integration Joint Board. The insights 67
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6 shared through this consultation will help guide future investment and ensure that changes to care packages are grounded in community values, statutory duties, and a shared understanding of the challenges ahead. Methodology A mixed‑methods engagement approach was used to gather views from the public, staff, service providers, and community groups on the consultation “Delivering care within budget in North Ayrshire”. The methodology combined quantitative and qualitative data collection across digital, paper‑based, and in‑person formats to ensure accessibility and broad participation. Public Online Survey A public survey was made available online using Microsoft Forms from 05/12/26 to 16/01/26. The survey collected both closed and open‑ended responses focusing on participants’ priorities, concerns, and ideas relating to the financial challenges facing local health and social care services. Public responses were analysed on a one-submission-per-person basis. Each response was treated as representing a single individual. The survey link was promoted through organisational social media channels, community networks, and partner agencies to encourage broad community participation. Information was also included in local newspapers informing the public about the consultation period and how they could participate. To support individuals without digital access or who prefer non‑digital formats, identical paper versions of the public survey were distributed. Paper copies were made available through local libraries and could also be requested directly to the strategic planning and performance team by members of the public. Completed paper surveys were returned for manual entry into the analysis dataset. Percentages for each question are calculated based on the proportion of the total number of respondents that answered each stem of the question. If there was no response this was counted as no answer and calculated as a proportion of the total respondents. For example, 68
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7 if a question had Yes, no, no answer as stems, and 60 out of 100 respondents answered yes this would be recorded as 60 % indicated Yes. Staff and Service Provider Surveys A separate survey was conducted with staff and service providers to gather professional perspectives on service delivery pressures, opportunities for improvement, and the feasibility of potential changes. This survey was also hosted on Microsoft Forms, with paper copies available on request. The questions mirrored the public survey to ensure consistency of approach. Staff and provider submissions included both individual responses and collective submissions. Respondents were asked to indicate the number of individuals involved in preparing the response. For analysis and graphical presentation, responses were weighted using the reported participant headcount. Where a submission did not provide an answer to a question, the reported participant number is reflected within the non-response category for that question. Percentages are calculated as a proportion of total respondents to each question, weighted by reported headcount. For questions allowing multiple selections, combined percentages may exceed 100 percent. Community Group Facilitated Surveys Community groups across North Ayrshire were invited to participate using facilitator packs. Each pack included: • Background information on North Ayrshire demographics • Data relating to current budget deficits and wider financial pressures • A facilitator guide outlining how to run a discussion • A set of survey questions aligned to the online forms Groups could return their collective feedback through the associated Microsoft Form link or by submitting completed paper copies of the facilitator pack to the Strategic Planning and performance team mailbox. This approach enabled structured group discussions while preserving comparability across data sources. 69
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8 Community Group submissions were permitted to represent collective views. Respondents were asked to indicate how many individuals contributed to the submission. For analysis and graphical presentation, community group responses were weighted using the reported participant headcount. This means that a submission representing multiple individuals contributes proportionately to the distribution shown within charts. Where a collective submission did not provide an answer to a specific question, the reported participant headcount is reflected within the non-response category for that question. Percentages are calculated based on total respondents to each question, weighted by reported headcount. Where multiple responses were permitted, percentages may exceed 100 percent. In‑Person Locality Events Six locality‑based engagement events were held across North Ayrshire to provide accessible, face‑to‑face opportunities for residents to participate. Each event included: • Poster boards presenting key information on current financial challenges and service pressures • Opportunities for attendees to speak with senior staff and ask questions • Interactive voting stations for participants to express priorities or preferences numerically • Comment cards enabling attendees to provide qualitative feedback in their own words These events were designed to support informal conversation while capturing both quantitative and narrative insights. Persona‑Based Engagement At each in‑person event, attendees were invited to complete “persona templates.” These templates encouraged participants to view potential service changes through the lens of an individual receiving care or someone supporting a person accessing services. This method provided deeper insight into lived‑experience perspectives and the potential real‑world implications of changes. 70
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9 Data Management and Analysis Responses collected through Microsoft Forms were exported securely for analysis. Paper responses were entered manually to ensure a complete dataset. Quantitative information was summarised using data graphs, while qualitative comments were thematically analysed to identify recurring themes, concerns, and suggestions across participant groups. Data from persona templates, comment cards, and community group discussions were integrated into the thematic analysis. The headcount weighting methodology was applied consistently across relevant questions within the community group and staff/provider sections. The same approach was applied to both responses and non-responses to ensure methodological consistency. Ethical Considerations Participation across all engagement activities was voluntary, and all responses were anonymised before analysis. Background information provided in facilitator packs and at in‑person events supported participants to give informed and meaningful feedback. 71
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10 Sample Across all engagement channels, a combined 1,538 people took part in the consultation. The consultation findings represent the views of those who chose to participant and do not constitute a statistically representative sample of the wider population. Online Survey, Facilitation Packs and Paper Responses The online survey formed the largest component of engagement activity, supplemented by facilitation packs completed by staff teams and community groups. In total: • Individuals: 560 responses • Staff / Providers: 135 facilitation packs, representing 679 people • Community Groups: 10 facilitation packs, representing 165 people Included in the above totals, were 36 paper surveys and 9 paper facilitation packs. Drop In Events In‑person drop‑in sessions were delivered across all six localities to ensure accessible opportunities for dialogue. Attendance levels were as follows: • Irvine: 12 participants • Kilwinning: 10 participants • Arran: 89 participants • Three Towns: 4 participants • Garnock Valley: 8 participants • North Coast: 11 participants Total drop‑in participation: 134 people Limitations of the Data Several considerations should be noted when interpreting the findings: 1. Self-Reported Participant Numbers The number of individuals represented within collective submissions was self- reported and was not independently verified. 2. Assumption of Shared Views 72
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11 Analysis assumes that all individuals included within a collective submission shared the views expressed in that response. It is not possible to determine whether individual views within a group differed. 3. Variation in Group Size There was significant variation in reported group sizes. Community groups ranged from 4 to 51 participants. Staff and provider submissions ranged from 1 to 170 participants. Weighting by headcount may amplify the proportional influence of larger groups relative to smaller groups or single respondents. 4. Partial Completion of Surveys Not all respondents answered every question. As collective responses are weighted by reported participant numbers, non-response from a larger group may have a proportionately greater impact on the number shown within non-response categories. 5. Multiple-Response Questions For questions permitting more than one answer, percentages reflect frequency of selection. Findings should therefore be interpreted in the context of these methodological considerations. 73
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12 Findings General Public Consultation A total of n=560 responses were received from the public consultation. From the total received, n=519 were complete responses and n=41 incomplete (Partially completed or no answers provided despite logging a response). Question 1 - What aspects of social care do you feel are most important? Participants were asked to identify which aspects of social care they considered most important. The results demonstrated a strong emphasis on core support that maintains dignity, safety and independence. 3% provided no answer to this question. Personal care emerged as the highest rated priority, selected by 77% of respondents suggesting that assistance with essential daily tasks, such as washing, dressing and eating was viewed as the foundation of social care and must be protected even in times of financial pressure. Personal safety support was the next most prioritised area (63%), highlighting the importance placed on ensuring people are safe at home, appropriately supported, and protected from harm. Over half of respondents (56%) identified supports to maximise 74
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13 independence as essential. This includes equipment, adaptations, reablement and other interventions that help people stay in their own homes for as long as possible. Two areas were jointly selected by 49% of respondents, this included models of shared support and choice and control over how care is delivered. A smaller proportion of responses were received for Practical support (such as help with housework or shopping), Care being free of charge or other. Question 2 - Which of these services do you feel are most integral to people’s care? When asked to identify which services are most integral to people’s care, respondents placed importance on tasks that directly support dignity, health, and daily functioning. Personal hygiene was identified as the single most critical service, selected by 87% of respondents. This highlights a strong public expectation that support with washing, bathing, and maintaining personal cleanliness must remain a core priority within social care. Eating and drinking followed closely, selected by 71%, reflecting the essential nature of nutrition and the risks associated with people being unable to safely prepare or consume meals. Continence 75
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14 management was also rated highly at 64%, demonstrating the importance of sensitive, reliable support that protects dignity, comfort, and health. Mobility-related support featured prominently; Mobility assistance (54%), Help with getting dressed (53%), Medication and treatment support (52%). Together, these findings show that respondents view daily living tasks and health related- interventions as central to enabling people to remain safe, stable, and independent at home. Services that provide social connection or broader wellbeing support were also valued, though by a smaller proportion. Emotional support (25%) and day services (21%). Fewer respondents prioritised telecare services (16%), transport to appointments or activities (11%), housework and laundry (8%), or shopping and running errands (5%). Question 3 – How do you feel about prioritising personal care over non personal care when resources are limited? The majority of respondents expressed strong support for prioritising personal care if resources become limited. 40% of participants stated they strongly agree with prioritising personal care over nonpersonal care, and a further 33% agree. Together, this means that 76
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15 three quarters of respondents (73%) endorse a model where essential personal care needs, such as washing, dressing, eating, and maintaining safety are protected ahead of other forms of support. A smaller proportion of respondents reported uncertainty. 9% selected neutral, suggesting that while they recognise the importance of personal care, they may also value non-personal supports or feel unsure about the consequences of reducing them. Levels of disagreement were relatively low. 8% disagree and another 8% strongly disagree. A further 3% did not provide an answer to this question. Question 4 – Do you know that there is an eligibility criteria for care? Awareness of eligibility criteria for care varied among respondents. 62% of participants stated that they were aware that an eligibility framework exists, indicating that a majority of people have at least some understanding that criteria determines access to social care services. However, a significant proportion, 34% reported that they did not know there was an eligibility criteria. This highlights a substantial gap in public awareness and suggests that many people may not fully understand how decisions about care are made, what the criteria 77
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16 involves, or when and how they are applied. A further 3% of respondents did not provide an answer. Question 5 – How Clear and accessible do you find the current eligibility criteria for care? Qualitative feedback on the clarity and accessibility of the current eligibility criteria revealed significant concerns among respondents. The most frequently raised issue, highlighted by the largest number of comments, was that the eligibility criteria are unclear or lacks transparency. Closely linked to this, the second most common theme was poor accessibility of information. Concerns centred on complex and difficult-to-navigate council websites, an overreliance on digital content, and the absence of clear, plain English- explanations. “I don’t think it is very clear.” “Where can I find the eligibility criteria?” 78
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17 Despite this, a smaller proportion of respondents provided positive feedback, noting that they understood the criteria or found them clear once explained by a professional. A notable number of respondents indicated they were unsure around clarity and accessibility and/or felt they had no need to understand the criteria or simply did not know where to find them. Concerns were also raised about inconsistency in how the criteria are applied, with references to a perceived “postcode lottery” depending on area, assessor, or staff interpretation. Respondents additionally linked the issue of clarity to wider system pressures, citing long waiting lists and capacity issues, which can obscure the role of eligibility in practice. Further themes included perceptions of unfairness or misuse, confusion about what qualifies someone for care, and the emotional stress families experience when navigating the system and digital exclusion. “Not easy to find information on this.” “Local authority website is not user friendly and can be very vague.” “Not easily accessible.” “Social work makes it clear.” “I got a lot of guidance from hospital, social work and care at home.” “Very clear and accessible.” “Huge waiting list for care package.” “Even if you are eligible, you still cannot get it.” “a vast number of clients who have access to services that don’t need them”. “unfortunately, some people get access to services/visits that they don’t actually require” “Not everyone can access social media.” “Need printed materials and easy-read formats.” “Lots of online info but if you don’t have a computer you’ll struggle.” “It feels like a postcode lottery.” “Very unclear and inconsistently applied.” “Unclear, subject to individual assessors’ interpretation.” 79
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18 A small but important theme emphasised was the need for more preventative and holistic approaches. Question 6 – Out of the following approaches, which should be prioritised to ensure fairness and sustainability of eligibility criteria? Respondents were asked to identify which approach they believe should be prioritised to ensure that eligibility criteria for social care are applied fairly and remain sustainable in the future. The results highlight a strong preference for flexibility and fairness in how decisions are made. The most frequently selected option was “Consider individual circumstances case-by-case,” chosen by 55% of respondents. This indicates that more than half of participants believe eligibility decisions should consider the unique needs, risks, and personal situations of each individual. The second most supported approach was “Focus on those with highest or greatest “Very intrusive and stressful for carers.” “There are veils over information… how can you ask about what you don’t know exists?” “feel that if you were more open you would be able to support more people, by looking to assist with preventative measures to avoid people getting into crisis” 80
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19 need,” selected by 28% of respondents. A further 14% felt that “Apply consistent thresholds across all services” should be the main priority. Only 4% of respondents did not answer this question. Question 7 – Please provide any further suggestions relating to question 6 Participants responses were themed and summarised below. Individual, case-by-case assessment (One size doesn’t fit all) - This was the most frequently raised theme, reflecting concerns that rigid, standardised criteria risked overlooking complexity in people's lives. Respondents emphasised that eligibility must recognise the diversity of needs, circumstances, and disabilities. Prioritising those with the greatest need - A strong proportion of respondents stressed that limited resources make prioritisation unavoidable, and therefore those with the highest levels of vulnerability, including palliative care, those living alone, or individuals with memory impairment, should be placed first. Fairness, consistency, and transparency of decision-making - Participants expressed a desire for clear, consistent rules that are applied equitably across cases but still allow room for professional judgement. Transparent processes were viewed as crucial for public trust. “Each person has different needs.” “One shoe does not fit all.” “Every individual’s circumstances are different; this really needs to be fully considered.” “The most in need should be considered priority… the most vulnerable.” “End of life needs to be given direct access to a care package.” “There is no other option but to prioritise those with the highest care needs.” 81
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20 Concerns about system abuse, over-allocation, and lack of reassessment - Many respondents voiced frustration that support is sometimes allocated to individuals whose needs have changed or reduced, while others with higher needs struggle to access help. The absence of regular reassessment was seen as a structural weakness. Financial contributions, charging, and use of benefits - A significant number argued that those with financial means should contribute more, including making use of benefits such as attendance allowance. The Role (and limits) of family support - Respondents described substantial variation in the availability and reliability of family support. Some families indicated they provide extensive help, while others cannot or choose not to. Concerns about burnout among unpaid carers were prominent. Importance of multi-disciplinary team (MDT) / Holistic assessment - A recurring suggestion was the need for coordinated assessment involving multiple professionals to ensure more accurate, holistic decisions. “Eligibility should be transparent and consistent across all services.” “There needs to be a guarantee no one is left out of the system.” “Rigid thresholds increase the chances of systemic oppression and discrimination.” “There is people getting carers that do not need them.” “Needs of a person can fluctuate.” “Attendance allowance should be used to assist with care provision.” “Make meal preparation, laundry, housework prescription collection etc a chargeable service.” “Carers can reach burnout very quickly without adequate support.” “Some people have several family members helping, while others have only one or two.” “Thorough assessment (including from health professionals already involved or who recently have been involved) in the hope of more holistic assessment, save duplication and staff workload.” 82
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21 Importance of dignity, rights, and person-centred support - Some respondents expressed ethical concerns about eligibility reform potentially undermining rights or personal autonomy. Mental health and hidden disabilities being overlooked - Respondents highlighted perceived inequalities, particularly relating to invisible or misunderstood conditions. Prevention and early intervention to avoid escalation – Respondents expressed concern around the cutting of “lower” need support resulting in increases in long term costs. A number argued that lack of investment and focus in relation to prevention and early intervention would lead to crisis and unnecessary hospital admissions. Community and family empowerment – A suggestion was made by some around the need for community and family empowerment, indicating some families could do more. Suggestions around education for families around care could be introduced. “Nothing about me without me.” “Care should be delivered to fit each person’s individual circumstances.” “Once again the difference in care for someone who requires mental health care is not recognised.” “People with Physical disabilities and hidden disabilities should be treated equally.” “For people with ASD especially females we mask a lot of our emotions and are unable to express what it is going on that we need support”. “If you don't attend to those with minor needs now, they will just escalate over time to being a high priority expensive case.” “understanding when people are at crisis point, person centred approach rather than a transactional approach” “Families need to be utilised along with more.” “Public information and open days showing people how to care for family - hair washing, shaving, toe nail cutting, changing sheets and safe handling. Then more people would be confident in caring for their family members themselves.” 83
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22 Geographical Inequality / Island Issues – Arran is discussed by a number of respondents outlining the unique challenges residents face and the need to take island life into consideration. Hospital flow and preventing delayed discharge – was described as a priority by respondents. Linking this to issues around prevention and early intervention. System navigation and (not knowing how to advocate) – Some respondents indicated concerns around the complexity of the system and the need for consideration of those less likely to advocate for themselves such as the elderly. Workforce issues (Recruitment, Pay, Quality of Assessment)- Some respondents indicated that some of the system pressures were sure to overstretched staff. All three should be applied – A small number of respondents indicated that all three options should be in place. “individual circumstances should include physical isolation i.e. rural isolation, location and a lack neighbours or proximity a help. It cannot be applied with one criteria across all of NAC”. “I know many people on the island that do not receive care that actually really need it”. “We must ensure that patients are not left in hospitals and this area is a priority so that our hospitals are not full and care is provided locally in home or community.” “a small amount of help early on can stop someone from ending up in the hospital”. “There needs to be a guarantee that no one is left out of the system. In some cases, many older people will say they are ok, when in reality they are probably struggling and need support”. “Care of the elderly at home requires more carers to meet demands.” “All 3 should be applied.” 84
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23 Question 8 - Thresholds for accessing social care are set locally to establish the point at which a local authority will provide an individual with care. What concerns might arise if thresholds for accessing care were changed in the future? Participants responses were themed and summarised below. Risk of harm and unmet need – A dominant concern across responses was the risk that individuals with genuine and often substantial needs would no longer receive timely or adequate support. Participants expressed concern that higher thresholds could lead to neglect, deterioration in health, increased isolation, and even avoidable deaths. Some stated that without essential assistance, people could become housebound, remain in soiled conditions, or face escalating risks in their own homes. Loss of eligibility and reduced access to care - A closely linked theme was the expectation that changes would result in people losing their current support or being unable to access help in future. Concerns were raised that fewer people overall would meet the threshold, leaving growing numbers without any formal support and increasing the burden on families, communities, and crisis services. Early intervention and increased crisis demand - Participants emphasised that raising thresholds would undermine early intervention, creating a system that reacts only at the point of crisis. Respondents warned that removing “lower level” supports could lead to more falls, poorer nutrition, medication errors, and preventable deterioration, resulting in increased A&E attendance and hospital admissions. Some linked threshold changes directly to bed blocking, arguing that without accessible care at home, people would remain in hospital longer and put unsustainable pressure on acute services. “People’s lives are at risk. No care means you become isolated, housebound and health deteriorates further putting more pressure on the system.” “People will die” “That some people are endangered due to the lack of care in the community to tend to their needs leading to fatalities” “People currently accessing care might no longer be eligible” “Care could be reduced or taken away.” 85
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24 People ‘Slipping Through the Net’ - There was concern noted that changes risk leaving significant groups unseen or unsupported. Respondents highlighted that some individuals, particularly those with communication difficulties, cognitive impairment, limited family support, or fluctuating needs already struggle to navigate the system. Higher thresholds, they felt, would worsen this and cause more people to “fall through the cracks,” with serious risks to psychological and physical wellbeing. Funding, Budgets and Workforce Pressures - A number of participants linked proposed changes to the broader financial and workforce challenges facing the system. Many believed that thresholds were being raised as a response to reduced budgets, insufficient staff, or pressures across local services. Respondents expressed concern that the lack of adequate staffing, funding, or capacity would intensify, and that restricting access would simply shift pressure onto other parts of the system, particularly hospitals and emergency care. Impact on Unpaid Carers and Families - Respondents highlighted that any reduction in formal care would almost certainly be absorbed by unpaid carers, many of whom indicated they were already at risk of burnout. They described scenarios in which carers would be forced to give up employment, take on physically demanding tasks, or experience significant stress and declining mental health. Several participants commented that they feared losing their own packages of care, which would leave them reliant on family members or force major life changes, such as moving home. “Early intervention can sometimes save hospital admission” “More elderly will suffer falls at home then require hospital admissions clogging up the NHS.” “People might slip through the cracks and be at risk of psychological harm” “People get left behind, fall through the net, get ignored.” “Thresholds are raised to accommodate falling budgets” “Local authority has no staff” “Carers burn out & Mental health deteriorates without appropriate respite services” “Partner's /carers wellbeing needs to be considered.” 86
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25 Inequity, Consistency and a “Postcode Lottery” - A recurring concern was the potential for inconsistent application of thresholds across different areas or assessors. Participants described the current system as variable and expressed fear that changes could worsen inequity, creating a “postcode lottery” within or between local authorities. Some called for national alignment, arguing that eligibility for essential care should not depend on where a person lives. Process Delays, Waiting Lists - Respondents also highlighted how existing delays can already place people at risk. They feared that higher thresholds would worsen waiting lists and leave people in unsafe situations for extended periods. A number stressed the need for clearer timelines and more efficient decision making to prevent deterioration, hospitalisation, or death while people wait for assessments or care to be arranged. Assessment Quality and Subjectivity - Participants expressed anxiety about the reliability and fairness of assessments, noting that risk is often subjective and may not reflect the complexity of individuals’ lives. They feared that stricter thresholds could result in a “tick-box” approach, reducing flexibility and professional judgement, and leaving some needs unrecognised, particularly when individuals underestimate or under-report their difficulties. Mental Health and Hidden Disabilities - respondents worried that people with mental health conditions, neurodivergence, or hidden disabilities would be disproportionately disadvantaged. They described concerns that these groups may not meet higher thresholds despite facing significant risks, potentially leading to increased psychological harm, worsening mental illness, or crisis situations. “All local authorities should have the same thresholds.” “Thresholds should be common to all areas.” “Process takes too long” “Eternal wait for decisions to be made” “should be assessed by individual needs” “Bias/opinion of those who make the decisions” 87
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26 Fairness and Rights-Based Concerns -Broad concerns were raised about fairness with some stating that care should be provided regardless of thresholds. Some concerns were noted around inequity in rights for under 65’s. Transparency of Decision-Making – Comments were recorded questioning who made decisions around thresholds and the request for more transparent decision making and information. Residential Care and Rural/Island Issues (Particularly Arran) – Respondents expressed concerns around changes in thresholds forcing elderly people off Arran causing disadvantage to islanders. Several comments were recorded around the impact of threshold changes and access to Montrose House on Arran. Efficiency, Prioritisation and Double Provision – Respondents indicated they felt there was inefficiency in the system and those with specific need such as no family should get priority. Some felt that there were unnecessary home visits provided that could be allocated elsewhere. “Risk of more mental health problems” “People with non-physical disabilities will be discriminated…” “If care is required care should be provided regardless of thresholds” “Very if under 65’s are not given the same right to care as older adults.” “Who has the power to change these?” “One of the concerns Is that care homes would start to fill up very quickly and access would be in short supply” “To much time is wasted on unnecessary visits.” Everyone who has service should be re assessed to make sure they actually need it”. 88
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27 Means Testing, Affordability and Financial Risk – Some indicated that changes could result in physical, financial risk or neglect and questioned that deprivation within North Ayrshire was already high and were concerned regarding the future. Advocacy and the Risk for People Without Support Networks – A number of respondents expressed concern for those unable to advocate for themselves or have no family voice. Need for Holistic, Person-Centred and Multiagency Approaches – Respondents indicated the need for a holistic approach when it came to thresholds ensuring that the right people were involved in the decision making and a multi-agency approach was adopted. Alternative Supports, Community and Preventative Options - A small number of respondents suggested exploring self-care opportunities, virtual support, community-based help, or third sector contributions as complementary approaches. “Deprivation within locality area already high so how can this be prioritised” “It may mean individuals who need it the most won't be able to afford it as they may need to contribute more financially, which would put extra pressure on families who are already supporting or need to offer more support” “People with no family have no one to advocate for them”. “People without advocates might fall through the cracks” “it needs a holistic approach on the needs of the individual. Any decisions should not be made on the basis of cost”. “Thresholds must be robust and on determining eligibility we must ensure that a multi- agency approach or involving many people to get a true picture”. “People left on waiting lists, at risk and could come to harm, lack of alternative supports available to access for self-care”. “South Ayrshire have developed response teams… first points of contact which has allowed Social Work professionals to work greater to the core values of the profession”. 89
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28 Question 9 - What do you see as the most effective ways to communicate eligibility criteria and decisions? Participants were asked to identify the most effective ways for the Partnership to communicate eligibility criteria and decisions. Clear written guidance emerged as the preferred method, selected by 84% of respondents. Participants noted that written information should be concise, easy to understand, and available in plain language. The second most preferred method, chosen by 68%, was conversations with care staff. Respondents highlighted that while written guidance is vital, it must be supported by opportunities to speak directly with knowledgeable staff who can explain how eligibility applies to their personal circumstances. Participants emphasised the importance of trusting relationships and clear communication from frontline workers. A significant proportion of people also valued digital tools to aid understanding. Online tools or explainer videos were selected by 45% of respondents, reflecting a growing expectation for accessible digital content that can simplify complex processes, provide visual examples, or guide people step-by-step through eligibility criteria. Equally, 45% identified feedback following the appeals or complaints process as an important communication method. Community events and drop-ins were selected by 44%, suggesting continued value in face-to- face engagement, particularly for those who may feel uncomfortable navigating online 90
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29 systems or who benefit from direct discussion in a community setting. A smaller proportion (10%) selected “Other.” Question 10 - How important is it that people get to choose how their own care is organised and delivered? Participants were asked how important it is for people to have choice in how their own care is organised and delivered. Responses show a strong and consistent belief in the value of personal choice, autonomy, and involvement in decision making. The majority of respondents felt that having choice was critical. 58% stated it was “very important”, highlighting an expectation that individuals should be active partners in shaping the support they receive. A further 24% described it as “somewhat important,” indicating broad recognition that, even if resources are constrained, people should retain meaningful influence over how their care is arranged. Together, 82% placed high value on choice and control. Only small proportions expressed ambivalence or lower levels of importance: • 10% felt neutral, • 4% felt it was not very important, and • Just 1% felt it was not important at all. • A further 4% did not provide an answer. 91
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30 Question 11 - Should there be limitations placed on choice to reduce costs and ensure sustainability of services? Participants were asked whether choice in how care is delivered should be limited in order to reduce costs and support the long-term sustainability of services. Responses were mixed, demonstrating the complexity of balancing personal autonomy with financial pressures in the social care system. The largest proportion of respondents (44%) felt that yes, some limitations on choice may be necessary to ensure services remain financially viable. However, a significant share (30%) answered no, indicating that they do not believe reductions in choice are an acceptable route to addressing financial pressures. A further 26% were unsure, reflecting uncertainty about how such limitations might work in practice or what types of choice might be affected. Only a small proportion (4%) did not respond to this question. 92
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31 Question 12 - In times of limited resources, do you feel that cost limits should be placed on individual care packages? Participants were asked whether cost limits should be placed on individual care packages during periods of limited resources. Responses showed a mixed set of views, reflecting the complexity and sensitivity of balancing financial sustainability with meeting individual needs. 27% of respondents stating they agree and a further 12% stating they strongly agree that cost limits may be necessary. However, a similar proportion expressed disagreement. 21% of respondents disagreed, and 16% strongly disagreed. A substantial proportion,20%, selected neutral, suggesting uncertainty about how cost limits would be applied in practice, or reflecting a recognition that the issue is not straightforward. Only 4% did not answer the question. 93
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32 Question 13 - Should people be charged for or contribute to the cost of non-personal care? Participants were asked whether people should be charged for, or contribute financially to, the cost of non-personal care services. Responses showed a clear majority view but also highlighted important differences in opinion and areas of uncertainty. The largest proportion of respondents (65%) answered “Yes”, indicating support for some level of financial contribution toward non-personal care. However, 19% of respondents said “No”, expressing opposition to charging. A further 12% were “Unsure”, suggesting uncertainty about how charging models might work in practice or what types of support would be affected. A small proportion (4%) did not provide an answer. 94
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33 Question 14 - Should charging policies be designed to protect those on low incomes? Participants were asked whether charging policies should be specifically designed to protect people on low incomes. The majority of respondents (68%) answered “Yes”, indicating a clear expectation that any charging framework must include protections for low-income households. A further 14% said they were “Unsure and another 14% responded “No”, indicating that while a minority, some people believed charging systems should be consistent for all service users or that other approaches to funding and resource management may be preferable. A small proportion (4%) did not provide an answer. Question 15 - How could introducing cost limits or raising care thresholds for care packages affect people who use services? Participants responses were themed and summarised below. Risk of people going without essential care - The most frequently raised concern was that cost limits or tighter thresholds would leave people without the care they genuinely need. 95
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34 Respondents feared that individuals could be forced to refuse support because they cannot afford it or be excluded entirely if they fail to meet higher thresholds. Many highlighted the danger that people might deteriorate more quickly, become isolated, or experience neglect, particularly those without family support or advocacy. Fairness means testing and ability to pay - A significant theme related to perceptions of fairness. While many supported the idea of means testing, this was consistently conditional on strong protections for people on low incomes. Respondents felt it was reasonable for those who can afford to contribute to do so but emphasised that those unable to pay should still receive all essential support. Some participants also expressed frustration about perceived inequities, noting tensions between those who have saved or worked and those who have not. Impact on health, safety and wellbeing - Participants described potential consequences for health and wellbeing if people received less care or had to wait longer for support. Respondents highlighted the increased likelihood of self-neglect, poor nutrition, unmanaged medication, declining mental health, and worsening living conditions. Some warned that delaying or reducing care would result in more people reaching crisis point, requiring more intensive, and more expensive, interventions in the long term. “They will go without care as won’t be able to afford it.” “People could lose services they currently rely on. People who need care would miss out. “It should be means tested which would be fair and equitable.” “The people who can afford to contribute towards their care costs should do so where applicable. “their quality of life will decrease and they likely to cost the taxpayer more in mental health, incidents and dealing with neglect” “the food goes uneaten, fluids not taken, medication not taken…. Basic needs MUST be met” 96
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35 Financial hardship and cost of living pressures - Concerns about affordability were prominent, with many respondents explaining that additional charges or reduced care could push people into debt, poverty, or impossible decisions. Individuals noted that disabled people and low-income households already face disproportionate financial pressures and may be forced to choose between essential care and basic necessities- such as heating and food. Some described the potential emotional toll, including stress, hopelessness, and, in the most severe cases, suicidal thoughts. Concerns about equality, rights and dignity - A strong theme centred on the risk that changes could undermine rights-based care. Respondents feared that cost limits or raised thresholds might disadvantage disabled people, older adults, or those with complex needs, creating a “two-tier” system in which those with the loudest voice, or the greatest financial means, receive better access. Potential benefits identified by some - Although a minority view, some respondents noted potential advantages if cost limits were implemented fairly. These included ensuring that the most vulnerable receive priority, reducing duplication or unnecessary services, and encouraging those who can afford additional support to contribute privately. A small number felt that clearer boundaries could improve fairness and efficiency. “Would ensure the most vulnerable and in need people will get the care they need.” “People who can afford extras could pay for what they want.” “It is already incredibly expensive being disabled… adding costs means people may not be able to heat or eat.” “It will put them into debt which can lead to suicidal thoughts and feelings.” “Cost limits shouldn't be introduced. It's discriminatory and ageist as well.” “There is a risk of creating a two-tier system - people who understand their rights and pursue solutions using the system versus those who don't understand and go on to experience crisis at a far higher cost to the HSCP” 97
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36 Risk of system level consequences - Several participants highlighted the wider system impacts of raising thresholds or reducing packages of care. Respondents warned that delays or reduced support would create greater pressures on hospitals, including increased admissions, more complex needs, and higher levels of bed blocking. Some predicted that more people would require residential care earlier, further increasing long-term costs. Preventing misuse or unnecessary care - Some respondents felt that cost limits could help prevent misuse of services, noting examples where people may receive care they no longer need or tasks could be completed independently. However, this view was always balanced by a need for assessments to remain fair, accurate, and person-centred. Increased pressure on unpaid carers and families - A recurring theme was concern that reductions in formal care would place significant additional strain on unpaid carers. Participants also noted that people without family support would be disproportionately affected and may face higher risk of harm. Impact on quality of care - Respondents also worried that introducing cost limits could result not only in less care, but in poorer quality care. This included rushed visits, reduced time with carers, inconsistent support, and tasks not being completed safely or thoroughly. Some highlighted the potential consequences for dignity, wellbeing, and basic daily functioning. “Raising thresholds will put added pressure onto carers and result in burnout, relationship breakdowns and increased hospital admission”. “Raising care thresholds will undoubtedly leave many more people in crisis - especially those who are currently only just managing and who run the risk of being left without support in the future”. “Raising costs would stop people from having services that they don't require. It would also create space for people who are on waiting lists and who are currently unable to receive services to finally receive them”. “The cared for person would miss out on quality of care which would currently be being provided”. “Individuals might receive fewer hours of care or the types of services they receive may be restricted”. 98
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37 Question 16 – What additional support might be needed for vulnerable people? The most frequently identified need was regular contact and safety monitoring. Respondents emphasised that vulnerable individuals, especially those living alone, require consistent check-ins to ensure they are safe, coping, and not experiencing deterioration. Many felt that even light touch monitoring can prevent crisis, provide reassurance, and reduce isolation. Wider supports identified by respondents included: • Emotional Support, Loneliness and Social Connection • Advocacy, Representation and Rights • Community-Based Supports and Third Sector Involvement • Navigation of the System and Access to Clear Information • Mental Health Support • Practical Daily Living Support • Financial Support and Income Maximisation • Holistic, Person-Centred and Individualised Assessment • Continuity, Consistency and Quality of Care • Care Home Access and Respite Support • Care home/ respite Question 17 – Any other feedback In the final question, participants were invited to share any other comments or reflections. The responses were wide ranging with several high-level themes emerged. The themes are summarised below. Funding, Budget and Opposition to Cuts - The most prominent theme was strong concern around the proposed cuts and in many cases, opposition to any reductions in social care funding. Assessment, Eligibility and Thresholds - Participants raised significant concerns about eligibility processes, including transparency, fairness, and the risk that tightening thresholds could lead to unmet need. Survey, Consultation and Design Feedback - Comments focused on the consultation itself. Some participants felt the survey was difficult to complete, overly complex, or framed in a way that forced people to make impossible choices. 99
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38 Staffing, Recruitment and Pay - Workforce issues featured with many respondents highlighting staffing shortages, recruitment challenges, workload pressures, and concerns about pay. Charges, Means Testing and Use of Benefits - Participants expressed a mix of support and concern regarding charging policies. Some felt that a fair, means tested contribution system was appropriate, especially for nonpersonal care, while others feared that any charges could push vulnerable people further into hardship. Islands and Montrose House - Island-based respondents, particularly from Arran, raised concerns about equity and access to services. Many expressed anxieties about the impact of limited care options and the reduced capacity of Montrose House, highlighting emotional strain, travel barriers, and fears of being moved off-island for care. Several felt that island communities are disproportionately affected by cuts and that decisions must better reflect island needs. Fairness, Rights and Dignity - A number of comments emphasised the importance of rights based, dignified care. Respondents feared that changes to eligibility, charging, or service levels could undermine equality and discriminate against certain groups, particularly disabled people and those with complex mental health needs. Unpaid Carers, Respite and Family Burden - Unpaid carers used this space to share the strain they are under and their concerns about increasing levels of responsibility if formal care is reduced. Respondents described burnout, mental health pressures, and a lack of affordable respite options NHS/HSCP Integration and Hospital Flow -Comments focused on the need for better integration between health and social care, particularly around discharge planning, communication, and preventing bed blocking. Respondents highlighted inefficiencies, communication gaps, and the need for shared systems and more coordinated approaches. Early Intervention and Prevention - A consistent theme across feedback was the value of preventative support. Participants stressed that reducing early stage services would lead to greater need, crisis, and cost in the long term. Many advocated for investment in low level help, community support, and reablement to keep people well at home. 100
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39 Service user feedback - Some comments were recorded as part of this consultation expressing appreciation for the care they or the person they care for receives. Comments were recorded suggesting the need for service user voice in future changes. Resource and private care - Respondents indicated the system was under resourced and overstretched. Suggestions included reintroduction of meals on wheels and reuse of closed nursing homes provided as suggestions. Mixed views were recorded around the use of private care companies with a broader call for reform at a system level. Community inclusion & support - Respondents indicated that social connection is essential and not optional. Views were expressed around the need for day services, clubs and community spaces to ensure inclusion with linkage to equality and human rights. Communication and shared IT - Respondents highlighted the need for better integration of IT systems across NHS and social care. Some indicated the need for a single point of contact or named person to ensure proactive communication. Mental health and recovery - Some indicated that potential cuts could significantly worsen mental health and increase social isolation. Concerns were raised that cuts could destabilise people with serious mental health conditions. Continuity of care, visit length and scheduling - Respondents stated that continuity of care was essential for dignity, trust and quality of care with concerns raised around visit lengths and workforce issues impacting on this. Equipment and housing - Respondents raised issues around equipment delays and inconsistency creating risk and reducing independence. Issues specific to Arran included housing shortages driving workforce issues and limiting service availability. Equipment and housing were seen as critical for preventing hospitalisation. 101
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40 Staff and Provider Consultation A total of n=135 responses were received from the staff and provider consultation representing n=679 individuals. Question 1- Please confirm you are responding on behalf of a NAHSCP Staff Team, Service or Provider in North Ayrshire. To ensure that participants were completing the correct survey, they were asked to confirm if they were responding on behalf of a NAHSCP staff team, service or provider in North Ayrshire. Percentages shown are calculated based on total respondents to this question and are weighted using the reporting number of participants involved in each submission. Where no answer was provided, the reported participant headcount is reflected within the non-response category Question 2 - Please indicate number of participants involved in this response. To enable weighting of collective submissions, respondents were asked to indicate the number of individuals represented in each response. Responses noted: 102
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41 • Individuals: 102 • Team: 33 (collective submissions ranged from 1 to 170 participants) • Total responses: 135 Total People Represented: 679 Question 3 - What aspects of social care do you feel are most important? This question allowed respondents to select more than one option. Percentages are calculated as a proportion of total respondents to this question and are weighted by reported participant headcount. Combined percentages may exceed 100 percent. Where a submission did not 91% 77% 49% 42% 40% 33% 28% 19% 2% Proportion of respondents (multiple responses permitted) Aspect of Social Care What aspects of social care do you feel are most important? (N=679) 103
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42 provide an answer, the reported participant number is reflected within the non-response category. Staff and providers responses placed the highest value on personal care, with 91% selecting it as a priority. Support that helps people stay independent also ranked strongly at 77%. Other aspects, such as shared support models (49%), personal safety (42%), and practical help (40%), were important to a smaller but still significant proportion of people. Fewer respondents highlighted care being free of charge (33%), choice and control over how care is delivered (19%), or other factors (28%). Question 4 - Please provide any additional comments in the box below Following their responses on the most important aspects of social care, staff and providers provided a wide range of qualitative comments that offered deeper insight into their priorities, values, and concerns. Across the responses, participants described a system under significant pressure but united in the belief that safe, person centred, holistic support is essential to wellbeing, independence, and dignity. Person-centred-centred, individualised care - People repeatedly emphasised that care must reflect individual circumstances, strengths, preferences, and needs. Respondents stressed that one size fits-fits-all approaches do not work and risk poorer outcomes. Holistic Care - A smaller but consistent theme highlighted that people’s needs are interconnected: physical, emotional, social, and environmental supports all matter. “Care will be very specific based on the person’s needs.” “Treat everyone as an individual to maximise their quality of life.” “Person-centred care and empowering choice is why I got into care.” “All aspects above are essential in creating holistic care for vulnerable individuals.” “Care needs to reflect the whole person and their situation.” 104
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43 Personal safety and risk- Safety was viewed as a core, non-negotiable priority. Many feared increased risk or harm if support was reduced, delayed or unaffordable. Supporting independence - Independence was seen as a major outcome in itself, achieved through small supports, equipment, adaptations, and enabling approaches. Emotional support & mental wellbeing - Respondents linked poor mental health with decline in physical care, functioning, and safety. Emotional support was seen as preventative. Social connection, day services & community participation - Social engagement was seen as essential, not optional — protecting mental health, reducing isolation, and offering carer respite. Sustainability & funding concerns - A major theme. Respondents fear the system is reaching breaking point: staff capacity, budgets, and resources cannot meet need. “Poor mental health can lead to breakdown in personal care.” “A focus on emotional support is important… mental wellbeing underpins everything.” “Support to be involved in the community is pivotal for wellbeing.” “Groups and hubs reduce loneliness and provide respite for carers.” “What is the point of personal care if someone cannot interact with others?” “The top priority… is keeping people safe.” “Lack of home care is causing harm — people are dying because of delays.” “Community Alarm is a lifeline for some people who live alone.” “Providing support to maintain independence is important.” “Supports to maximise independence should be prioritised.” “People need equipment and adaptations to remain at home.” “The sector is reaching a critical point — safety will become difficult to sustain.” “We need a long‑term plan that is sustainable without more cuts.” “Lack of resources is harming patients and the whole system.” 105
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44 Shared support models - Shared care and joint working models are viewed as efficient ways to support service users and minimise the impact of cuts. Staff noted these models have already reduced in recent years. Consultation inaccuracies & concerns - Some respondents challenged the wording, assumptions, and accuracy of the consultation, especially around services that no longer exist. Gaps in care & expanding services - People described major gaps in home care availability, transport, day services, and wider supports that prevent crisis. Means testing non‑personal care - A minority expressed support for means‑testing tasks like shopping, transport, and housework. Choice, control & SDS - Choice over how care is delivered, not just provider, was repeatedly highlighted. People want autonomy, flexibility, and involvement. “Why is practical support listed? We have no such services anymore.” “The survey forces impossible choices.” “Some options don’t reflect reality.” “Shared support … must be expanded.” “Models of shared support scaffold services.” “Clear joint working reduces duplication and improves outcomes.” “We need more, not less, access to homecare.” “People are stuck in hospital because there is no care at home — people are dying because of this.” “Small supports prevent crisis and hospital admission.” “Means‑tested support beyond personal care should be considered.” “Choice of provider is important.” “Service users should have a say — care should be tailored.” “In NAC, choice is often just provider choice — not choice over delivery.” 106
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45 All important - One of the most frequent responses rejected the idea of prioritising only four aspects, saying all elements are interdependent. Early intervention & prevention - Strong consensus that removing “lower‑level” supports increases crisis, cost, and hospital admissions. Affordability & equity of services - Charges for telecare, transport and other supports make essential help inaccessible for low‑income residents. Duty of care - Concerns that raising thresholds or cutting services breaches moral and legal responsibilities to vulnerable residents. Clarity of service purpose & focus on core tasks - A minority noted that expectations must reflect the service’s actual remit — personal care, meals, and medication — not historic home‑help models. “Care continuing to be free prevents people missing out on essential care.” “Charging makes services inaccessible for low‑income people.” “Individuals without care packages cannot afford essential supports.” “All of the above are important.” “Choosing 4 creates a false narrative that others are less essential.” “Impossible to choose — all are essential.” “All of the above are important.” “Choosing 4 creates a false narrative that others are less essential.” “Early intervention is key to saving the HSCP in future.” “Removing small supports increases risk and cost later.” “Without early support, needs escalate.” “All of the above are important.” “Choosing 4 creates a false narrative that others are less essential.” “All residents who need care can’t be ignored — it isn’t a lottery.” “We have a duty of care — cuts expose people to harm.” “The service used to be home help — it is not now.” “It should be for personal care, meal prep and medication.” 107
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46 Question 5 - Which of these services do you feel are most integral to people’s care? This question allowed respondents to select more than one option. Percentages are calculated as a proportion of total respondents to this question and are weighted by reported participant headcount. Combined percentages may exceed 100 percent. Where a submission did not provide an answer, the reported participant number is reflected within the non-response category. Most staff and providers identified personal hygiene and eating and drinking as the services most integral to people’s care, with both selected by 88%. Continence management followed at 84%. Getting dressed was chosen by 62%, medication and treatment by 55%, and mobility by 53%. Emotional support (14%), telecare services (13%), day services (5%), transport (3%), and household tasks (1%) were selected far less often. These responses show which core tasks staff and providers view as central to maintaining people’s daily wellbeing and functioning. Question 6 - Please provide any additional comments in the box below. 108
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47 Person centred, individualised care - Staff felt care must be tailored case-by-case through robust assessment and care planning; what is “most integral” depends on the person’s goals, risks, conditions, and context. Holistic Care / All Services Matter - Respondents strongly reject forced trade-offs; they argue all listed supports contribute to wellbeing, prevention, and cost avoidance. Separating tasks undermines real-world care. Interconnectedness of Personal Care Tasks - It was felt that personal care components (hygiene, dressing, mobility, eating, continence, medication) are inseparable in practice; prioritising one in isolation creates risks. “All the options above are important… it would depend on their vulnerabilities.” “Again, the majority of the services and support listed above are essential in creating holistic care packages.” “All are important… Could be seen to go against SSSC code of practice.” “As a Provider we cannot simply select 5 options as these are all equally relevant & important…” “All options above are needed—nothing excluded.” “Package of care would depend on individual needs assessment.” “Priority would be different depending on the individual—adequate assessment and care plans are invaluable.” “We should ensure that individual needs are being met on a case by case basis— involve them and their families…” “As noted in previous response, the service most integral… is person specific.” “Basic personal care should include nutrition, assistance to eat, helping people get out of bed, continence management, medication and treatment—prioritised in isolation could have detrimental effects…” “Someone who has received continence care… should receive support to get dressed afterwards… an essential part of their care.” “We felt that personal hygiene, getting dressed, mobility and eating and drinking were all connected and would be done at the same time.” 109
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48 Essential Basic Needs/ Safety and Critical Care - Core activities of daily living and risk-critical tasks (nutrition, mobility, continence, medication) prevent harm (falls, infection, choking, pressure damage) and avoid influx of admissions. Removing these could put people’s lives at risk. Emotional Wellbeing and Social Connection - Emotional support, social connection, and day services are key to mental health, resilience, and prevention often under‑recognised compared with “keep alive” tasks. Practical Support gaps - Gaps exist around shopping/errands/transport; some suggest charities/other orgs might cover elements, but access is patchy and can’t be assumed. Suggestions for technology to support perceived gaps. Consultation Inaccuracies and Concerns - Respondents critique the survey design: forcing a “pick 5,” splitting personal care, and including options that aren’t locally available. They fear poor data will drive poor decisions. “If not supervised… choking hazard and death” “Removing support with mobility or continence will lead to infections, falls, bedsores—ultimately costing the service more.” “Eating and drinking for some may pose a significant risk of choking and death if not supervised.” “Without positional changes… increased risks of pressure sores.” “If we don’t get the fundamentals of care correct, we cannot move on.” “We feel that technology could be considered more often in the right circumstances.” “Several of the services above can be provided by other organisations, independent of the Partnership. “ “there are no services to help people with shopping, errands or appointments so unsure why this is included.” “The emotional well‑being aspects have always been what speak to me more…” “Day services provide much needed emotional support and social interaction…” “This list has only prioritised keeping people alive but not providing a good quality of life.” “A number of the community patients we see are isolated and have limited opportunity to see or meet other people. Day services are a valuable way to address this.” 110
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49 Human Rights Based Framing and Legislation - Many see basic care as a human right, cutting support risks neglect and contravening codes and regulations (e.g., SSSC). Family Support Role - Families were noted as often contributing significantly, but reliance varies; equity, capacity, and clarity around expectations and charging were raised. Workforce/ System Capacity Implications - It was felt that reducing services risks staff burnout, increased admissions, delayed discharges, and shifting costs (e.g., more home visits when transport is cut). Inapplicable - A small number of participants noted that some items don’t fit all service populations (e.g., children, families and justice services), which affected how they responded to the question. “I would have preferred an option to prioritise these rather than only pick 5.” “Feel this question is unfair splitting up personal care… and making it a choice with only 5 options.” “As aforementioned, there are no services to help people with shopping, errands or appointments so unsure why this is included.” “feel that selecting only 5 is poor choice” “Families should be more involved with shopping, dressing etc.” “Should family be doing more? YES” “all aspects are important to an individual’s needs - it also depends on how much family support they have as they can participate in some care” “If carer/workforce was reduced… significant increase in staff burnout and loss of care staff… increase in hospital admissions and longer stays.” “If no transport patients still need seen—more house calls… not cost‑effective… further issues for staff.” “A number of the above statements do not relate to the population served by team (children).” “All areas are integral… Could be seen to go against SSSC code of practice.” “For the patient group we support… basic human rights and need. If these are not met this would impact physical, emotional and mental wellbeing.” 111
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50 Question 7- How do you feel about prioritising personal care over non-personal care when resources are limited? Percentages shown are calculated based on total respondents to this question and are weighted using the reporting number of participants involved in each submission. Where no answer was provided, the reported participant headcount is reflected within the non-response category. The graph shows most respondents expressed agreement with this approach, with 47% indicating they agree and 40% indicating they strongly agree. A smaller proportion selected neutral (4%). Disagreement was less common, with 7% disagreeing and 2% strongly disagreeing. There were no recorded non‑responses. Overall, responses are concentrated toward the agreement end of the scale, with relatively few respondents expressing neutral or negative views. Question 8- Please provide any additional comments in the box below. Personal Care as Essential / Must Be Prioritised - Many respondents agree that if forced, personal care should be prioritised because it prevents immediate harm (skin breakdown, malnutrition, infection, medication errors) and is essential for dignity and safety. 0% 2% 7% 4% 47% 40% % of survey participants Agreement Level How do you feel about prioritising personal care over non-personal care when resources are limited? (N=679) No Response Strongly Disagree Disagree Neutral Agree Strongly Agree 112
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51 Non-Personal Care Still Essential / Neglect Creates Crisis - Even those who prioritise personal care warn that removing non-personal care causes deterioration, malnutrition, isolation, relapse, safeguarding risks, and increased system costs in the long run. Personal vs Non-Personal Cannot Be Separated - Respondents stress that “non-personal” tasks often directly support personal care (shopping supports eating, laundry supports continence care), therefore categorisation feels artificial. Individualised, Person-Centred Decision-Making - The strongest theme across all responses: prioritisation must be based on individual need, not a blanket rule. Needs differ based on disability, age, conditions, risks, and support networks. “People need dignity and personal care is an important part of this.” “Personal care is the bare minimum and essential for existence.” “Personal care should be the foremost important aspect as this prevents long‑term issues.” “Personal care support should take precedence over non‑personal care.” “If shopping is not available, they will not eat.” “Neglecting non‑personal care will lead to severe breakdowns and crisis intervention.” “Social isolation and loneliness are significant concerns.” “Cuts to transport or shopping will indirectly increase costs and needs.” “Some non‑personal tasks come hand in hand with personal care, like continence care and laundry.” “Access to nutritious food IS personal care.” “Not everyone’s non‑personal care is low‑risk.” “It depends on individual need and risk.” “This should not be a blanket assessment.” “Both personal and non‑personal care are important depending on the person’s situation.” “Prioritisation must be ethically justified and supported by clear eligibility criteria.” 113
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52 Risk, Safety, and Clinical Consequences - Respondents repeatedly highlight risk of harm if either type of care is removed: dehydration/malnutrition, choking, missed medication, falls, skin breakdown, admission or delayed discharge. Importance of Social Connection & Mental Wellbeing - Many emphasise that non-personal care (day services, community access, support with routines) is essential to prevent loneliness, depression, cognitive decline, and crisis. Charging / Means Testing for Non-Personal Care - Some respondents support charging for non-personal care if people have sufficient funds, though caution about fairness and the risk of creating inequality. Structural, System, and Workforce Issues - There were concerns about system capacity, strategic planning, and workforce pressures. Some argue the prioritisation problem is a symptom of chronic underfunding and suggest a review of the whole care system. Preventative Support vs Crisis-Driven Care - Respondents argue that cutting non-personal care shifts the system into permanent crisis response, undermining prevention and long-term sustainability. “If food preparation is removed, malnutrition and dehydration risks increase.” “From an SLT viewpoint, modified diets cannot be safely prepared without support.” “Safety is an issue—basic needs not being met leads to medical escalation.” “Social activities are just as important… a lifeline for those with no interaction.” “The impact of social isolation and loneliness is well known and should be equitable with personal care.” “Keeping people clean but isolated is not a quality of life.” “Non‑personal care should be a chargeable service.” “Those with sufficient funds should be asked to pay for social supports.” “Disability benefits exist to cover shopping and transport.” “Charging must avoid penalising those who rely on these supports for basic safety.” “This needs a Scotland‑wide strategic approach.” 114
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53 Human Rights, Dignity, and Ethical Concerns - Participants raise rights-based concerns about limiting support. Several reference the effect this will have on service user’s dignity, quality of life, and note that limiting support may go against national rights frameworks. Natural Supports / Family Networks - Some argue family, neighbours, and community can help with non-personal tasks if available. This could support the Partnership moving to providing only personal care, however, respondents warn this must not be assumed and a full assessment must take place. Question 9 - Do you know that there is eligibility criteria for care? Percentages shown are calculated based on total respondents to this question and are weighted using the reporting number of participants involved in each submission. Where no answer was provided, the reported participant headcount is reflected within the non-response category. 655, 97% 22, 3% 2, 0% Do you know that there is eligibility criteria for care? (N=679) Yes No No Response “Crisis intervention is cost‑ineffective in the long run.” “Removing preventative support increases future demand.” “Withdrawals harm wellbeing and store up more complex needs for the future.” “People have a right to live well with dignity as active members of their community.” “Prioritising one aspect over another suggests the HSCP considers some rights more legitimate.” “This may not be a tenable or legal position.” “Use natural supports where safe and appropriate.” “Not everyone has family.” “Relying on family assumes capacity that may not exist.” 115
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54 The majority of respondents (97%, 655 people) reported that they are aware that eligibility criteria exist. A small proportion (3%, 22 people) indicated that they were not aware. There were no recorded non-responses. Overall, the findings indicate a high level of awareness of eligibility criteria among participants, which is expected given that respondents were staff and providers for whom knowledge of eligibility criteria is part of their professional role. Question 10- Please provide any additional comments in the box below. Respondents broadly accept that eligibility criteria are necessary in a resource‑limited system. However, they express significant concern about clarity, consistency, fairness, and transparency. The prevailing view is that current eligibility frameworks risk becoming reactive rather than preventative, with thresholds rising to the point that people only receive support once their needs become critical. Awareness Exists, but Understanding Is Limited - Many respondents are aware that eligibility criteria exist, particularly staff working within HSCP or integrated teams. However, there is widespread uncertainty about the detail, scope, and practical application of the criteria. Lack of Transparency and Public Accessibility - Respondents consistently highlight that eligibility criteria are hard to find, not clearly communicated, and not easily understood by the public, families, or even staff. There is a strong call for improved transparency and accessible information. “I know there is an eligibility criteria however unsure exactly what that entails.” “We are aware of criteria but not aware of the specifics of this.” “I work within the HSCP and am aware that they exist.” 116
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55 Inconsistent Application and Subjectivity - A major concern is that eligibility criteria are applied inconsistently, leading to unequal outcomes. Respondents describe subjectivity in assessments, variation across teams, and people with similar needs receiving different decisions. Rising Thresholds and People Falling Through the Gaps - Many respondents are concerned that thresholds have increased to the point where only critical or substantial needs are supported, leaving people with moderate needs without help until they deteriorate. Delays, Waiting Lists, and Service Pressure - Eligibility criteria are seen as operating within a system under severe pressure, resulting in long waits, overwhelmed services, and delayed intervention. “There should be transparency of the criteria on websites.” “Criteria can be hard to find.” “The general public may not be aware of the services that are available to them – information is not readily accessible.” “Who has access to this criteria? It has to be available, clear and precise.” “There is inconsistencies in how the eligibility is applied and people with similar issues receive different responses.” “Staff working in different areas may view eligibility differently although criteria is set.” “Eligibility definitions… are vague and most won’t understand the differentiation.” “The level of risk presented can be subjective.” “Only critical and substantial referrals are being accepted, long waiting lists, people falling through the gaps.” “The current eligibility framework risks leaving those in the ‘Moderate’ category without support.” “By the time families reach the ‘Critical’ threshold…the damage… is often irreversible.” “The threshold cannot just keep rising.” “There are long waiting lists.” “There are gaps / delays in services. Services are overwhelmed.” “If people are declined… do they wait and become more acute and then fit criteria?” 117
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56 Person-Centred and Individualised Assessment - Respondents strongly reject a “one size fits all” approach and stress that eligibility must reflect individual need, risk, and context, with the person involved in decisions. Assessment Quality and Workforce Practice - Several responses point to assessment practice as a core issue, including poor enforcement, defensive decision‑making, inconsistent assessor confidence, and avoidance of difficult conversations. Equity, Fairness, and ‘Postcode Lottery’ Concerns - Respondents raise concerns about equity, including variation by geography, age, service area, and service type, creating perceptions of unfairness. Complexity of Multiple Eligibility Frameworks -The presence of multiple criteria (e.g. carers, home care, mental health, substance use) causes confusion for staff and the public, making it difficult to navigate, adhere to and undermines consistency. “The criteria isn’t a problem; it’s the assessing of the individual’s needs.” “These criteria are often poorly enforced/adhered to.” “Often the people who shout loudest get exceptions made for them.” “Staff seem to prioritise avoidance of a complaint over enforcing criteria.” “Better assessments… and more feedback from carers is required.” “Question of whether the area is becoming a ‘postcode lottery’?” “Different eligibility criteria for different groups e.g. >65 / <65.” “Would free >65 care be reviewed in an area of high deprivation?” “Staff found more than one type of criteria when looking.” “Ensure people know which criteria are being applied and for what reason.” “Eligibility criteria cannot be ‘one size fits all’, as needs do not work that way.” “The individual needs to be centre and involved when care is required.” “Need to look at needs of an individual.” “This requires person‑centred planning.” 118
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57 Prevention vs Crisis-Driven Intervention Respondents emphasise that strict eligibility criteria undermine early intervention and prevention, leading to higher long-term costs and worse outcomes. Need for Review, Updating, and Shared Approach - There is a strong call for eligibility criteria to be reviewed, updated, consistently applied, and embedded across services with shared ownership. Question 11- If the group answered yes above, how clear and accessible do they find the current eligibility criteria for care? The overwhelming theme is that eligibility criteria are clearer for professionals than for the public, with significant barriers related to complexity, jargon, digital access, and inconsistent application. Many respondents see this as undermining prevention, person‑centred care, and trust. Clear and accessible (for professionals) - Eligibility criteria are generally understood and accessible to professionals who work directly with assessments or within HSCP services, who have familiarity with system language and processes. “Needs to be updated and non‑subjective.” “A distribution of refreshed guidance would be useful.” “There is work to be done to embed this assessment.” “Again, a shared joint approach across services.” “By the time the Council is legally forced to act…the cost is significantly higher.” “Do they wait and become more acute / chronic and then fit criteria?” “Given I work in a service which assesses for care, I find the criteria very clear and accessible.” “Very clear.” “Clear if you are aware of the system and wording.” 119
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58 Not clear / not accessible (general) - Many respondents reported that eligibility criteria are not clear overall, describing confusion, inconsistency, and difficulty locating information. Not accessible for service users, families, carers - A strong theme that eligibility criteria are not accessible or understandable for service users, families, and carers, who often only learn about them during assessments through staff. Digital access barriers & online-only information - While information may exist online, reliance on digital access creates barriers for older people and those without internet access or digital literacy. Complexity, jargon & poor usability - Eligibility criteria were frequently described as overly complex, wordy, and full of professional jargon, making them difficult to understand without specialist knowledge. “Accessible on internet but not everyone has access or knows what to look for.” “Buried on the internet – not easy to find.” “Older people especially may not have access to online information.” “Not clear.” “Not particularly accessible.” “The group felt that this wasn’t clear.” “Probably not clear for service users’ families.” “The group do not feel that this information is freely available for families and carers.” “I don’t think this is communicated to service users, either face to face or in the wider community.” “Subjective. Full of jargon. Non‑specific.” “Document is very wordy and uses some terms that are vague or ‘woolly’.” “Hard to complete unless you have knowledge. Too complex a form.” 120
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59 Inconsistent application / subjectivity - This was a recurring theme as respondents highlighted variation in interpretation and application, leading to perceptions of unfairness and confusion, particularly when similar needs result in different outcomes. Awareness exists but lack of detailed understanding - Many respondents were aware that eligibility criteria exist but lacked understanding of the detail, thresholds, or how they are applied. Waiting lists, delays & service pressures -Even where criteria are clear, respondents raised concerns about waiting times, delays, and pressure on services limiting access. Rising thresholds / restrictive criteria - Eligibility criteria were perceived as becoming increasingly restrictive, limiting access and focusing support at crisis point. “Aware of a criteria, however unsure of this criteria.” “We all knew there was a criteria but not what that actually looks like.” “Only aware of it but don’t know what they are.” “Criteria is clear. Waiting times for assessment are concerning.” “Not very accessible due to community care cuts.” “hospital staff are left having difficult discussions with families in relation to sending people home to be assessed in community for increase in care when they are telling you their family member is not safe. very stressful.” “current criteria lack clarity and do not sufficiently support social work staff in making safe decisions” “Unclear and inconsistent across Scotland.” “Everyone seems to have their own opinion on what should be met.” “People who ‘shout the loudest’ seem to get care quicker.” “it can sometimes seem like a case of who shouts loud enough - whether this is a member of the community complaining via MSPs, or certain workers advocating in ways other workers might not have and ultimately getting the outcome they desire for their cases.” “Far more restrictive than ever before in my 27 years work with the service.” 121
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60 Prevention & early intervention concerns - Respondents, again, expressed concern that lack of clarity and high thresholds undermine prevention and early intervention, leading to higher long‑term costs and harm. Person-centred concerns / needs-led vs service-led - Eligibility criteria were often viewed as service‑led rather than needs‑led, with insufficient focus on the individual’s circumstances. Workforce knowledge vs public knowledge gap - A clear divide exists between professional understanding and public awareness, with staff able to navigate criteria while family’s struggle. Outdated or not relevant to all groups - Some respondents felt the criteria were obsolete or not suitable for all client groups. Need for clearer guidance, simplification & communication - There was a strong call for clearer, simpler guidance, improved communication, and use of visual aids to improve understanding and consistency. “Clear enough for health providers but probably not for patients.” “Only aware of this as we use it for our work.” “Somewhat clear and accessible but probably not widely known.” “Some provision should be made for lower levels of support to minimise the risk of people slipping into crisis.” “The way in which they are applied is significant, particularly in the context of prevention.” “It needs to be more person centred.” “Criteria did not meet individual needs of the service user.” “The criteria… does not belong to the person being assessed.” “Outdated and not relevant to all teams.” “Not clear regarding young adults with ASN and what service they fit into.” 122
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61 Question 12- Out of the following approaches which should be prioritised to ensure fairness and sustainability of eligibility criteria? Percentages shown are calculated based on total respondents to this question and are weighted using the reporting number of participants involved in each submission. Where no answer was provided, the reported participant headcount is reflected within the non-response category. The most frequently selected option was a focus on those with the highest or greatest need (40%). This was followed by applying consistent thresholds across all services (31%) and considering individual circumstances on a case-by-case basis (28%). A small proportion of respondents (1%) did not provide a response. Overall, preferences were distributed across the three approaches, with no single option selected by a majority of staff and providers. Question 13 - Please provide any additional comments in the box below 40% 31% 28% 1% Focus on those with highest or greatest need Apply consistent thresholds across all services Consider individual circumstances case-by-case No Response% of survey participants Approach to eligibility critera Out of the following approaches, which should be prioritised to ensure fairness and sustainability of eligibility criteria? (N=679) “Eligibility criteria should be made more publicly accessible and easier to understand.” “A flow chart or visual aids would be better.” “There is a need for a clearer, more transparent framework and better communication.” 123
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62 There was broad agreement that individual circumstances assessed on a case‑by‑case basis should be prioritised to ensure fairness, dignity, and sustainability. While focusing on those with the highest or greatest need is essential, respondents consistently stressed that rigid thresholds and crisis‑driven models undermine prevention, equity, and long‑term sustainability. A balanced approach, combining consistent thresholds, professional judgement, and early intervention, was viewed as most aligned with person‑centred, ethical, and rights‑based care. Case-by-Case / Individual Circumstances Prioritised - The dominant theme across responses is that considering individual circumstances on a case‑by‑case basis is essential for fairness. Respondents consistently rejected blanket approaches, emphasising that people’s needs, risks, and supports vary significantly. Focus on Highest or Greatest Need - Many respondents felt that those with the highest or greatest need should be prioritised, particularly in a context of limited resources. This was often framed as a safety and ethical requirement. “Individual circumstances is the only fair solution.” “No 2 people are the same.” “Context matters in Social Care… individual circumstances must be considered.” “Case by case would then identify those of highest and greatest need.” “It goes without saying that every case should be deemed on its own merits.” “If applied fairly then those in most need should go to the top.” “Those assessed as being most at risk should be prioritised at all times.” “Focusing on those with the highest or greatest need ensures limited resources are allocated ethically and safely.” “The highest needs however with focus on case‑by‑case basis.” 124
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63 Consistent Thresholds for Fairness - Some respondents recognised the importance of consistent thresholds to ensure transparency and fairness, particularly to avoid arbitrary decision‑making. However, few supported consistency without flexibility. Prevention & Early Intervention Concerns - A strong theme was concern that focusing only on high or critical need undermines early intervention and prevention, leading to escalation, poorer outcomes, and higher long‑term costs for the Partnership. Person-Centred / Needs-Led vs Service-Led - Respondents emphasised that eligibility decisions should remain person‑centred and needs‑led, rather than driven by service availability, time allocations, or rigid systems. Equity vs Equality (Support Networks and Context) - Many respondents highlighted that fairness is about equity, not equality, noting that family support, advocacy, and personal circumstances must be considered when assessing for care. “But it is important to maintain a consistent threshold to ensure fairness.” “Ensure consistency across all services whilst focusing on those with the highest need.” “The focus should be on early intervention and prevention.” “Some provision should be made for lower levels of supports to minimise the risk of people slipping into crisis.” “By only focusing on greatest need are we creating a bigger issue?” “Not addressing early needs may lead to increased residential or 24‑hour support.” “Everyone is an individual so needs should be tailored to each person.” “A more person‑centred approach should be taken… focus on individuals and requirements rather than times.” “Eligibility should be about what the person needs, not fitting them into a matrix.” “Fairness comes from equity.” “Some people don’t have family or friends capable of offering help.” “Some people with the highest need also have family or additional resources.” “Consistent thresholds not workable – equity not equality.” 125
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64 Inconsistent Application / ‘Shout the Loudest’ Concern - There was, again, widespread concern that prioritisation is sometimes influenced by complaints, advocacy, or who ‘shouts the loudest’, undermining trust in the system. Sustainability & Resource Pressures - Respondents acknowledged financial and capacity pressures, noting that prioritisation decisions must balance fairness with sustainability. Human-Rights / Ethical Framework - Some respondents explicitly raised concerns that aspects of the criteria were incompatible with human rights obligations, ethical social work practice, and legal duties. Concerns About Blanket / Rigid Thresholds - Many respondents warned against blanket or ‘critical‑only’ thresholds, highlighting the risk of unmet need and escalation. “Often people are being prioritised as they ‘shout the loudest’.” “Sometimes it’s the people who have advocates who shout loudest who get the highest level of care.” “Sustainability is not achieved by raising thresholds to save money.” “Small, early investment can prevent expensive statutory intervention.” “A case‑by‑case approach is the only method compatible with a Human Rights‑Based Approach.” “Rigid eligibility thresholds create systemic barriers to rights.” “Fairness requires looking at whole‑family circumstances.” “One size doesn’t always fit or meet the needs of the person.” “Blanket thresholds will fail too many people.” “A ‘critical‑only’ approach is not supported due to the risk of unmet substantial needs.” 126
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65 Need for Review, Re-evaluation, or Tiered Support - Respondents noted the importance of reviewing existing care packages, removing unnecessary support, and developing tiered or community‑based options. It was felt that a review would result in money being freed up within the Partnership. Lack of consensus / Overlap Between Options - Several groups found the options difficult to distinguish, noting overlap between case‑by‑case and highest need, and lack of a single clear answer. Question 14 - Thresholds for accessing social care are set locally to establish the point at which a local authority will provide an individual with care. What concerns might arise if thresholds for accessing care were changed in the future? Respondents expressed strong concern that increasing thresholds for accessing social care would increase unmet need, undermine prevention, place unsustainable pressure on unpaid carers and health services, and create a false economy driven by crisis intervention. There was widespread agreement that higher thresholds risk harm, inequity, safeguarding failures, and loss of trust, particularly for those without advocacy or family support. Risk of Unmet Need, Harm, or Deterioration - Raising thresholds was widely seen as increasing the risk that people’s needs would worsen before support is offered, potentially leading to unsafe situations. “I think all of the above are relevant.” “The last two options are quite similar.” “Group found this question too difficult to answer.” “Who is to define highest or greatest need?” “Services should be re‑evaluated and removed if no longer needed.” “More tiered support would free up availability.” “Many lower threshold needs can be met by universal services.” 127
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66 Loss of Prevention & Early Intervention / Escalation to Crisis - Respondents consistently warned that higher thresholds would undermine early intervention, resulting in crisis‑driven care that is less effective and more expensive. Impact on Unpaid Carers (Burnout and Breakdown) - Unpaid carers were identified as a group at high risk if thresholds increase, with significant concern about physical, mental, and emotional strain. Increased Pressure on NHS, Hospitals & Other Services - Higher thresholds were expected to displace demand onto hospitals, GPs, A&E, mental health services, and emergency responses. People Falling Through the Gaps / Being Overlooked - Many respondents feared vulnerable individuals would not meet revised thresholds and would remain invisible until crisis. Inequity & Postcode Lottery Concerns - There were strong concerns about inconsistency across services, exacerbating inequality and unfair access. “Individuals being left in unsafe circumstances without access to care.” “Risk to life, increase in mental health issues, addictions.” “People may fall through the gap and care needs may be significantly greater when eligible.” “Delaying services further will add even more pressure to the NHS.” “More hospital admissions may occur due to unmanaged needs.” “Increased strain on community services.” “Vulnerable people might get overlooked.” “Individuals may slip through the net.” “People falling through the gaps and being missed.” “We are waiting for them to reach crisis points and not giving support early on.” “Raising current thresholds will increase crisis intervention situations.” “Unpaid carers taking the brunt of the effect.” “Carer stress leading to carer breakdown.” “Families being expected to fill the gap.” Disparity between postcodes.” “Further postcode lottery on what you will or will not receive.” “Thresholds will not be the same across areas.” 128
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67 “ Mental Health, Wellbeing & Social Isolation - Respondents linked reduced access to care with isolation, declining mental health, and loss of social participation. Service Withdrawal, Instability & Transition Risks - Changing thresholds raised concerns about withdrawing long‑standing care packages without adequate transition or support for the service user. Workforce Pressure, Burnout & Moral Distress - Higher thresholds were expected to increase complexity of work, emotional strain, and burnout among staff. Financial False Economy / Long-Term Cost Increases - Many respondents argued that raising thresholds would increase long‑term costs through crisis care and residential placements. Safeguarding & Protection Risks - Concerns were raised that safeguarding risks may go unnoticed until serious harm occurs. “People would be housebound with no social skills.” “huge effects on mental health and wellbeing.” “Reduced social participation and independence.” “Stopping care for those who have had it for long periods is always challenging.” “People previously receiving support no longer qualifying.” “Individuals becoming dependent on support that is then removed.” “Staff burnout dealing with more complex situations.” “Social care workers moving away from what they are trained to do.” “Lower staff morale if need cannot be met.” “We cannot save our way out of a deficit by creating crisis cases.” “Late intervention is both more expensive and less effective.” “Higher thresholds will increase residential placements.” “Safeguarding concerns may go unaddressed until risks escalate.” “Risk of unseen harm, especially in protection cases.” “More ASP [adult support and protection] referrals 129
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68 Confusion, Inconsistency & Loss of Trust - Changing thresholds without clear communication with existing service users and the general public was seen as risking confusion and creating a loss of trust in our services. Ethical, Human Rights & Dignity Concerns - Respondents expressed concern that higher thresholds undermine dignity, fairness, and rights-based practice. Dependency on Advocacy / ‘Shouting the Loudest’ - Threshold changes were feared to worsen inequity by privileging those with advocates. Digital or Access Barriers - There was secondary concern that changes may rely on digital processes, and this could exclude older people, or disadvantage people without access to devices. Question 15- What do you see as the most effective ways to communicate eligibility criteria and decisions? “Mix up, uncertainty, do not know if they qualify.” “Confusing service users.” “Breakdown of trust between community and services.” “Ethical obligation to support those at highest risk.” “Hidden harm and unmet need will become more prevalent.” “People must reach a higher level of harm before intervention.” “Those who shout the loudest get services.” “People with no one to speak up for them may miss out.” 130
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69 This question allowed respondents to select more than one option. Percentages are calculated as a proportion of total respondents to this question and are weighted by reported participant headcount. Combined percentages may exceed 100 percent. Where a submission did not provide an answer, the reported participant number is reflected within the non-response category. Clear written guidance was the most frequently selected option (92%), followed by online tools or explainer videos (81%). Community events or drop-ins were selected by just over half of respondents (53%). Feedback following the appeals and complaints process was identified by 46%, while conversations with care staff were selected by 33%. Other methods were selected by 29% of respondents. Overall, responses indicate a preference for clear, accessible written and digital communication methods, alongside a range of supplementary approaches. Other responses were noted in responses to question 16. Question 16 – Please provide any additional comments in the box below. 92% 81% 53% 46% 33% 29% Clear written guidance Online tools or explainer videos Community events or drop-ins Feedback after any appeals and complaints process Conversations with care staff Other Proportion of respondents (multiple responses permitted) Communication Method What do you see as the most effective ways to communicate eligibility criteria and decisions? (N=679) 131
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70 Clear, Accessible Written Guidance as the Foundation - There is very strong consensus that clear, plain‑language written guidance is the most effective and essential method for communicating eligibility criteria and decisions. Written information is valued because it is consistent, referable, shareable, and less likely to be forgotten than verbal communication. Respondents emphasised the importance of accessibility (reading age, Easy Read, large print, translations) and ensuring guidance is easy to find. Inclusivity, Equity of Access, and Multiple Formats - Respondents consistently stressed that no single communication method works for everyone. Effective communication must be multi-channel and inclusive, recognising barriers such as digital exclusion, disability, cognitive or communication difficulties, literacy, poverty, and limited mobility. Equity of access was a recurring principle. Importance of Skilled, Confident Staff Conversations - While written guidance is essential, respondents highlighted that conversations with knowledgeable staff are critical for interpretation, reassurance, and trust—particularly where decisions are complex or “Clear, accessible written guidance appears to be the best…it is always accessible, whereas things like a conversation may be forgotten.” “Guidance needs to be in written form to refer back to and provide to others where required.” “Written advice needs to be at a level accessible to everyone. The average reading age for adults in Scotland is 9–11 years old.” “Clear written guidance confirms what is available and manages expectations from members of the public and for assessing staff.” “All of the above – individuals are individual and not one option above will suit everyone.” “Equity of access means all of these formats are needed.” “Not everyone has access to online or goes online. It can be difficult to find things online.” “Information should be in clear simple language… copies should be given to local support organisations.” 132
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71 distressing. Staff must be well-trained, confident, and consistent, with clear internal guidance to avoid mixed messages or inappropriate referrals. Managing Expectations Early and Transparently - Many respondents emphasised the need to explain eligibility criteria early, particularly at the point of referral, to avoid false expectations and later distress. Transparency about what can and cannot be offered, how decisions are made, and what “thresholds” mean was seen as key to maintaining trust. Feedback, Appeals, and Complaints - Respondents supported feedback and appeal routes but warned of capacity pressures and the emotional toll on staff and service users. There was concern that feedback loops must be proportionate, resourced, and sensitive, recognising that people may be ineligible due to financial constraints rather than lack of need. “Care staff should be knowledgeable when discussing criteria and decisions.” “SW staff should have clear guidance to allow them to have these discussions with service users.” “Staff at present do not know criteria for other services and submit referrals with service users expecting a service they do not meet the criteria for.” “The criteria for care should be explained at the point of the initial referral.” “Clear written guidance can put a stop to service user complaints and manage expectations.” “Explaining how decisions are made and what evidence is used increases trust.” “Rejections need to be given with clearly defined reasons that link back to eligibility criteria.” “We need to be careful with the feedback loop around appeals and complaints.” “Sometimes with the time and distress invested, it would have been easier to see the individual.” “Clear signposting to appeals and feedback routes helps people feel more confident.” “Is there designated resource for the anticipated increase in this?” 133
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72 Engagement Beyond Traditional Channels - There was mixed confidence in community events, with concerns about accessibility and reach. However, respondents suggested taking information to places people already attend (e.g. health appointments, established groups) and using broader media to increase awareness. Carers, Families, and Wider Support Networks - Carers and extended family were repeatedly identified as key partners in understanding, interpreting, and supporting eligibility decisions. Effective communication must actively include them. Systemic Pressures, Funding Constraints, and Workforce Anxiety - A significant portion of feedback went beyond communication methods to highlight systemic pressures, including funding reductions, rising thresholds, and workforce stress. Respondents questioned whether communication alone could resolve tensions when demand exceeds resources and stressed the importance of honesty about these constraints. “Carers should be included when a review is carried out.” “Support for carers to understand criteria is essential.” “Extended family need to be supported more and given more information.” “Rather than community events that may not be well attended, take information to groups already set up.” “At events such as flu/covid jabs, the information could be readily available.” “TV/radio/social media marketing.” “People are being asked to do more with less, crises are escalating, and workers feel ill equipped.” “Is it not the case that Government need to increase investment if demand is outstripping resource?” “The public lacks understanding of why delays and changes occur, which contributes to mistrust.” “Transparency, shared understanding and mutual trust will help hugely.” 134
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73 Question 17- How important is it that people get to choose how their own care is organised and delivered? Percentages shown are calculated based on total respondents to this question and are weighted using the reporting number of participants involved in each submission. Where no answer was provided, the reported participant headcount is reflected within the non-response category. Most respondents rated this as important to some degree, with 47% indicating it is somewhat important and 21% indicating it is very important. Just under a third of respondents (28%) selected a neutral response. Very small proportions indicated that this was not very important (1%) or not important at all (0%). A small number of respondents (3%) did not provide a response. Overall, responses are weighted towards viewing choice in care organisation and delivery as important, with limited opposition expressed. Question 18- Please provide any additional comments in the box below 3% 0% 1% 28% 47% 21%% of survey participants Importance Rating How important is it that people get to choose how their own care is organised and delivered? (N=679) No Response Not Important at all Not very important Neutral Somewhat important Very important 135
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74 Across responses, choice is widely recognised as important and foundational to person-centred care, dignity, human rights, and Self-Directed Support (SDS) legislation in Scotland. However, respondents consistently stress that choice must be balanced against: • assessed need and professional judgement • individual capacity and safeguarding • financial constraints and sustainability • workforce availability and consistency of standards There is a strong sense that “meaningful choice”, rather than unlimited choice, is the realistic and defensible position. Choice as Central to Person-Centred Care, Dignity and Rights - Many respondents describe choice as fundamental, intrinsic to person-centred practice, and embedded in legislation, policy and standards. Choice is seen as core to dignity, respect, engagement, independence and human rights, particularly within SDS and Health and Social Care Standards. Limiting choice is viewed by some as a regression to paternalistic models of care. “This sits at the heart of person-centred practice.” “People should be treated as experts in their own lives.” “Meaningful choice is a fundamental requirement of the Health and Social Care Standards (My support, my life).” “It is part of the legislation SDS and what we should be doing as a local authority.” “Choice is the difference between care that is ‘done to’ a person and care that is ‘designed with’ them.” 136
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75 Legal and Policy Frameworks (SDS, Standards, Human Rights) - Respondents frequently reference statutory duties and national frameworks, noting that choice is not optional; it is underpinned by SDS legislation, Scottish policy and regulatory standards. Restricting choice to manage cost is seen by some as legally and ethically risky. Balancing Choice with Cost, Sustainability and Resources - While choice is valued, many respondents stress the reality of constrained budgets, workforce shortages, and the need for cost-effective, sustainable models. There is concern that unlimited or poorly defined choice can strain services and reduce equity. Capacity, Safeguarding and Risk - Capacity is repeatedly highlighted as a key moderating factor. Choice must be proportionate to an individual’s capacity. Where capacity is limited, prior wishes, advocacy, family involvement, and safeguarding are essential. There is concern about exploitation and unrealistic decision-making. “Self‑Directed Support … is a mandatory legal obligation for the Local Authority to offer individuals choice in their Package of Care.” “This is written in statutory law in Scotland.” “Our concern is that the Human Rights of people… will be compromised if we say anything else.” “Is it being suggested that some options are taken off the table as a means of controlling cost? If so, is this a legally defensible position?” “I think it’s important but currently we also have to consider the financial constraints.” “Choice must be balanced carefully alongside affordability and risk considerations.” “Giving people full choice can put added strains on Local Authority finances.” “If government funded then take what’s offered or pay for choice of care service.” 137
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76 Assessed Need vs Wants and Expectations - Many responses draw a clear distinction between need and preference. Choice should operate within assessed need and professional judgement. Respondents express concern that expectations can be unrealistic, leading to inequity, inefficiency, or inappropriate use of resources. Equity, Consistency and Standards of Care - Respondents highlight the importance of consistent standards, avoiding a two-tier system where those who can afford or articulate choice do better than others. Awareness, Information and Accessibility of Choice (Especially SDS) - Some people feel many service users are unaware of SDS options or find the system inaccessible. Better information, advocacy, and support are needed to make choice real rather than theoretical. “This is dependent on the capacity of the individual.” “We should consider what someone’s views may have been before (when they had capacity).” “If they haven’t been assessed – then they could either be missed or exploited.” “Not all individuals will have capacity to make the right decision for themselves.” “Choice is good, but standards of care should be consistent.” “Potential for a two tier service going forward.” “I think it needs to be a standard service that is the same to all.” “Consistency is key and gender choice should be available.” “There needs to be a clear distinction between what is needed, and what is wanted.” “Care should be based on need first.” “Some people are unaware of what they want versus what they need.” “Some people will manipulate their needs to gain as much as they can.” “Most people think it is from NAC or private – few people are aware of self-directed funding.” “In our experience this is a very complicated system to navigate.” “Better outcomes for people when they understand all options on offer.” 138
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77 Role of Professionals, Families and Co-Production - Respondents emphasise partnership working between service users, families, carers and professionals, with co-production improving outcomes and sustainability. Question 19- Should there be limitations placed on choice to reduce costs and ensure sustainability of services? Percentages shown are calculated based on total respondents to this question and are weighted using the reporting number of participants involved in each submission. Where no answer was provided, the reported participant headcount is reflected within the non-response category. Just over half of respondents (54%, 366 people) indicated that limitations should be placed on choice to ensure sustainability of services. A further 38% (258 people) reported that they were unsure. A smaller proportion (8%, 52 people) indicated that limitations should not be 366, 54% 52, 8% 258, 38% 3, 0% Should there be limitations placed on choice to reduce costs and ensure sustainability of services? (N=679) Yes No Unsure No Response “Professional opinions need to be considered at all times.” “Where folks lack capacity then a family member should be consulted.” “If family carers and care providers co‑created a joint plan…” “We want people to use what we offer and therefore need to work with the person.” 139
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78 placed on choice. Overall, responses indicate a range of views, with a majority in favour of limitations, alongside a substantial proportion expressing uncertainty. Question 20 - Please provide any additional comments in the box below. Overall, responses highlight a clear tension: while many accept that some limits are necessary to ensure sustainability, fairness and safety, there is strong concern that further restrictions could undermine Self-Directed Support, person-centred care, dignity and human rights. The prevailing view supports “meaningful” or “bounded” choice — operating within clear, transparent parameters linked to assessed need, affordability and outcomes — alongside a recognised need for clearer definition and communication about what “choice” means in practice. Legal, Ethical and Human Rights Constraints on Limiting Choice - A significant number of respondents argue that choice cannot simply be reduced, as it is embedded in law, codes of practice and human rights principles. Limiting choice purely for cost reasons is seen by some as unlawful, unethical, or a backward step. SDS legislation is repeatedly cited as setting firm boundaries on how far choice can be constrained. Acceptance of Some Limits to Ensure Sustainability and Fairness - Alongside legal concerns, many respondents accept that some limitations are inevitable and already in place. Boundaries are viewed as necessary to prevent unsustainable spending, inequity between service users, and collapse of services altogether. Without limits, individual high-cost preferences could disadvantage others. “Given the Self-Directed Support legislation this is not able to be reduced.” “I think choice is highly important, restricting this could be an infringement on human rights.” “Can’t take choices away from people because it’s codes of practice and law.” “Limits should never compromise safety or human rights.” “Regardless of costs if the person requires the services, then they should have access to them.” 140
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79 Assessed Need Must Come Before Preference - A strong recurring theme is that need, not preference, should drive provision. Respondents emphasise assessment, professional oversight and regular review. Choice should sit within assessed need, not override it, particularly where safety or harm may arise. Risk of Unrealistic Expectations and Over-Consumption - Several respondents express concern that unrestricted choice can lead to over‑provision or unrealistic expectations. Choice may incentivise people to select more, or more expensive services than necessary, especially when public funding is involved. Limits are therefore seen as a tool for expectation management. “Some limitations seems fair.” “Limitations already in place.” “Without boundaries one person’s high‑cost preferences could reduce what is available for others.” “Current costs are unsustainable; therefore, choice may be lost altogether if this continues.” “Upper limits should be set.” “The assessed need should be met and strive towards reaching outcomes… but this must be managed in a cost effective manner.” “Care should be assessed at need and reassessed as required.” “It needs to be reviewed by professionals… ensuring that no harm occurs.” “The most important thing is that individuals receive the correct level of care available.” “When people choose their own services, they tend to over choose.” “Some service users’ expectations of the service can be too high.” “Some individuals may have unrealistic expectations, and this may assist in managing these.” “It takes away people’s choice and shouldn’t be a menu selection.” (counter‑view highlighting tension) 141
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80 Choice vs Sustainability - Some respondents reject the framing of the question itself. Rather than limiting choice, respondents suggest better system design, improved commissioning, integration with NHS, and creative models of care as more effective routes to sustainability. Differentiating Types of Choice - Respondents frequently argue that not all choices are equal. Limits may be more acceptable for equipment, providers, or non‑essential aspects, but personal care, dignity, routines and wellbeing should remain protected. Public vs Private Funding Distinction - Many respondents feel greater limits are justified where care is publicly funded, with additional choice available through self-funding. Clarity, Communication and Transparency Are Critical - Respondents repeatedly note that “choice” is poorly defined. Any limits must be clearly explained, consistently applied, and transparently communicated to avoid mistrust and disengagement. “Care should be individualised… thinking creatively is more relevant than setting arbitrary limits.” “Choice should not be regarded as a euphemism for chaos.” “SDS and the ideal of choice is already failing… we should not be looking to restrict it further but rather develop it.” “Social care needs better communications with NHS… save duplication.” “Mixed model – some items e.g. equipment should have limited choice.” “Yes, in principle but not for personal care that maintains wellbeing.” “Personal choice should be restricted to aspects of personal care… restrictions on other aspects.” “Choice is fine if you’re privately paying for service but if government funded then acceptable to cut accordingly.” “People should have the choice to investigate options above the level of agreed need but recognise these will need to be self‑financed.” “If government funded then accept what’s offered or pay for choice.” 142
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81 Question 21- In times of limited resources, do you feel that cost limits should be placed on individual care packages? Percentages shown are calculated based on total respondents to this question and are weighted using the reporting number of participants involved in each submission. Where no answer was provided, the reported participant headcount is reflected within the non-response category. A majority of respondents expressed disagreement with this approach, with 34% strongly disagreeing and 30% disagreeing. A smaller proportion selected a neutral response (12%). In contrast, 19% of respondents agreed and 5% strongly agreed that cost limits should be applied on care packages. There were no recorded non-responses. Overall, responses indicate that opposition to placing cost limits on individual care packages was more common than support, although a range of views was expressed. 0% 34% 30% 12% 19% 5% % of survey participants Importance Rating In times of limited resources, do you feel that cost limits should be placed on individual care packages? (N=679) No Response Strongly disagree Disagree Neutral Agree Strongly agree “Not clear ‘choice’ – choice of what aspect of care?” “This question needs more context.” “Unclear what choices would be limited.” “Realistic communication about what is available and what is not needs to be provided and then adhered to.” 143
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82 Question 22 - Please provide any additional comments in the box below. Overall, respondents express significant concern about placing fixed cost limits on individual care packages, particularly where this could undermine needs‑led assessment, safety, dignity and equality. While there is recognition of financial pressures and the need for cost control, most responses support a case‑by‑case, flexible approach rather than universal caps. Many emphasise that cost limits risk disproportionately disadvantaging people with complex or lifelong needs and may lead to greater harm, crisis intervention, and higher long‑term costs. A minority support cost limits in principle, but only where safeguards, reassessment, and prioritisation of essential care are firmly in place. Care Must Be Needs-Led, Not Cost-Led - This is the dominant theme across responses. Respondents strongly assert that care packages should be based on assessed need, with cost limits seen as incompatible with a needs-led system. Fixed caps are viewed as impractical and potentially dangerous. Risk of Harm, Inequality and Penalising Complex Needs - Many respondents highlight the ethical risks of cost limits. Cost caps are seen as unfairly penalising people with severe, complex, lifelong or disability-related needs, which are outside their control. This raises concerns about discrimination, safeguarding, and inequity. “As assessments are needs led this would not be feasible in practice and would lead to service users being placed at too high a risk of harm.” “If the care package has been assessed and need is identified then the cost should not be a barrier.” “A care package should be based on assessed need therefore how can you reduce this to fit budget without causing harm?” “An assessed care package should be given regardless of cost.” 144
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83 Case-by-Case Flexibility Over Blanket Caps - Respondents repeatedly argue that if any cost controls are used, they must be flexible, proportionate, and applied individually, with regular review and professional judgement. Financial Pressures Are Real but Should Be Managed Elsewhere - Respondents recognise limited resources but argue that better commissioning, provider management, prevention, integration with health, and reducing waste should be prioritised before limiting care packages. Long-Term Cost of Cuts: Crisis, Hospitalisation and Greater Spend - Reducing care packages may save money short-term but risks carer breakdown, hospital admissions, crisis intervention and higher long-term costs to health and social care systems. “I don’t think people should be penalised and made to pay because of more severe disabilities and needs that are out with their control.” “Individuals may require intensive care based on their individual needs that could be limited due to cost thus placing the most in need at disadvantage.” “If people have more significant needs the cost of their care package will be higher.” “Certain vulnerable person groups require high needs… they should not be penalised for this.” “Should be needs led on a case by case basis.” “All cases should be looked at on a 1:1 basis, no 2 people are the same.” “There shouldn’t be the same limit across the board.” “Must be personalised.” “It often leads to unmet needs, carer breakdown, higher crisis spending, and poorer outcomes.” “If inadequate support then health needs are likely to increase admissions to hospital.” “People may return in the future needing more care and support than they initially required.” “If my care was to be cut… this would be a backward step and could lead to mental health issues.” 145
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84 Fairness, Contributions and Means Testing - Some respondents support fair contributions, rather than caps. Means testing and contributions based on ability to pay are seen as more equitable than limiting care based on cost alone. Recognition That Cost Controls and Scrutiny Already Exist - Some respondents note that cost limits and scrutiny are already in place. There is concern that further limits may duplicate or worsen existing controls, rather than addressing underlying issues. Balanced or Conditional Support for Cost Limits - A minority support cost limits with safeguards. Some respondents accept cost limits as necessary during financial pressure, but only if applied flexibly, with safeguards to ensure essential care, dignity and personalisation are not compromised. Question 23- Should people be charged for or contribute to the cost of non-personal care? “Are there not reviews and limits already in place?” “Cost limits are already placed on care packages… which then go through scrutiny boards.” “There have to be checks and balances of costs… this is monitored.” “I think means testing is an important part of providing a fair system for all.” “Those in better financial positions could be assessed to consider contributions.” “I do agree they should be limited to a degree, but not at the expense of care deemed essential.” “Cost limits may be necessary… but strict limits could undermine dignity or independence.” “Caps must be accompanied by clear risk‑based prioritisation and safeguards.” 146
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85 Percentages shown are calculated based on total respondents to this question and are weighted using the reporting number of participants involved in each submission. Where no answer was provided, the reported participant headcount is reflected within the non-response category. The majority of respondents (90%) indicated that people should be charged or contribute to the cost of non-personal care. A smaller proportion (9%) reported that they were unsure. Very few respondents (1%) indicated that people should not be charged. There were no recorded non-responses. Overall, responses indicate strong support for charging or requiring contributions towards the cost of non-personal care, with limited opposition expressed. Question 24- Please provide any additional comments in the box below. Overall, there is qualified support for people contributing to the cost of non‑personal care, particularly where this supports sustainability of services. However, respondents consistently stress that any charging must be means‑tested, fair, transparent and proportionate, and must not place individuals at risk, create hardship, or undermine wellbeing. There is significant concern about how non‑personal care is defined, with strong views that some activities (notably food preparation and social supports) are essential and should not be treated as optional extras. 608, 90% 10, 1% 59, 9% 2, 0% Should people be charged for or contribute to the cost of non-personal care? (N=679) Yes No Unsure No Response 147
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86 General Support for Charging for Non‑Personal Care (in Principle) - Charging for non-personal care is widely seen as acceptable and, in some cases, necessary to ensure sustainability, provided it is implemented appropriately. Means Testing and Ability to Pay as Essential Safeguards - Respondents overwhelmingly support means-tested contributions, ensuring people only pay what they can afford and are not pushed into financial hardship. Fairness and Equity Concerns - There is discomfort about systems where some people are charged and others are not for the same services, particularly where people feel penalised for working or having contributed through taxes. “Absolutely, especially if financial assessment has been carried out.” “Means testing is an important part of providing a fair system for all.” “Yes, contributions may be reasonable for non‑personal care, but they should be means‑tested, fair and affordable.” “Non personal care should be an extra cost.” “If people can afford it then I’m happy for them to be charged for this if it ensures long term sustainability of services.” “I agree with the charging policy as this helps us when people have the income to do so.” “Similar to the cost attached to the Alert system, some form of charge would be beneficial.” “It is unfair that people of low income receive non personal care free, whilst people of wage earning would have to pay.” “All people should be charged not just people that have worked and contributed via taxes.” “Group commented it would be unfair to charge some and not others for the same services they receive.” 148
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87 Non-Personal Care Is Still Essential to Wellbeing - Respondents strongly challenge the idea that non-personal care is less important. Activities such as food preparation, social support, shopping and cleaning are seen as essential to nutrition, mental health, independence and wellbeing, even if classed as “non-personal”. Clear Definitions of What Counts as Non-Personal Care - Respondents highlight inconsistency in how non-personal care is described and applied, calling for clearer boundaries to avoid inappropriate charging. Use of Benefits and Income to Fund Non-Personal Care - There is strong support for better education and guidance on using benefits to pay for non-personal care, alongside income maximisation. Risk of Charging Leading to Reduced Uptake and Harm - Evidence and experience suggest that introducing or increasing charges can lead people to cancel services, increasing isolation, risk, and downstream costs. “Non personal care is just important for patients as personal care.” “Social activities are shown to offer significantly better mental health outcomes and are essential.” “Not for food shopping or food prep as this is essential to nutritional care.” “I think food preparation is classed as a personal care task.” “Shopping, transport, cleaning, laundry and housework – these are not services social work provide.” “Food prep should not be included as non-personal care.” “There should be a review of chargeable services.” “Income should be maximised and people should use their benefits to fund non‑personal care.” “Disability benefits should be in place to cover the cost of such activities.” “Better education is required around what these payments are actually for.” “When charges were introduced many service users cancelled or reduced services.” “Charging reduces equity, participation and wellbeing.” “People returning community alarms due to cost is resulting in risk of falls.” 149
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88 Proportionate, Sensitive and Flexible Implementation – Respondents emphasise the need for flexibility, sensitivity, clear communication, and safeguards to avoid services “working for the system rather than people”. Enforcement, Consistency and Managing Non-Payment - Some respondents support firmer approaches where people can pay but do not, provided safeguards are in place. Question 25- Should charging policies be designed to protect those on low incomes? Percentages shown are calculated based on total respondents to this question and are weighted using the reporting number of participants involved in each submission. Where no answer was provided, the reported participant headcount is reflected within the non-response category. 407, 60% 15, 2% 255, 38% 2, 0% Should charging policies be designed to protect those on low incomes? (N=679) Yes No Unsure No Response “I’m not averse to people contributing… but concerned how services realise this can lack flexibility and nuance.” “Never applied in a way that puts someone’s health, safety, or dignity at risk.” “Small charges within reason could bring in additional monies but won’t put people off.” “There should be a system in place that flags when a SU hasn’t paid invoices.” “The Partnership should take a more assertive approach when people do not pay despite having the means” 150
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89 The majority of respondents (60%) indicated that charging policies should provide protection for people on low incomes. A further 38% reported that they were unsure. A small proportion (2%) indicated that charging policies should not be designed in this way. Overall, responses indicate broad support for incorporating protections for low-income individuals within charging policies, alongside a substantial level of uncertainty. Question 26 - Please provide any additional comments in the box below. Many respondents strongly support charging policies that explicitly protect people on low incomes, citing deprivation, poverty, disability‑related costs, and the risk of people declining essential care due to inability to pay. Others argue that income alone should not determine charging, raising concerns about fairness, perceived penalisation of people who have worked or saved, and the risk of creating stigma or inequity between groups. A common middle ground emphasises means‑testing, flexibility, transparency, and individual financial assessment, with income considered alongside savings, capital, essential expenditure, and personal circumstances rather than as a single determining factor. Strong Support for Protecting Low‑Income and Vulnerable Households - Many respondents believe charging policies must explicitly protect those on low incomes to prevent hardship and exclusion from services. Protecting low‑income households is seen as fundamental to social care values, particularly in areas of high deprivation. Charging is viewed as ethically problematic if it causes people to decline support or choose between care and basic necessities. “If you are unable to pay a charge then this should be waived.” “It would be very upsetting if service users began to decline support because they could not afford it.” “Further impact on people on low income would be unethical.” “Support should prioritise those most financially and socially vulnerable.” 151
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90 Poverty, Deprivation and Disability‑Related Costs - Respondents highlight the real‑world context of deprivation, disability and cost‑of‑living. Low income is often compounded by higher living costs linked to disability, energy use, transport and equipment. Charging policies that do not account for this risk deepening poverty and increasing inequality. Means Testing and Individual Financial Assessment as the Preferred Approach - A very strong and recurring theme is the need for means‑tested, individualised assessments. Rather than blanket protections or blanket charges, respondents favour financial assessments that consider income, savings, capital, essential expenditure and individual circumstances. Fairness Concerns: Penalising Workers, Savers or Pensioners - Many respondents express concern that income‑based protection can feel unfair to those who have worked, paid taxes, or saved. Some view income‑based charging as creating resentment or division, arguing that people who have worked or planned financially should not be disadvantaged compared to those who have not. “Families with disabled members face significantly higher costs.” “Charging policies that do not strictly protect low‑income households effectively create a ‘tax on disability’.” “High charging thresholds act as a barrier to service access.” “Should be means tested.” “Again, a reasonable criteria will identify those who can / cannot contribute financially.” “Depends on an individual basis.” “Income alone is not the only relevant consideration.” “Individuals may have low income but high savings, or vice versa.” 152
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91 Income Is Not the Only Measure of Ability to Pay - Several respondents challenge the idea that income alone should drive protection. Assets, savings, capital, spending choices and family circumstances are seen as equally important, with concern that focusing only on income oversimplifies financial reality. Protecting Access to Essential Services and Avoiding Harm - Respondents warn that people on low incomes may self‑ration, decline services, or disengage, leading to worsening outcomes and higher long‑term costs. Income Maximisation and Support as a Mitigating Measure - Many respondents emphasise income maximisation as part of protection. Rather than simply waiving charges, respondents highlight the importance of ensuring people receive all benefits and entitlements before determining charges. “It is chronically unfair that because someone has worked and has a pension they should be charged.” “There would be no encouragement for individuals to strive for employment if everything is free.” “Same service, same cost.” “It should be the same for everyone and should be at a low cost.” “Income is less relevant here… if you have £1 million of assets…” “Other monies like capital and savings have to be considered too.” “Some people live in poverty as they don’t get benefits.” “Assessment is required to identify what people are spending their money on.” “People on low incomes already struggle and should not have the added pressure.” “Charging could lead to people declining support entirely.” “To ensure access to essential services and prevent financial hardship.” “Patients should be guided to access Money Smart to maximise income.” “Income maximisation is already offered.” “Need to protect those on low incomes by maximising benefits.” 153
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92 Need for Clear, Transparent and Consistent Policy - Respondents call for clear definitions of “low income”, consistent application across age groups and services, and transparent decision‑making to avoid confusion or perceived unfairness. Question 27 - How could introducing cost limits or raising care thresholds for care packages affect people who use services? Overall, respondents overwhelmingly anticipate negative impacts from introducing cost limits or raising eligibility thresholds for care packages. The dominant view is that such changes would increase unmet need, risk of harm, inequality and crisis intervention, particularly for people with complex, moderate or emerging needs who may no longer qualify for support until their situation deteriorates. Many respondents warn this would lead to worsening health and wellbeing, increased pressure on unpaid carers, higher NHS demand, and greater long-term costs. A recurring concern is the creation of a two-tier system, disadvantaging those with low income, limited advocacy, or less capacity to navigate the system. While a minority suggest clearer thresholds could improve awareness or efficiency, most stress that needs-led care would be fundamentally undermined. Increased Risk of Harm and Unmet Need - This is the most dominant theme across responses. Respondents consistently warn that cost limits or higher thresholds would result in people not receiving the care they need, placing them at risk of physical harm, neglect, safeguarding concerns and deterioration. “Policy would also have to be clear and transparent.” “Clarity around this across age range would be required.” “Question is vague – what is low income?” “Those with a higher level of need would be left at risk.” “Some individuals can end up missing out on critical help.” “Care needs could go unmet.” “Individuals may be put in unsafe circumstances.” “Not meeting needs causes harm.” 154
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93 Needs Escalating to Crisis and Higher Long‑Term Costs - Many respondents highlight the false economy of limiting early or moderate support. Raising thresholds delays intervention, meaning people only receive help when their needs become critical. This leads to crisis responses, hospital admissions, residential placements and higher long‑term costs. Disproportionate Impact on Vulnerable and Complex‑Needs Groups - Respondents express strong concern for groups already facing disadvantage. People with learning disabilities, physical disabilities, long‑term conditions, children with additional needs, and those without informal support networks are seen as most at risk of harm from raised thresholds or capped packages. Creation of a Two‑Tier System and Increased Inequality - A recurring theme is inequity of access. Respondents fear a system where those with money, knowledge or advocacy can buy or argue for care, while others go without, deepening inequality and marginalisation. “Low level care not being delivered will result in crisis situations.” “Needs escalating before they receive support.” “People enter hospital or crisis services more frequently.” “More costly in the long run (crisis intervention).” “Preventable deterioration becomes common.” “This will adversely affect the Learning Disability group I work with.” “People with complex needs would be affected most.” “Those with the least voice are most at risk.” “Possibility of a two tier system.” “Those financially stable are able to pay for additional services and those with low income are not.” “Individuals who ‘do not shout the loudest’ will lose out.” “People who understand their rights will fare better than those who don’t.” 155
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94 Increased Pressure on Families and Unpaid Carers - Many responses highlight hidden transfer of burden. Reducing formal care shifts responsibility onto families and unpaid carers, increasing stress, burnout, relationship breakdown and risk of placement failure. People Declining or Avoiding Support Due to Cost or Thresholds - Respondents note that people may stop asking for help, decline essential services, or disengage entirely due to fear of costs, stigma, or ineligibility. Impact on Mental Health, Wellbeing and Social Inclusion - Beyond physical care, wider impacts are emphasised. Reduced care would increase isolation, anxiety, depression and loss of independence, particularly where social and preventative supports are cut. Increased Pressure on the NHS and Other Services - Respondents consistently highlight system‑wide consequences. Reduced social care provision is expected to increase demand on hospitals, emergency services, mental health services and safeguarding systems. “The ‘unpaid’ work usually falls on family members.” “Increase carer stress. Destroy familial relationships.” “Families may absorb the workload, leading to burnout.” “Increased families in crisis.” “People who need it won’t ask for it.” “They may opt not to ask for supports.” “People will decline essential services due to cost.” “Some people won’t reach out for help when they need it.” “Services being removed, mental health and wellbeing.” “Loss of social interaction.” “Reduce choice, control and independence.” “People become housebound and isolated.” 156
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95 Legal, Ethical and Human Rights Concerns - Some responses frame the issue explicitly in rights‑based terms. Cost limits and raised thresholds are seen as potentially incompatible with statutory duties, care standards and human rights principles. Minority Views: Potential Efficiency, Awareness or Independence - Some respondents suggest clearer thresholds may improve understanding of limits, reduce inappropriate use, or encourage independence, but these views are typically caveated and outweighed by risk concerns. Question 28 - What additional support might be needed for vulnerable people? Overall, respondents emphasise that vulnerable people would require significantly enhanced wrap-around support to remain safe, independent and engaged if pressures on formal care increase. There is strong consensus that support must move upstream, focusing on early intervention, advocacy, communication, and community-based resources rather than crisis response. Advocacy, Navigation and Rights‑Based Support - One of the strongest recurring themes is the need for increased advocacy and system navigation support. Vulnerable people often struggle to understand complex systems, changing criteria, and financial implications. Independent advocacy and dedicated support workers are seen as essential safeguards to prevent people from “falling through the cracks”. “Increase pressure on NHS by putting people in hospital.” “More people end up in hospital.” “Increased acute hospital admissions.” “More inappropriate referrals.” “Impeding on their human rights.” “Contradicts Health and Social Care Standards.” “Transforms care into a minimum safety net.” “People may be forced into institutional settings.” “It might be a fairer system.” “Could enable more people to access services sooner.” “It may assist people to become more independent.” 157
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96 Clear, Accessible Communication and Information - Many respondents stress the importance of how information is communicated, not just what is communicated. People need plain‑language, accessible, timely information about changes, eligibility, and options, with one‑to‑one support where needed. More Frequent Reviews, Welfare Checks and Monitoring - There is strong concern that vulnerable people need closer oversight, particularly if services are reduced. More frequent reviews, check‑in calls, and face‑to‑face visits are needed to ensure needs are still being met and to detect emerging risk early. Income Maximisation, Financial Support and Safeguards - Financial vulnerability is a major concern. Respondents consistently highlight the need for income maximisation, benefits checks, budgeting support, and safeguards where people are asked to contribute to care costs. “More advocacy.” “An individual support person that can be contacted with any concerns.” “Local navigators who can help residents understand Self‑Directed Support options.” “Advocacy is a statutory safeguard that prevents people from falling through the cracks.” “Access to consistent and available advocacy services.” “Easy read step by step application.” “Clear guidance in plain language.” “One to one support to understand options.” “People struggle to understand complex systems.” “Communication, reassurance, suitable information packs.” “Vulnerable SUs should be reviewed more frequently.” “Additional check visits or phone calls.” “Welfare checks.” “Unscheduled drop‑in visits to check people are safe.” “A phone call will not be acceptable — face to face interaction is required.” 158
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97 Telecare, Technology and Assistive Supports - Technology is seen as a supporting tool, not a replacement for care. Expanded telecare (sensors, alarms, monitoring) can help manage risk and independence, but availability, affordability and suitability remain concerns. Emotional, Social and Mental Health Support - Respondents strongly emphasise emotional and social needs, particularly post‑COVID. Vulnerable people need social connection, befriending, community activities and emotional support. Support for Unpaid Carers - Carer wellbeing is repeatedly highlighted as critical. Protecting carers through respite, training, emotional support and practical help is seen as essential to sustaining care at home and preventing breakdown. “Income maximisation and sign posting to community supports.” “Full benefits checks/support.” “Support in managing their money.” “Contributions waived where this is not financially sustainable.” “Help with budgeting or benefit entitlements.” “More telecare, such as property exit sensors and sensor mats.” “Higher use of telecare.” “Digital aids.” “Technology could be effective but availability is limited.” “Social connection and emotional support.” “More social/emotional support is needed for older people.” “Opportunities for social interaction.” “Befriending and people going into homes for social interaction.” “Access to mental health services.” “Guaranteed short breaks and specialist training for carers.” “Better support for carers.” “Carer support — respite, training, emotional support.” “Protecting the wellbeing of the carer is the most cost‑effective support.” 159
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98 Stronger Community, Third‑Sector and Preventative Support - Many respondents call for expanded community‑based infrastructure. Community hubs, third‑sector services and preventative supports are viewed as vital for people who do not meet eligibility thresholds but still need help. Specialist and Targeted Services for High‑Need Groups - Respondents stress that some groups need tailored approaches. Learning disability, dementia, palliative care, care leavers, and people with complex needs require specialist services that should not be diluted by generic approaches. Prevention, Early Intervention and System Coordination - Respondents argue for shifting resources toward early intervention, coordinated working, and proactive support to prevent escalation. Question 29 - Any other feedback? Overall, respondents express deep concern about the direction, framing and values underpinning the consultation, alongside frustration about long-standing system “More community supports to provide lower level supports.” “Low‑barrier community hubs.” “Coordination and advertising of third sector provision.” “Not volunteer‑led — it has to be sustainable.” “The learning disability population is a highly specialised area.” “Specialist dementia and palliative support.” “Transitional housing for vulnerable young people leaving care.” “Highly complex areas should be considered in isolation.” “Early intervention to prevent escalation.” “Wrap‑around support rather than crisis management.” “Stronger front‑door processes.” “Better inter‑agency communication.” 160
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99 inefficiencies, leadership decisions, and perceived misalignment between financial decisions and frontline realities. Many feel the exercise risks normalising service reduction rather than addressing root causes such as governance, commissioning models, integration failures, workforce sustainability, and prevention. A recurring message is that early intervention, whole-system reform and genuine co-design are being overlooked in favour of short-term, divisive cost-shifting to service users and staff. Loss of Trust in Leadership, Governance and Decision‑Making - A strong theme is frustration with senior leadership and governance structures, including perceived inequity between frontline cuts and senior pay or management costs. System Inefficiency, Duplication and Poor Integration - Many respondents identify inefficiency and fragmentation as key drivers of cost pressure. Poor integration between NHS and social care, particularly incompatible IT systems, duplicated assessments, and unclear responsibilities is seen as wasteful, frustrating for staff, and confusing for service users. Prevention, Early Intervention and Holistic Care Are Being Undermined - This is one of the most consistent themes. Respondents repeatedly state that early intervention, reablement, emotional support and community‑based prevention are the first services to be cut, despite being the most cost‑effective long‑term. “NHS and social care need to work more seamlessly — different IT systems waste huge amounts of time.” “Patients are left wondering why teams don’t communicate.” “We duplicate workload unnecessarily.” “I do question the value and worth of the IJB management role and costs.” “Why are we talking about cutting services to the elderly and giving senior leadership large pay rises?” “In such desperate times how can this be justified?” “Early intervention is key and was missed by this questionnaire.” “We always cut preventative services first — this puts more pressure elsewhere.” “We need to invest in good health early.” 161
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100 Risk of Shifting from Person‑Centred Care to Task‑Based Care - Respondents warn that financial pressure is pushing services away from holistic, relationship‑based care toward a narrow focus on safety and basic tasks. Workforce Pressures, Staffing Models and Morale - Workforce sustainability is a major concern. Respondents highlight high sickness absence, reliance on bank staff, unrealistic visit times, rota inefficiencies, and poor morale, all of which affect quality and cost. Poor Use, Loss and Mismanagement of Resources and Assets - Respondents identify avoidable waste. Concerns include equipment being over‑issued, not returned, or misused; block contracts not being scrutinised; and insufficient recovery of debt. Fairness, Responsibility and Charging Debates - Some respondents argue more strongly for means‑testing and personal contribution where affordable; others fear this undermines universality and equity. There is frustration at perceived inconsistency. “There is a risk of moving to a task delivery model rather than whole‑person care.” “This goes against social work values.” “Permanent carers need to increase — reliance on bank staff is not sustainable.” “15‑minute visits are unrealistic.” “Staff are under immense pressure and morale is suffering.” “Equipment is issued too readily and often not returned.” “Block payments and contracts need revisited.” “Too many people do not pay for services, and nothing happens.” “Those who can afford to pay should.” “Services feel unfairly delivered.” “People should not be penalised for need, but responsibility matters too.” 162
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101 Marginalisation of Certain Groups and Inequalities - Respondents fear widening inequality. There is concern that learning disabilities, mental health, addictions, carers, and deprived communities are insufficiently considered and most likely to be harmed by service reduction. Criticism of the Consultation Design and Framing - Many respondents challenge the process itself. The consultation is described as divisive, unclear in purpose, overly adult‑care focused, insufficiently accessible, and lacking options that promote innovation or collaboration. Call for Co‑Design, Transparency and a Better Way Forward - Respondents strongly advocate for co‑design with staff, communities, third sector and people with lived experience; greater transparency; and a reframing of the challenge around hope and shared responsibility. “The learning disability population will be disproportionately affected.” “This risks further marginalising already excluded communities.” “Those without advocacy will lose out.” “We struggled to understand what this questionnaire is trying to achieve.” “It feels designed to force impossible choices.” “This encourages fear rather than collaboration.” ID Please indicate number of participants involved in this collective response 1 24 2 8 3 51 4 29 5 9 6 4 7 14 8 5 9 6 10 15 “It feels designed to force impossible choices.” “This encourages fear rather than collaboration.” “This should be used as a learning opportunity.” “There is capacity to find a better way forward.” “Service users should be at the centre of any decision.” “We need collaboration, imagination and hope.” “This should be used as a learning opportunity.” “There is capacity to find a better way forward.” “Service users should be at the centre of any decision.” “We need collaboration, imagination and hope.” 163
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102 Community Group Consultation Question 1- Please confirm you are responding on behalf of a community group in North Ayrshire. All participants who took part in the community group based element of the consultation confirmed that they were responding on behalf of a community group in North Ayrshire. 100% (n=165) of contributors indicated “Yes.” ID Please indicate number of participants involved in this collective response 1 24 2 8 3 51 4 29 5 9 6 4 7 14 8 5 9 6 10 15 165, 100% Please confirm you are responding on behalf of a Community group in North Ayrshire (N=165) Yes 164
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103 Percentages shown are calculated based on total respondents to this question and are weighted using the reporting number of participants involved in each submission. Where no answer was provided, the reported participant headcount is reflected within the non- response category. Question 2 - Please indicate number of participants involved in this collective response. Community groups were asked to indicate how many individuals contributed to each collective submission. Across the ten group responses, participation levels varied significantly, reflecting the diverse size and composition of community organisations involved in the consultation. The smallest groups reported 4 to 6 participants, while larger groups contributed responses on behalf of 24, 29, and 51individuals. This distribution demonstrates strong collective engagement across a broad spectrum of community groups, with larger organisations providing substantial representation and smaller groups still contributing meaningful perspectives. The total number of individuals represented across all community group submissions was 165 people. Question 3 - What aspects of social care do you feel are most important? Community group respondents highlighted a broad range of priorities when asked which aspects of social care they consider most important. The results show a clear emphasis on choice, shared support, and affordability, reflecting the diverse ways in which community members understand and experience social care. 165
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104 The most frequently selected priority was choice and control over how care is delivered, identified by 42% of respondents. This was closely followed by models of shared support (39%). A substantial proportion of respondents (36%) also selected “Other”, which suggests the presence of diverse additional priorities not fully captured by the categories provided. Similarly, 36% felt that care being free of charge was essential. Personal safety support was highlighted by 28% of respondents, signalling the importance placed on safeguarding and ensuring people remain safe and well within their community. Smaller but still meaningful proportions selected personal care (13%), practical support such as housework or shopping (13%), and supports to maximise independence (7%), reflecting recognition that day-to-day practical assistance continues to play an important role for many groups. A further 15% did not provide a response to this question. This question allowed respondents to select more than one option. Percentages are calculated as a proportion of total respondents to this question and are weighted by reported participant headcount. Combined percentages may exceed 100 percent. Where a submission did not provide an answer, the reported participant number is reflected within the non- response category. Question 4 - Please provide any additional comments in the box below Following their responses on the most important aspects of social care, community groups provided a wide range of qualitative comments that offered deeper insight into their priorities, values, and concerns. These comments reveal a strong emphasis on lived experience, rights-based approaches, holistic care, and the importance of community-centred supports. Lived experience as essential evidence - Participants stressed that any interpretation of the consultation must be rooted in the real-life experiences of people who both provide and receive care. Respondents highlighted the voices of unpaid carers and cared for individuals, noting their day-to-day realities. 166
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105 Rejection of prioritisation - A strong theme was discomfort with being asked to rank or choose between essential supports. Participants argued that people’s needs are not comparable. For many, the act of prioritising implied that certain needs were less legitimate or less fundamental, which they rejected. Interconnected needs - Many respondents described social care needs as inherently holistic and interdependent and warned that breaking down support into isolated categories oversimplifies complex realities. Choice and control as a legal and ethical foundation - Choice and control emerged as a broad expectation, not an optional element. Participants referenced statutory rights under the Social Care (Self-directed Support) (Scotland) Act 2013 and Article 19 of the United Nationals Convention of the Rights of Persons with Disabilities - The Right to Live independently and be included in the community. The respondents noted that “choice and control is not optional; it is the foundation of SDS”. All support types linked to safety, dignity and prevention -Participants presented concerns around the distinction between different types of care and suggested this is not how people experience support. Participants suggested that “removing destabilises the rest.” Suggesting that even low level or practical supports play a critical preventive role in maintaining wellbeing and avoiding crisis situations. Importance of community based and preventative supports - Respondents described access to community settings providing peer support as transformative. “People are not homogenous, and no two support packages look the same” “You can’t compare one person’s needs with another’s.” “Every disabled person needs an element of all of that. Asking us to pick four is impossible”. “Why is choice and control even a question?” “With all those different boxes, you cannot have one without the other.” “Every single form of support prevents neglect. You can’t pull one bit out and say the rest don’t matter.” “The Peer Support I've gotten from the RAMH Recovery College has saved my life” 167
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106 Need for inclusive, equality focused-, LGBT+ affirming care - A number of comments emphasised the importance of inclusive services that actively recognise and respect diversity. Respondents highlighted the need for care environments where identity is affirmed, noting, for example, that LGBT+ individuals can feel pressure to “go back in the ‘closet’”. Participants also pointed out that some groups, particularly older LGBT+ people, may face greater risk of isolation due to estrangement from support networks. Concerns around the consultation design - Some participants expressed frustration with aspects of the consultation itself. They felt certain questions were based on a misunderstanding of disability and care. Independence – Broader than technology - Respondents challenged narrow definitions of independence, particularly those heavily focused on digital solutions and expressed the essential nature of independence and quality of life. “Need to have spaces for LGBT+ People in the community” “focusing exclusively on digital provisions… is not a panacea” “Feeling useful is a huge part of independence for me.” 168
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107 Question 5 - Which of these services do you feel are most integral to people’s care? Community group respondents highlighted a broad mix of services as integral to people’s care, with the strongest emphasis on emotional support and core daily living tasks. The most frequently selected service was emotional support (52%), followed by mobility assistance (48%) and personal hygiene (48%), underscoring the importance placed on mental wellbeing, safe movement, and dignity in everyday care. A second tier of priorities featured getting dressed (34%), day services (30%), and transport to appointments or activities (30%). Together, these choices point to the value respondents place on routine daily functioning, structured community engagement, and the practical help required to participate in community life. Eating and drinking (27%) was also identified as integral, reflecting concerns about nutrition, hydration, and safety around meals for those who cannot always prepare or consume food independently. Lower levels of selection were recorded for continence management (16%), housework, making beds and laundry (9%), shopping and running errands (9%), and medication and treatment (8%). Notably, telecare services (0%) were not selected by community group respondents in this question. A 34% “no response” rate was recorded for 52% 48% 48% 34% 34% 30% 30% 27% 16% 9% 9% 8% 0% Emotional support Mobility Personal hygiene Getting dressed No Response Day services Transport for appointments or other activities Eating and drinking Continence management Housework, making beds, and laundry Shopping and running errands Medication and treatment Telecare services like community alarms Proportion of respondents (multiple responses permitted) Services of Social Care Which of these services do you feel are most integral to people’s care? (N=165) 169
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108 this item in the community group dataset, indicating that a sizeable minority did not choose a specific service category here. This question allowed respondents to select more than one option. Percentages are calculated as a proportion of total respondents to this question and are weighted by reported participant headcount. Combined percentages may exceed 100 percent. Where a submission did not provide an answer, the reported participant number is reflected within the non- response category. Question 6 - Please provide any additional comments. Respondents provided a range of answers relating to this question and themes are described below in order of priority. All listed services are interdependent and essential -Respondents emphasised that the question design did not reflect how care works in real life. People described the list of services as “artificially separated” and “impossible to rank”, because every element contributes to a person’s overall safety, dignity, and ability to live independently. Participants stressed that for many disabled people and those with long-term conditions, supports are interconnected. Tasks such as dressing, mobility, continence, eating, and emotional support are deeply interconnected, and removing one destabilises the whole support package. Person centred, holistic assessment is essential - Respondents reiterated that care should never be broken down into isolated tasks. Instead, it must be assessed holistically, taking account of the person’s health, environment, mental wellbeing, communication needs, and daily routines. “You can’t separate these things. They all work together. Take one away and everything else starts to fall apart.” “It depends entirely on what’s wrong with you and how you function… most people need a mix.” “the consultation will impede upon Self-directed Support legislation and guidance which states what the local authorities must do to give access to SDS in a way that supports people’s right to choice, dignity and being able to take part in the life of their communities”. 170
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109 Participants stated that person-centred planning, as required under Self-Directed Support (SDS), cannot be upheld through a ranking approach. Emotional support and social connection are integral, not optional – Emotional support was consistently raised as fundamental, yet respondents felt it is often treated as secondary or “non-essential.” People emphasised that emotional security, reassurance, communication, and connection underpin safe, dignified care. Practical support is as essential as personal care Participants rejected the idea that tasks such as housework, laundry, shopping, or food preparation are less important than washing or dressing. Examples highlighted how ‘practical’ tasks directly affect safety, health, and wellbeing. Practical support was described as a core part of maintaining dignity and preventing deterioration. Issues raised around the question - Many respondents strongly criticised the framing of Question 5. They felt it, misrepresented how care works, forced people to make “impossible choices”, risked creating division among disabled people and non-disabled people and could be used to justify cuts. Community-based supports (day centres, peer support) are essential components of care - Community spaces, day services, transport, and peer networks were described as vital for preventing isolation and maintaining mental health. Data from young carers reinforces that ALL types of support are valued - Young carers, supporting siblings, parents, or grandparents, highlighted the importance of a wide range of “Try providing continence care or medication without reassurance or communication. You can’t do it safely or humanely “ “If you help someone shower but leave them in a dirty bed because laundry isn’t ‘essential’, what are you actually achieving?” “This feels like asking which parts of your life you can live without.” “Take away day services or transport and people become housebound. Then mental health deteriorates, carers burn out, and costs increase.” 171
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110 services for both them and the people they care for including emotional support, structured day services, respite and practical help (laundry, shopping, errands). Their feedback demonstrated that younger carers rely on multiple forms of support, not just personal care tasks. Challenges around legal basis -Participants raised significant concerns that the question conflicts with legal duties under Self-Directed Support legislation. They emphasised that SDS requires, choice, control and dignity along with participation in community life. Participants argued that asking people to rank essential services is incompatible with these obligations. Human rights / disabled people’s rights - Participants highlighted that social care is grounded in rights and referenced domestic SDS law. Some felt the question encouraged competition for resources and “that the consultation perpetuates a blame culture towards disabled people as the main driver of threats to national and local economic stability”. Question 7- How do you feel about prioritising personal care over non-personal care when resources are limited? The results show a varied response among the n=165 participants, indicating significant differences in opinion on whether personal care should be prioritised when resources are limited. “feels like they want us to move back in decades.” 0% 38% 7% 41% 0% 15%% of survey participants Agreement Level How do you feel about prioritising personal care over non-personal care when resources are limited?(N=165) No Response Strongly Disagree Disagree Neutral Agree Strongly Agree 172
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111 A large proportion of participants expressed disagreement with the idea of prioritising personal care at the expense of non-personal support. 38% strongly disagreed, while a further 7% disagreed, demonstrating that nearly half of participants rejected the notion that these types of care can be separated or ranked in terms of importance. Only 15% strongly agreed, and 41% remained neutral. Percentages shown are calculated based on total respondents to this question and are weighted using the reporting number of participants involved in each submission. Where no answer was provided, the reported participant headcount is reflected within the non- response category. Question 8- Please provide any additional comments Across all engagement groups, there was a strong and consistent rejection of the idea that personal care can or should be separated from so-called non-personal care. Participants repeatedly stated that this distinction does not exist in real life and does not reflect the lived experience of people who rely on social care, their families, or those who provide care. Strong rejection of separating personal and non-personal care -Respondents disagreed with the framing of the question, describing it as “false, reductive, and dangerous”. They explained that non-personal supports, such as shopping, laundry, cleaning, transport, emotional reassurance, prompting, and food preparation, are often what enable personal care to happen safely and with dignity in the first place. Participants emphasised that “all care is personal when you’re disabled”, illustrating that every element of support affects an individual’s wellbeing, safety, autonomy, and capacity to live independently. Support needs are interconnected and holistic - People strongly felt that non-personal care is just as essential as personal care because it prevents deterioration, supports wellbeing and sustains daily functioning. Some felt that social care should be “purpose led which enables freedom, choice, control and self-determination”. “If someone doesn’t get help with shopping, how do they eat? If they’re left in a dirty bed, what happens next? Hospital.” “Some non-personal care can give connection and interaction, while personal care brings dignity.” “The purpose of life is a life of purpose” 173
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112 Prioritisation undermines independent living and human rights - Disabled respondents and representative organisations highlighted that separating personal from non-personal care contradicts the principles of independent living and Self-Directed Support (SDS). They warned that framing care in this way risks denying people their rights and reducing their ability to participate in community life. Others emphasised that personal care alone cannot sustain a meaningful life. Participants stressed that access to both types of support is fundamental to dignity, autonomy, and equality. Importance of individual circumstances - Across groups, participants emphasised that needs vary widely between individuals and change over time. They argued that decisions should be based on holistic, person-centred assessment, not prioritisation. Impact on people with learning disabilities, autism, mental health needs, and hidden disabilities - Respondents expressed concern that separating care types disproportionately harms people whose needs are not easily recognised or quantified. They described the framing as particularly unsafe for people with learning disabilities, autism, mental health conditions. Young carers’ perspectives - Young carers also highlighted that both personal and non-personal supports are essential. While a small number prioritised one form over the other. “When we had the lockdown… my personal care got cancelled. I was living in my clothes for weeks.” “Having a shower… then sitting in your room all day isn’t going to cheer you up.” “It all depends on the individual circumstances… giving people the option to choose makes their life more flexible.” “drawing this distinction would disproportionately impact people whose needs are less visible, reinforcing inequality and increasing safeguarding risk”. 174
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113 Question 9 - Do you know that there is eligibility criteria for care? The results show a mixed level of awareness among community group respondents regarding the existence of eligibility criteria for social care. Of the n=165 participants, 44% (n=73) reported that they were aware that eligibility criteria exist. However, a slightly larger proportion, 53% (n=87), indicated that they did not know such criteria were in place. A small number, 3% (n=5), provided no response. This suggests that more than half of respondents were unaware of the formal framework that determines access to social care support. Percentages shown are calculated based on total respondents to this question and are weighted using the reporting number of participants involved in each submission. Where no answer was provided, the reported participant headcount is reflected within the non- response category. Question 10- Please provide any additional comments A range of opinions were recorded in this section and summarised below. Lack of transparency and poor communication about eligibility criteria - Across responses, participants expressed significant concern about the lack of clear, accessible information on eligibility criteria for social care. Many reported that they had never been provided with the criteria, even those who had long-term involvement with services. One participant noted that “We’ve never been given the eligibility criteria. Not even internally.” 73, 44% 87, 53% 5, 3% Do you know that there is eligibility criteria for care? (N=165) Yes No No Response 175
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114 “someone may have went over it at the very start, but no one has covered it again,” highlighting that any information shared is easily lost without ongoing communication. Inequity and inconsistency in how criteria are applied - Several respondents felt that eligibility decisions did not seem fair, balanced, or consistently applied. There was a perception that some people received more support than they required, while others with high levels of need were unable to access timely help. For some, this inconsistency raised questions about whether wider systems such as the benefits structure also required reform. Barriers to accessing social care and systemic complexity - Participants described navigating the eligibility process as difficult, with the system feeling inaccessible. One respondent shared a lived experience of significant disability and being told that arranging social care would take months, leaving them unable to walk, bend or move during that period. This participant indicated a gap between criteria, assessment, and real-life urgency, particularly when people experience sudden or unexpected changes in health. Language, accessibility and communication barriers - Carers raised concerns about the language used in the consultation question. The terminology was described as not user-friendly and lacking plain English, making the process harder to understand. Risk of disadvantage for those without advocacy or confidence - A theme presented was concern that unclear or inaccessible information disproportionately disadvantages people who are less confident, less articulate, or without anyone to advocate on their behalf. Participants underscored that people should not be required to quote legislation, policy language, or procedural terminology to receive the help they need. Question 11- If the group answered yes above, how clear and accessible do they find the current eligibility criteria for care? “Known people getting more than they should and others not getting the help they need.” “It was completely useless… I was told it could take months to arrange social care.” “A parent of a disabled child should not need to quote legislation to get help.” 176
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115 Lack of Clarity & Accessibility of Eligibility Criteria - Across responses, people consistently reported that the eligibility criteria are not clear, not accessible, and not routinely provided. Several stated they had never been given written criteria, nor had scoring or thresholds been explained. Others described the process as unclear “at the beginning” and said it only becomes easier after you are already in the system. Inconsistent or Overly Technical Information - Where information was given, participants described it as inconsistent, overly technical, or dependent on the individual worker’s interpretation. This inconsistency was described as making it difficult to understand decisions, prepare for assessments, or challenge outcome. Difficulty Accessing Information – Some people reported that they simply did not know how to access the criteria. Another reflected that they only understood the criteria once someone else (e.g., a parent) explained it to them. Lack of Proper Communication at Assessment - Participants highlighted that eligibility was not explained during assessment or review, leaving them unsure of how decisions were made. Several said they were never given written criteria, and one person noted that someone “may have gone over it at the very start,” but it was never explained again. Language and Accessibility Barriers - Respondents noted the language used is not user-friendly, with calls for easy read formats. System Failures Leading to Delays or Unmet Need - A powerful example described the system unable to respond relating to an extreme need. One participant reflected on being unable to care for themselves for a year after becoming disabled and said friends stepped in because they were told support, “could take months”. Another said the eligibility system is “a joke,” reflecting frustration with delays and unmet need. “You’re assessed, but you’re never told what the rules actually are.” “Not accessible as did not know how to access it.” “the language is not user friendly and easy-reads would be helpful.” 177
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116 Question 12- Out of the following approaches which should be prioritised to ensure fairness and sustainability of eligibility criteria? The responses to this question show a strong preference for a consistent, system-wide approach to applying eligibility criteria in North Ayrshire. A significant majority of respondents,76%, felt that the most important priority is to apply consistent thresholds across all services. A smaller proportion, 15%, selected considering individual circumstances on a case-by-case basis. An even smaller group, 9%, believed that the priority should be to focus on those with the highest or greatest need. This indicates that although some respondents see targeted prioritisation as important, most felt that fairness is better achieved through consistent application rather than through selective emphasis on certain groups. Percentages shown are calculated based on total respondents to this question and are weighted using the reporting number of participants involved in each submission. Where no answer was provided, the reported participant headcount is reflected within the non- response category. Question 13 - Please provide any additional comments in the box below Participants views around this section are summarised below. Preference for case by case decision making - Participants were unanimous that eligibility decisions must be individualised, grounded in lived experience, and based on meaningful 76% 15% 9% Consider individual circumstances case-by-case Apply consistent thresholds across all services Focus on those with highest or greatest need % of survey participants Out of the following approaches, which should be prioritised to ensure fairness and sustainability of eligibility criteria? (N=165) “Eligibility must be applied on a case by case basis.” “Social workers and professional workers need to see people and how they are living before deciding whose funding is cut.” 178
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117 conversations. They stressed that disabled people’s needs vary widely and cannot be reduced to generic criteria. Several contributors emphasised that only case by case assessments prevent people from falling through the cracks. Rejection of blanket thresholds & standardised comparisons -There was strong, consistent rejection of blanket eligibility thresholds or attempts to rank or compare different impairments. People felt these approaches were unfair, and harmful. Fairness = equity (not sameness) - Respondents highlighted that treating everyone equally by applying identical thresholds ignores the varied barriers disabled people face. Fairness must recognise different levels of need and support. Some described the use of fairness in the consultation as misleading or a “weaponisation” of the term. Concerns about prioritisation of only highest need - Participants deeply opposed any move to prioritise only those with “critical” needs. They stated this approach excludes people requiring early or moderate support that prevents deterioration. Independent Living Principles & Human Rights - Contributors emphasised that proposals contradict the core principles of SDS and the UNCRPD, including choice, dignity, participation “blanket approaches risk undermining SDS in its entirety, turning it from a rights-based framework into a rationing exercise driven by cost rather than need”. “You can’t claim to support Self-Directed Support while stripping away everything that makes life worth living.” “How do you compare a physical impairment to a learning disability? It’s a loser’s game.” “Fairness does not mean sameness.” “Fairness must be understood in the context of equity.” “Weaponisation of fairness… implying some people take too many resources.” “By focusing on those with the highest need it excludes those who need urgent support for a short period which then grows into a long term need.” “Narrowing eligibility was seen as reducing people to mere survival rather than the ability to live full and meaningful lives”. “We’ve spent decades trying to get people out of institutions. This feels like dragging us back there.” “Proposals confining people to their homes contradict UNCRPD obligations.” 179
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118 and independent living. They warned that restricting eligibility undermines decades of progress. Threshold raising impacts on dignity & inclusion - Many expressed fear that narrowing access would strip disabled people of autonomy, dignity and community involvement. Some described the emotional and wider impact as severe. Negative system impacts - Respondents warned that raising thresholds would cause crises, increase long term costs, and destabilise families and care arrangements. Prevention would be lost, increasing pressure on NHS and unpaid carers. Holistic assessments required (Social Model of Disability) -People stressed that assessments must consider the whole person, their environment, and the barriers they face not isolated “Assessment must be holistic and grounded in the social model of disability.” “They’re not talking about living. They’re talking about existing.” “It’s basically saying our lives aren’t worth the same.” “This is edging towards something much darker. It’s like saying some lives are worth investing in and some aren’t” “Rigid thresholds don’t save money. They just delay the bill — and make it bigger.” “People will fall through the cracks.” “Support must consider all parts of a person’s life and how they interlink.” “There is somebody who doesn’t know what this means emotionally if you don’t meet criteria need.” o 180
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119 tasks or medical labels. Ethical concerns / emotional impact - People described fear, anxiety, and distress about what changes would mean for their lives and survival. Question 14 - Thresholds for accessing social care are set locally to establish the point at which a local authority will provide an individual with care. What concerns might arise if thresholds for accessing care were changed in the future? Shift from prevention to crisis-driven, high-cost care - Participants warned that raising thresholds particularly moving to a “critical only” model would undo preventative care and force the system into crisis response. Small amounts of early support were described as essential to avoid escalation. Reduced access to care & increased risk of harm - Participants feared that raising thresholds would exclude many people who need support, with clear safety risks. The describe concerns that withdrawal of support would destabilise lives and increase harm. Disproportionate impact on deprived areas & inequalities (Postcode lottery) -Concerns were raised that increased thresholds would worsen existing inequalities and create local variation in access to care. “You’re not removing need. You’re just delaying it until it explodes.” “Less people will have access to care.” “People will die. Those who don’t will need far more care later.” “This is an inhume level of practice. It is dystopian.” “Tiny bits of support keep people going. Take that away and everything collapses.” 181
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120 Fear, anxiety & loss of trust in the system - Participants expressed strong emotional reactions, including fear, distrust, and a belief that decisions were predetermined. Threats to rights, independence & participation - People highlighted that changes to thresholds would undermine autonomy and erode rights protected under SDS and human rights frameworks. Uncertainty about thresholds creates distress - Lack of clarity about current thresholds and how they might change created anxiety and confusion. “People in more deprived areas will suffer more due to health inequalities.” ▪ “Budgets and resources take precedent over the freedom and participation in society. Any further cuts or changes to thresholds will continue to erode disabled people’s international”. “Any further cuts or changes to thresholds will continue to erode disabled people’s international and domestic rights”. “Could lead to people moving out of North Ayrshire due to postcode lottery.” “I think the Council will just make it harder/impossible…” “You’ve already decided where cuts will fall…” “Would anyone who no longer meets the new threshold have their care withdrawn?” 182
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121 Increased burden on families and unpaid carers - Raised thresholds were seen as transferring responsibility to families particularly harmful for already overwhelmed carers. Question 15- What do you see as the most effective ways to communicate eligibility criteria and decisions? The results show a preference for clear, accessible, and direct communication when sharing information about eligibility criteria and decisions. The most frequently selected method was clear written guidance, chosen by 95% of respondents. The second most preferred method was conversations with care staff, selected by 70% of participants. This reflects the value “shift pressure onto unpaid carers.” 95% 70% 68% 48% 39% 1% Clear written guidance Conversations with care staff Community events or drop-ins Online tools or explainer videos Feedback after any appeals and complaints process Other Proportion of respondents (multiple responses permitted) Communication Method What do you see as the most effective ways to communicate eligibility criteria and decisions? (N=165) “I am really frightened to be honest. I live with my parents which is very lucky, if my support package is affected. But I don’t want to have to put that extra pressure on my mum. My parent’s elderly. It’s not fair.” 183
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122 respondents place on personal interaction, the opportunity to ask questions, and the reassurance provided by speaking directly with knowledgeable staff. Community events and drop-ins were also highly rated, selected by 68%. Digital communication also featured prominently: 48% of participants selected online tools or explainer videos, signalling that while written and in-person methods are strongly preferred, many people also welcome digital resources that simplify complex information or visually guide them through processes. Just under two-fifths of respondents (39%) identified feedback provided after appeals or complaints processes as an important communication method and a very small number (1%) selected “Other”. This question allowed respondents to select more than one option. Percentages are calculated as a proportion of total respondents to this question and are weighted by reported participant headcount. Combined percentages may exceed 100 percent. Where a submission did not provide an answer, the reported participant number is reflected within the non- response category. Question 16 – Please provide any additional comments in the box below Participants provided the following information and is summarised below. Multiple communication methods are essential - Participants stressed that communicating eligibility and decisions cannot rely on a single method. People need information through clear written guidance, face to face conversations, accessible online explainers, and community-based events, recognising that different formats allow people to absorb information at their own pace and in environments where they feel safe and supported. Transparency, honesty & consistency are critical - Participants emphasised that communication must go beyond tools and formats it must be trustworthy. They described major gaps between what SDS promises and what people experience, highlighting inconsistencies, mixed messages, and a lack of openness about decisions. They suggested that “there is no singular method of practice which should be used to disseminate information.” “You’re told one thing on paper, and something completely different happens when you try to access support.” 184
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123 without transparency about criteria, limitations and processes, trust reduces and families feel the system is working against them rather than with them. Frontline staff need better knowledge & training - A recurring concern was that frontline staff often do not fully understand SDS legislation, eligibility rules, or people’s rights. Some participants reported having to educate professionals themselves. Participants indicated that staff need stronger training so they can communicate accurately, clearly, and confidently with the people they support, including minority groups who may require more sensitive or informed engagement. Importance of independent advocacy - Independent support organisations were described as essential safeguards that help people navigate a complex and often intimidating system. Participants rejected attempts to discredit these organisations, noting that they provide information grounded in law and national guidance. Independent advocacy ensures people understand their rights, can challenge decisions, and are not left to navigate unclear or inconsistent processes alone. Clear, accessible, inclusive communication - Participants highlighted that information must be accessible to everyone, including disabled people who face higher levels of digital exclusion. This includes Easy Read formats, large print, alternative colours, Braille, BSL, audio options, multiple languages, and paper copies. They called for communication that complies with the Equality Act and the Principles of Inclusive Communication, ensuring people can access information regardless of disability, literacy level, or digital access. Cultural competence & safe spaces for minority groups -For some groups, including LGBT+ people, mainstream communication spaces do not always feel comfortable or inclusive. Participants emphasised the need for identity-aware communication, delivered by people “If independent advice is treated as a nuisance, people lose one of the few protections they have.” “greater risk of digital exclusion present for disabled people, who are four times more likely to face digital exclusion than non-disabled people” “I had to send the social worker the guidance because they didn’t know it.” 185
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124 who understand their experiences. Specialist community spaces were described as more appropriate and comfortable for discussing sensitive issues such as eligibility, support needs, or rights. Disconnect between legislation, policy & practice -Participants described a widening gap between the rights and principles promoted in SDS legislation and the reality of local practice. While SDS emphasises choice, dignity and control, participants stated that people can experience the opposite when information is inconsistent, unclear, or withheld. Need for clear explanations of eligibility criteria & decisions -A major theme was that people are assessed and given decisions without being told the rules, thresholds, or how those decisions were reached. A number had never received a copy of the criteria. Question 17- How important is it that people get to choose how their own care is organised and delivered? Responses to this question show a clear consensus that having choice and control over how care is organised and delivered is highly important to community group participants. The majority of respondents, 72%, rated this as “Very important”, signalling a strong expectation that people should be active partners in shaping their own care arrangements followed by a further 19% who selected “Somewhat important”. “There is a growing vacuum between legislation and practice.” “People need clear explanations of eligibility thresholds, how decisions are made, and honest discussion about limitations.” 9% 0% 0% 0% 19% 72% % of survey participants Importance Rating How important is it that people get to choose how their own care is organised and delivered? (N=165) No Response Not Important at all Not very important Neutral Somewhat important Very important 186
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125 Notably, no respondents selected “Not important at all,” “Not very important,” or “Neutral”, indicating that participants felt strongly and consistently that the ability to influence one’s own care is a fundamental expectation. A small number (9%) did not provide a response. Percentages shown are calculated based on total respondents to this question and are weighted using the reporting number of participants involved in each submission. Where no answer was provided, the reported participant headcount is reflected within the non- response category. Question 18- Please provide any additional comments in the box below. Participants responses were themed and summarised below. Choice and control are fundamental rights, not preferences - Across responses, participants were clear that choice is a core human right, not an optional preference. They emphasised that Self-Directed Support (SDS) was founded on the principle that disabled people must have genuine control over their lives and support. Participants described choice as essential to dignity, independence, and participation. They stressed that SDS legally embeds this right, and that any erosion of choice contradicts the Social Care (Self-Directed Support) (Scotland) Act 2013. Choice enables person-centred, safe, flexible care - Respondents highlighted that being able to choose who provides care, how, and when is essential for safety and wellbeing. For people with complex needs or trauma histories, the wrong worker or rigid system can increase harm. Others noted that choice reduces unnecessary or unwanted support and enables people to shape care around real daily life, making wellbeing genuinely self-empowered. Loss of choice leads to harm, crisis & system breakdown - Several comments warned that reducing choice destabilises care arrangements, increases distress, and leads to crisis. People expressed that when flexibility and control are removed, it undermines trust, causes anxiety, and increases the risk of breakdown. “choice is the difference between living and just existing.” “I didn’t ask to need social care; I just need it.” “The wrong person at the wrong time can make everything worse.” 187
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126 Choice is especially critical for minority & marginalised groups - Respondents stressed that choice is particularly vital for people facing identity-based marginalisation, including LGBT+ communities. Choice protects unpaid carers & prevents burnout - Carers’ wellbeing featured strongly and participant felt choice was core to this. Lack of choice leads to loss of meaning, autonomy and quality of life - Participants shared powerful examples of how reduced choice strips away everyday meaning and personal freedom. Legal and ethical imperative: Restricting choice breaches SDS principles -Respondents repeatedly stated that choice is legally protected and reducing it would breach statutory duties under SDS. Barriers to choice still exist in practice - Despite the principle of choice being widely promoted, respondents noted that barriers remain in real practice. Choice matters but awareness is low - Young carers provided insight into varied awareness and experiences of choice. While many recognised its importance, others felt the offer of choice was limited. Question 19- Should there be limitations placed on choice to reduce costs and ensure sustainability of services? “for example, to choose their own care option for example jimmy may want to go to an LGBT pickleball group and may use his support to enable to get there and back safely”. “Needs to be reasonable, realistic and relevant to each person’s life”. “One of my neighbours gets home help but they put her in her bed in pyjamas at 7.30pm. She wants to stay up later but isn't physically allowed to due to the care system that’s been arranged for her without her voice being heard.” “She loved her evenings of crafting — now she’s trapped in bed for hours.” “If choice goes, SDS goes with it.” “SDS is not actively promoted in North Ayrshire with barriers put in place to accessing this”. “They still talk about choice, but it’s becoming meaningless.” 188
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127 The results show a strong level of opposition to limiting people’s choice in how their care is organised as a way to reduce costs or sustain services. 65% of respondents (n=107) answered “No”, indicating a majority who believe that restricting choice is not an acceptable approach, even in the context of financial pressures. Just under one-third of participants, 31% (n=52), felt that “Yes,” some limitations may be necessary. A small proportion, 4% (n=6), selected “Unsure,” indicating uncertainty or hesitation around the potential impact of such limitations. Percentages shown are calculated based on total respondents to this question and are weighted using the reporting number of participants involved in each submission. Where no answer was provided, the reported participant headcount is reflected within the non- response category. Question 20 - Please provide any additional comments in the box below Participants responses were themed and summarised below. Strong rejection of limiting choice - Participants strongly indicated they disagreed with the principle of limiting choice. 52, 31% 107, 65% 6, 4% Should there be limitations placed on choice to reduce costs and ensure sustainability of services?(N=165) Yes No Unsure “When you take away what works, you create crisis and crisis costs more.” 189
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128 Choice and control are fundamental rights, not preferences - Participants strongly rejected the idea that limiting choice could ever be justified on financial grounds. Several participants stressed that choosing how support is delivered is central to dignity, equality, and normality in everyday life. Choice enables person-centred, safe, flexible care - Respondents highlighted that genuine choice is what makes care safe, effective, and tailored to people’s real lives. Without it, participants felt the alternative was rigid arrangements and reduced alignment with their needs. Loss of choice leads to harm, crisis and system breakdown - Participants warned that restricting choice creates destabilising ripple effects across the whole care system. They described real examples where lack of choice has caused: • Breakdown of Personal Assistant (PA) arrangements • Reliance on higher-cost alternatives • Hospital admissions • Increased unpaid care • Deterioration in physical and mental health Choice is especially critical for minority & marginalised groups - Although fewer comments touched directly on marginalisation, respondents did stress that limiting choice could disproportionately harm those with the fewest alternative supports or people with complex needs. Choice protects unpaid carers and prevents burnout -Participants expressed concern that restricting choice would intensify pressure on unpaid carers, many of whom are already at breaking point. “When you take away what works, you create crisis – and crisis costs more.” “People who use social care aren’t having it because it’s a luxury. It gives you some sort of normality.” “Without choice, lives become destabilising.” 190
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129 Lack of choice leads to loss of meaning, autonomy and quality of life -Respondents described the emotional and social impact that loss of choice can have. They noted that when people are forced into arrangements they have not chosen, autonomy diminishes and wellbeing declines. Legal and ethical imperative: Restricting choice breaches SDS principles - A strong theme was the belief that limiting choice is not only harmful but contradicts the legal purpose of SDS. Participants warned that using cost arguments to reduce choice risks turning SDS into “rationing” rather than rights-based practice. Barriers to choice still exist in practice - Although the question focused on future limitations, respondents highlighted that choice is already restricted in practice through: • inconsistent processes • repeated reassessments • delayed decision-making • inflexible or limited options People expressed frustration that disabled people are routinely expected to “give things up first,” while systemic inefficiencies go unchallenged. Choice matters, but awareness and experiences vary - A minority of participants expressed conditional views, acknowledging financial pressures but still emphasising that restricting choice is not the solution. “If sustainability means taking away our rights, then something is very wrong.” “Please remember you are dealing with human beings… Put the humanity back into care services.” 191
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130 Question 21- In times of limited resources, do you feel that cost limits should be placed on individual care packages? The results show a divided response, with no single viewpoint dominating, highlighting the complexity and sensitivity of discussions around placing cost limits on individual care packages. The largest proportion of respondents, 42%, strongly disagreed with the introduction of cost limits. This indicates a significant concern that setting financial caps could restrict essential support. A further 2% disagreed, reinforcing that nearly half of participants overall were opposed to the idea. Meanwhile, 32% of respondents agreed that cost limits may be necessary during times of limited resources. This suggests that while some participants were uncomfortable with the concept, others recognised the financial pressures on services and felt that limits could play a role in ensuring system-wide sustainability. Notably, no respondents selected “strongly agree,” indicating that even those in favour held relatively cautious or moderate views. A further 20% selected neutral, reflecting uncertainty or ambivalence. Additionally, 4% did not provide a response. Percentages shown are calculated based on total respondents to this question and are weighted using the reporting number of participants involved in each submission. Where no answer was provided, the reported participant headcount is reflected within the non- response category. 4% 42% 2% 20% 32% 0% % of survey participants Importance Rating In times of limited resources, do you feel that cost limits should be placed on individual care packages? (N=165) No Response Strongly disagree Disagree Neutral Agree Strongly agree 192
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131 Question 22 - Please provide any additional comments in the box below Participants responses were themed and summarised below. Strong and widespread rejection of cost limits - Participants opposed the introduction of cost limits. They emphasised that need does not stop at a financial ceiling and that such limits would restrict essential support. Cost limits conflict with Self Directed Support (SDS) principles and human rights - Respondents highlighted that cost limits contradict the core principles of Self Directed Support, which require needs based, outcomes focused assessments rather than budget driven caps. Hidden rationing and disproportionate impact on people with complex needs -Participants warned that cost limits would amount to hidden rationing. People with the highest or most complex needs, including those with multiple impairments or communication barriers, would be disproportionately penalised. Several stressed that those needing the most support stand to lose the most, worsening inequality and reducing access to essential care. Risk of institutionalisation and loss of autonomy - Many expressed concern that cost limits would push people toward residential or institutional care, even when community-based support is more appropriate, desired, and cost-effective. Cost limits increase long-term costs and crisis response - Respondents argued that restricting care would destabilise effective arrangements, remove preventative support, and lead to avoidable crises. “Need doesn’t stop at an arbitrary figure.” “Cost limits fundamentally undermine the principles of Self-Directed Support.” “Those who need the most will lose the most.” “If you can’t live within the limit, they start talking about residential.” “You save money on paper and spend more in reality.” 193
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132 Emotional impact: fear, threat, anxiety - The prospect of cost limits created significant distress among disabled people and carers. Respondents described feelings of fear, uncertainty, and threat, particularly when cost limit discussions occurred alongside reassessment processes. Calls for alternative solutions: flexibility, prevention, workforce investment -Participants stressed that sustainability should be achieved through better system design, not through restricting care. Some suggested more frequent but supportive reviews of packages, ensuring care focuses on recovery, independence, and maintaining quality of life. Ethical concerns and appeals to dignity -Many framed the issue as a moral question, noting that human life and dignity cannot be reduced to financial limits. Some conditional agreement - A minority expressed conditional or cautious openness to aspects of financial oversight, such as increased review of packages. “It feels like a threat, stay quiet or you’ll lose everything.” “Increased reviews on financial packages could help.” “How much is a life worth to you?” “Increased reviews on financial packages could help.” 194
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133 Question 23- Should people be charged for or contribute to the cost of non-personal care? The results show a wide range of views on whether individuals should be charged for, or contribute financially to, the cost of non-personal care. The responses illustrate that this is a sensitive and complex issue, with notable divisions among participants. Just under one-third of respondents,31% (n=51), answered “Yes”, indicating support for some form of financial contribution toward non-personal care tasks such as housework, shopping, meal preparation, or transport. However, a larger proportion,42% (n=70) answered “No”, demonstrating that the majority of those who expressed an opinion do not support charging. A further 18% (n=29) selected “Unsure”, reflecting uncertainty. Finally, 9% (n=15) did not provide a response. Percentages shown are calculated based on total respondents to this question and are weighted using the reporting number of participants involved in each submission. Where no answer was provided, the reported participant headcount is reflected within the non- response category. Question 24 - Please provide any additional comments in the box below Participants responses were themed and summarised below. Charging is unfair, regressive & poorly communicated - Respondents consistently described current charging practices as unfair and poorly explained. The lack of clear information about 51, 31% 70, 42% 29, 18% 15, 9% Should people be charged for or contribute to the cost of non-personal care? (N=165) Yes No Unsure No Response 195
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134 what expenses can be offset during financial assessments was highlighted as a major failing, with several noting that “protection shouldn’t depend on how well you know the system.” Charging risks deepening poverty and pushing people out of essential support - Participants stressed that charging, especially when applied to people with already stretched income, risks pushing disabled people and their families into poverty. Rising living costs were cited as making any contribution unrealistic Contributions must be genuinely proportionate and account for disability-related expenses - Where some respondents accepted that contributions might be appropriate in principle, they emphasised that they must be proportionate to actual circumstances. Inconsistency about national policy and Scottish Government commitments -Participants questioned why charging is being consulted on at all when there is a national commitment to ending non-residential care charges. Many expected progress towards removing charges altogether, referencing previous government commitments. Charging can be counterproductive & increase long-term costs - Several comments highlighted that charging can be counterproductive when it results in people refusing support they cannot afford. “Where are they going to get the money? Fuels went up 100%, food inflation at 38% etc - but benefits have not went up. Theres no money to take from us”. “You can’t squeeze money out of people who don’t have any.” “Only if this is coupled with efforts to support people to maximise income.” “We had the promise… about scrapping social care charges. How can you ask about taking away care in a consultation like this?” Charging more for non-personal care than the cost of arranging a Personal Assistant was described as “illogical and undermining independence.” 196
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135 Divided views around fairness and affordability - Young carers showed a more varied set of views. While some felt contributions could help more people receive support, others worried that any charge would negatively affect low-income families, including their own. Some areas of charging may be appropriate - A small number of respondents indicated that contributions might be reasonable in limited circumstances. Others noted that if charging is used at all, it should follow a pro-rata approach, rather than a blanket income-based calculation. Existing issues with charging - Participants pointed out specific flaws in current charging structures, including situations where the charge for non-personal care exceeds the cost of arranging support through a Personal Assistant, an approach seen as illogical and damaging to independence. Question 25 - Should charging policies be designed to protect those on low incomes? The results show a strong consensus that charging policies must be designed to protect people on low incomes. 98% of respondents (n=161) answered “Yes,” demonstrating near-universal agreement that any system of charging for social care must include safeguards for those who are least able to pay. 161, 98% 4, 2% Should charging policies be designed to protect those on low incomes? (N=165) Yes Unsure “Participants were particularly concerned about people whose only income is benefits, who are often asked to contribute despite having no realistic disposable income” “Yes, but it should be pro rata and not always based on income” 197
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136 Only 2% (n=4) selected “Unsure,” and no respondents chose “No,” indicating that participants did not view equal or flat-rate charging as fair or appropriate. Percentages shown are calculated based on total respondents to this question and are weighted using the reporting number of participants involved in each submission. Where no answer was provided, the reported participant headcount is reflected within the non- response category. Question 26 - Please provide any additional comments Participants responses were themed and summarised below. Charging policies must protect people on low incomes -Participants felt that charging policies must explicitly protect those with the least financial capacity especially disabled people living on benefits. Disabled people face unavoidable and higher daily living costs - Respondents described a wide range of higher day to day costs for people living with disability. They highlighted that financial assessments frequently fail to account for these real world- pressures. Lack of transparency and poor communication about disability-related expenses (DRE) - A repeated concern was that people are rarely informed about disability related expenses that can be offset in financial assessments. Participants felt this lack of transparency unfairly penalises those who are less familiar with the system or who lack advocacy. Charging risks deepening poverty, exclusion and hardship - Participants warned that charging can quickly push low income disabled households into poverty, leading people to reduce or decline essential support “If the policy doesn’t protect people on low incomes, it’s not fair, it’s punitive.” “The assessment might say someone can afford it, but real life says they can’t.” “If the policy doesn’t protect people on low incomes, it’s not fair – it’s punitive.” “People are not routinely informed about disability‑related expenses or supported to evidence them.” 198
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137 Charging increases pressure on unpaid carers and deepens gender inequality -Respondents described how unaffordable charges shift the burden of care onto unpaid carers predominantly women. Protection should be automatic, transparent, and embedded in policy - Participants were firm that protections must not rely on individuals having the knowledge or confidence to challenge the system. They argued that safeguarding those with the lowest incomes should be automatic, consistently applied, clearly explained, and built into policy. They also highlighted that confusing or inconsistent charging processes undermine trust: “If you can’t explain it clearly, it’s not working.” National policy commitments: confusion and frustration -Some participants expressed frustration that this question was being asked at all, given the Scottish Government’s stated commitment to ending non-residential care charges. A call for systemic reform, not cost-shifting onto individuals - Participants felt strongly that wider reforms are needed rather than shifting financial responsibility onto disabled individuals or carers. Minority/conditional perspectives - A small minority offered conditional comments, such as suggesting that households’ benefit income should be properly considered, or that contributions might be acceptable only with strong safeguards. Question 27 - How could introducing cost limits or raising care thresholds for care packages affect people who use services? Participants responses were themed and summarised below. “when people can’t pay, the care doesn’t disappear, it lands on families.” “A commitment to fully resource social care.” (referencing Joseph Rowantree Foundation & Scottish Women’s Budgeting Group recommendations)” “If the policy doesn’t protect people on low incomes, it’s not fair – it’s punitive.” 199
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138 Shift from prevention to crisis, with higher long-term costs - Participants stressed that withdrawing early or moderate support would push individuals into crisis rather than preventing it. Increased burden on unpaid carers (especially women), with profound equality and human rights concerns - Participants emphasised that any reduction in formal care transfers responsibility to unpaid carers, most of whom suggested, are already providing support far beyond what is safe or sustainable. Carers described exhaustion, constant night-time interruptions, and the emotional and physical toll of filling widening gaps in support. Reduced access to care and people falling through the cracks - Participants warned that individuals with significant needs may no longer qualify, pushing them towards crisis or increased reliance on GPs, NHS services and emergency responses. Social isolation, loss of autonomy, and poorer mental health - Participants felt that raised thresholds risk isolating disabled people, cutting them off from community life, meaningful activity, and personal autonomy. Widening inequalities and creation of a postcode lottery - Participants highlighted that changes would not affect all communities equally. Some feared that people may feel “You’re not removing need. You’re just delaying it until it explodes.” “You’re running on empty all the time. There’s nothing left to give.” “Lead to a postcode lottery… May impact on health by socio‑economic status.” “When support is cut, it doesn’t disappear – it lands on families.” “Isolate individuals… Happiness decreases… People may be in financial difficulty.” “I didn’t stop working by choice. I stopped because there was no support.” “Less people will have access to care.” 200
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139 compelled to move away from North Ayrshire to access support elsewhere, reinforcing a postcode-based divide in care. Financial strain, poverty, and withdrawal from employment - Carers described how lack of support forces them out of the workforce. The indicated that reduced income leads to poverty, debt, and a loss of long-term stability. Human rights and legal principles at risk (SDS & UNCRPD) - Participants repeatedly referenced what they felt as a contradiction between proposed changes and the principles of Self-Directed Support and UNCRPD rights. They noted that raising thresholds would; reduce freedom, dignity and control, restrict participation in community life and undermine the right to independent living. People will seek alternative solutions - Participants felt that as support becomes harder to access, people would be forced to find alternatives. They felt that this might include relying heavily on neighbours, family, or going without support entirely. National context – austerity, pandemic after-effects, and systemic narratives - Participants described the changes as part of a wider political and economic landscape, over a decade of austerity and discussed reducing public services and a narrative framing disabled people as an economic burden. Question 28 - What additional support might be needed for vulnerable people? Similar responses were recorded across this question and the previous but the themes from participants are summarised below. “People will look for alternative solutions.” “You’re stuck in the house, no money, no break. That destroys your mental health.” “Budgets take precedence over the freedom and participation in society… further cuts will continue to erode disabled people’s international and domestic rights.” “Any further raising of thresholds, or an introduction of cost limits, will cause immeasurable damage… considerable human rights breaches.” 201
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140 Early, Consistent and Person-Centred Support (Prevention, not Crisis) - Participants stressed that people become vulnerable when support is delayed, inconsistent or removed. Timely, flexible intervention was described as essential to preventing crisis. Participants highlighted the need for early involvement at key transition points, such as leaving school, moving between services, hospital discharge, or the onset of illness to avoid avoidable deterioration. Independent Advocacy, Information & Navigation Support - Many participants described the system as difficult to navigate without help, noting that rights and options are often unclear. Independent organisations were described as vital safeguards, especially for those without family advocates or who face communication barriers. Better Support for Unpaid Carers - Carers expressed the need to be listened to and properly supported, with clearer explanations from social work. Accessible, Trustworthy Communication & Staff Training - Participants emphasised the need for accessible, informed and empathetic communication. Stating that staff should understand SDS, eligibility and people’s rights, avoiding misinformation. Community, Belonging & Social Connection - Respondents said communities themselves need education to better understand the lives of vulnerable people. Peer networks, group spaces and social opportunities were seen as vital to preventing isolation. Practical, Everyday Living Support - Participants stressed the importance of everyday assistance. Young carers highlighted the burden of these tasks and the anxiety caused when support is removed. “If you don’t know your rights, you don’t get support.” “We’re having to educate professionals about the law.” “Please don’t take away shopping I’m not old enough to do it on my own.” “Tiny bits of support keep people going. Take that away and everything collapses.” “If carers collapse, the whole system collapses with them.” 202
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141 Emotional Support, Befriending and Safe Relationships - Befriending services and emotionally supportive relationships were described as essential, though often difficult to access due to long waiting lists. Financial Pressures and the Need for Income-Related Support - Participants highlighted the rising cost of living and the need for financial relief—especially for energy bills and essential items. Without this support, people may struggle to maintain health and independence. Peer-mentoring within financially stressed groups was seen as helpful. Support for Young People, Especially Disabled Young People - Young disabled people want their potential recognised rather than dismissed. They asked for better pathways to involvement, understanding and independence, including help with information they can access themselves (like simple online explanations). Community Education & Reducing Stigma - Participants noted that the wider community needs a better understanding of vulnerable people’s lives to reduce stigma and promote inclusion. Education was seen as key in helping communities respond respectfully and supportively. “I like it when carers remember things about the person I look after — their interests and what they like.” “More financial relief for energy bills.” “It’s important that the person I care for can get things like incontinence pants or toiletries — I don’t use the money and it worries me.” “Young people with physical disabilities should have their potential recognised — not dismissed.” “The community should be educated to understand more about the life of a vulnerable person.” 203
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142 Transport, Mobility & Access to the Community - For older adults and those with mobility needs, continued access to transport is essential so that they can leave the house and avoid becoming isolated. Meaningful Activity & Life Opportunities - Participants indicated, people want access to purposeful activities that support wellbeing and the freedom to live a full life rather than simply meeting basic needs. “Vulnerability” is Created by System Failures, Not Disabled People - Participants challenged the assumption that disabled people are inherently vulnerable. They argued vulnerability is created through systemic barriers, delays, and processes that restrict independence and access. Concerns About the Consultation Process Itself - Concerns were raised about the consultation’s validity. Respondents described short timelines, limited publicity, inaccessible formats, and a framing that forced unrealistic choices. Some felt the questions were designed to justify decisions already made. Employability and Training - Young people with physical disabilities stressed the need for improved support around employment and skills. They described experiences of their potential being overlooked or dismissed by services. “Disabled people aren’t vulnerable by default. They’re made vulnerable by the system.” “Concerns about losing independence if movement becomes harder”. “All the tools to live daily life well and independently.” “It’s the illusion of choice… there is an expectation to choose between vital things.” “Not enough people know about it… they can make it say whatever they want it to.” “For young people who have physical disabilities to have their potential realised and not dismissed by social work or other agencies. Improved services for employment and training”. 204
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143 Question 29 - Any other feedback? - The feedback in the last question highlighted two areas of concern. The first was the unintended impacts and sustainability of Personal Assistant roles under Self-Directed Support. Participants described how reductions in non-critical support could lead to fragmented hours, unstable employment, and the loss of trusted staff. Secondly, participants expressed concerns about the design, timing, and credibility of the consultation process. They felt the survey structure forced people to choose between essential supports, the timeline was too short and poorly aligned with wider budget processes, and the consultation took place over the Christmas period, limiting participation. Many believed the questions were framed to justify predetermined decisions rather than genuinely gather views. There was frustration that frontline staff had not been encouraged to participate and that the consultation had not been well promoted. A number of participants also commented on the emotional impact of the process. Some noted that the volume and phrasing of questions created fear and anxiety. Finally, participants shared personal reflections emphasising that the consultation felt aligned with a medicalised model that pushed people toward accepting cuts to essential support. “The questions asked have installed fear and opened up a pandora box of worry asking to choose between services feels like a Sophie’s choice” 205
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144 Drop-in Events Analysis Board 1, Question 1 - Which of these services do you feel are most integral to people's care? Please provide any additional comments by using the cards below. The graph shows how many respondents identified each service as being most integral to people’s care. Personal hygiene was selected by the highest number of respondents (42). This was followed by getting dressed (35), mobility (33), and continence management (33). Eating and drinking was selected by 29 respondents. Medication and treatment (22) and emotional support (20) were also frequently identified. Fewer respondents selected day services (17), telecare services (15), transport for appointments (14), and housework, making beds and laundry (12). Shopping and running errands was selected by the smallest number of respondents (8). Overall, responses were spread across a range of services, with higher numbers associated with activities linked to personal care and daily living. Board 1, Question 2 - Please provide any additional comments by using the cards below. 35 15 14 33 17 22 20 12 42 29 8 33 0 5 10 15 20 25 30 35 40 45 Which of these services do you feel are most integral to people’s care? 206
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145 Person centred, individualised care People repeatedly emphasised that care must reflect individual circumstances and needs and that services are interconnected. Respondents stressed that a one-size-fits-all approaches do not work. Support for unpaid carers - A smaller but consistent theme highlighted the need to better support unpaid carers to enable better care. Workforce needs - A theme emerged that recognised the need for permanent contracts for staff along with support for housing in Island settings. Personal financial contributions -Respondents were in favour of financial contributions towards care from those who can afford it. General funding concerns -There is concern for budgets and resources along with an awareness of difficult decisions required. “Recruitment on the island so vacancies advertised locally.” “Give carers permanent contracts, no contract no mortgage.” “More front-line staff.” “I think those who are able to pay should make some contribution to their care.” “Resources have to be paid for, and we all need to contribute.” “Waste of resources needs to be addressed.” “How social care is funded by Scottish Government must be considered.” “Worried about cuts in care.” “It is impossible to choose as they are all linked together” “What may be important/ essential for one person will not be the same for the next person as everyone's care needs are different.” “Really difficult to prioritise between needs, and what needs might be needed in the future.” “Personalised care is central.” “The risk is the carers health breaking down.” “There is no support for unpaid carers, if more was done to support unpaid carers it would make things better for both the person giving care and the person receiving care.” “Level of unpaid care by families does not appear on your boards.” 207
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146 Consultation inaccuracies & concerns -Some respondents challenged the wording, assumptions and accuracy of the consultation. Some also stated they were unable to meaningfully answer because the question required the selection of five options, leading to arbitrary or inaccurate responses. Board 2, Question 1- How do you feel about prioritising personal care over non- personal care when resources are limited? The chart shows how respondents felt about prioritising personal care over non-personal care when resources are limited. The largest number of respondents selected Strongly agree (42). Smaller numbers selected Agree (4) and Neutral (3). In contrast, 10 respondents selected Disagree and 11 selected Strongly disagree. Overall, responses indicate a wide range of views, with strong agreement being the most frequently selected position, alongside a notable number of respondents expressing disagreement. Board 2, Question 2 - Please provide any additional comments by using the cards below. 42 4 3 10 11 0 5 10 15 20 25 30 35 40 45 Strong Agree Agree Neutral Disagree Strongly Disagree How do you feel about prioritising personal care over non-personal care when resources are limited? “Asking us to prioritise only sets us as rivals for attention - and risk leaving the most vulnerable unrepresented.” “Question far too vague - tone deaf question.” “I think it is cruel to ask the public to pick a narrow range of care as "most important" as all work together in helping people live dignified lives.” 208
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147 Unable to prioritise personal over non-personal care -Respondents felt very strongly that they were unable to prioritise personal care over non personal care and both are necessary to enable people to live fulfilling lives. Removing non-personal care will impact on personal care - It was acknowledged that if non personal care is removed or reduced that there could be risks that individuals would require other care services. Emotional and social support - Concerns that social and emotional support is vital. Levels of care can impact on isolation and being able to socialise. Other issues -There were a range of other comments that varied in nature, mentioning safety concerns and other specific concerns. “Personal and non-personal care are necessary when people need help.” “There is an assumption that "non-personal care" is a luxury that the partnership can’t afford.” “Some non-personal care is crucial, e.g. community alarms and transport to appointments - those without family support are in vital need of these services. There needs to be a mix of funding between personal and non-personal care.” “It will cost significantly more in the future.” “Depriving some people of non-personal care may force them into a more expensive personal care situation.” “Emotional social support critical for wellbeing.” “People need personal care as much as social emotional support.” “Unsafe for families and dementia patients.” “Need to detail what personal care is and what level.” 209
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148 Board 3, Question 1 - Out of the following approaches, which should be prioritised to ensure fairness and sustainability of eligibility criteria? The chart shows how respondents selected which approach should be prioritised to ensure fairness and sustainability of eligibility criteria. The most frequently selected approach was applying consistent thresholds across all services, which was chosen by 39 respondents. Considering individual circumstances on a case-by-case basis was selected by 23 respondents. Focusing on those with the highest or greatest need was selected by 16 respondents. Overall, responses indicate that applying consistent thresholds across services was the most commonly identified priority among respondents. Board 3, Question 2 - Please provide any further suggestions to ensure fairness and sustainability of eligibility criteria by using the cards below. Prioritise individual needs through eligibility and assessment - Respondents felt strongly that each individual case should be assessed to make sure they receive the care they require. People who have the greatest needs would receive the support. 39 23 16 0 5 10 15 20 25 30 35 40 45 Apply consistent threshold across all services Consider individual circumstances case-by-case Focus on those with highest or greatest need Out of the following approaches, which should be prioritised to ensure fairness and sustainability of eligibility criteria? “Consider individual circumstances case- by-case.” “Once assessment done and needs identified, greatest need should be prioritised.” “Blanket decisions fail all, decisions by individual.” 210
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149 Early intervention and assisting moderate needs may prevent crisis situations - It is acknowledged that if non personal care is removed or reduced, there could be risks that individuals would require other care services. Decision Making - There was some concern over who makes decisions relating to levels of care. Board 4, Question 1 - What concerns might arise if thresholds for accessing care were changed in the future? Prioritise individual needs through eligibility and assessment Respondents were concerned that people’s health will be impacted and may result in death and that they did not want eligibility/ thresholds to change. Duty of Care -There is a need and legal requirement to provide care by local authorities and the Scottish Government. Funding should be found from elsewhere. “Providing a small amount of support earlier can avoid crisis or escalation later for the individual and unpaid carers.” “If we only support people with critical needs, everyone will become critical.” “By not providing services for those with moderate and low risk, means that ultimately those people will fall into critical and substantial risk categories and cost more.” “Who assesses the eligibility criteria? Do they have qualifications and experience.” “I think eligibility shouldn't be decided by people in a council office who has no medical/psychological education.” “People will die.” “People are going to die.” “Would not want to see eligibility criteria change.” “Disabled people will not be able to have a good fulfilling life, it will be only an existence.” “Funding should be found from less viral services of which there are many.” 211
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150 Board 4, Question 2- In times of limited resources, do you feel that cost limits should be placed on individual care packages? The chart shows how respondents felt about placing cost limits on individual care packages during times of limited resources. The highest numbers of respondents selected Strongly disagree (17) and Disagree (16). A smaller number selected Agree (12). Very few respondents selected Strongly agree (3) or Neutral (3). Overall, more respondents expressed disagreement than agreement with placing cost limits on individual care packages, with relatively few neutral responses. 3 12 3 16 17 0 2 4 6 8 10 12 14 16 18 Strongly Agree Agree Neutral Disagree Strongly Disagree In times of limited resources, do you feel that cost limits should be placed on individual care packages? 212
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151 Board 5, Question 1 - Should people be charged or contribute to the cost of non-personal care? The chart shows responses to the question of whether people should be charged for, or contribute to, the cost of non-personal care. The majority of respondents selected Yes (34). A smaller number selected No (10), while 6 respondents indicated that they were Unsure. Overall, more respondents supported charging or contributions for non-personal care than opposed it, with a smaller group expressing uncertainty. Participants also shared further comments on this question, as noted below: Means tested charging -Some respondents agreed that some people should be charged and contribute to costs. Many mentioned that it should be means tested based on what people can afford. 34 10 6 Should people be charged for – or contribute to – the cost of non-personal care? Yes No Unsure “It should be means tested.” “Means tested? but is this fair?” “Charged for non-personal care yes but should be means tested.” 213
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152 Complexity of issue/ question - It is acknowledged that this is a difficult issue and question to answer. Some people may not be able to pay anything e.g. those on benefits. Board 5, Question 2 - Should Charging policies be designed to protect those on low incomes? The chart shows responses to the question of whether charging policies should be designed to protect those on low incomes. The majority of respondents selected Yes (49). A small number selected No (3), while 2 respondents indicated that they were Unsure. Overall, most respondents supported the inclusion of protections for people on low incomes within charging policies. Participants also shared further comments on this question, as noted below: General comments – mixed views - Responses were varied. Some respondents suggested that people need to be made aware of what benefits and payments they are entitled to. Others mentioned means tested payments and other ideas for funding. 49 3 2 Should charging policies be designed to protect those on low incomes? Yes No Unsure “No! not if they can’t afford to but still need the vital support.” “this question is far more complex than to have a yes no answer.” “Making sure people are aware of disability related expenses that can be claimed for” “Could small increases be made to other areas to offset difficulties i.e. increase council tax.” “Would not be adverse to more means tested approval to some care costs.” 214
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153 Board 6, Question 1 - How could introducing cost limits or raising care thresholds for care packages affect people who use services? Reducing support may cause other issues - Reducing services and early support may cause problems later which may cost more in the longer term. Also, may cause pressures for the NHS and unpaid carers and families, as well as financial risks. Respondents were concerned about the risk of harm to those who need care. Less support could reduce quality of life - If services are reduced, it could have an impact on the quality of life for some people. Most people felt that if services are reduced then people would not receive the help they needed. Board 6, Question 2 - What additional support might be needed for vulnerable people? Individual needs - Some respondents highlighted that support is individual and not the same requirement for all. The were requests for less wastage, more investment in early intervention and more reviews of needs and care packages to ensure people get the care they need. “I'm worried that I won’t be supported to remain living in my own home.” “If disabled people end up housebound, they will have no quality of life and end up needing mental health support.” “Costing for services should be based on an individual case by case basis.” “Different people would have different priorities.” “More review of existing care packages, ensuring that care needs are genuine.” “There would be no opportunity for early intervention resulting in a problem becoming a crisis.” “People will fall through a bigger gap and may turn up in crisis needing more support than they would if early intervention isn’t an option, costing more in the long run.” 215
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154 Combined Analysis Question 1 - What aspects of social care do you feel are most important? A combined data approach is essential so that no single perspective is viewed in isolation. By bringing together public responses, staff insights, community group feedback and locality event findings, the Partnership can identify patterns, shared concerns and areas where views diverge. This strengthens the validity of the conclusions, reduces the risk of bias, and ensures that decisions are informed by a balanced, representative understanding of people’s experiences and priorities. Integrating multiple data sources also provides a richer picture of impact, helping ensure that future policy and service changes are fair, transparent and grounded in lived reality. 33% 19% 49% 2% 28% 91% 42% 40% 77% 36% 42% 39% 15% 36% 13% 28% 13% 7% 35% 49% 49% 3% 7% 77% 63% 37% 56% 34% 34% 48% 4% 21% 76% 49% 36% 60% -40% -20% 0% 20% 40% 60% 80% 100% 0% 20% 40% 60% 80% 100% 120% 140% Care being free of charge Choice and control over how care is delivered Models of shared support No Response Other Personal care Personal safety support Practical support Supports to maximise independenceProportion of respondents (multiple responses permitted) Aspect of Social Care What aspects of social care do you feel are most important? Staff and Provider (n=679) Community Group (n=165) Public (n=560) Combined (n=1404) 216
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155 Responses were received from individual members of the public, staff and providers, and organised community groups. Community group responses were submitted collectively on behalf of groups (10 group submissions representing approximately 165 participants). Staff and Provider responses included a mix of individual and team submissions (135 submissions representing approximately 672 participants). Percentages are therefore presented as the representing participants selecting each option, rather than the proportion of responses. Participants could select more than one option; therefore, percentages do not sum to 100%. Combined results are weighted across all survey submissions. This chart shows the proportion of respondents identifying different aspects of social care as most important, broken down by respondent group (staff and providers, community groups, and the public), alongside a combined overall view. Across all groups, personal care emerges as the highest priority, particularly among staff and providers (91%) and the public (77%) and is also the strongest result overall (76%). Supports to maximise independence is another key area, with notably high importance among staff and providers (77%) and a strong combined response (60%), indicating broad agreement on the value of promoting independence. Personal safety support is also consistently rated as important, especially by the public (63%), compared with staff and providers (42%) and community groups (28%). Models of shared support was rated relatively evenly amongst all three groups, with a combined response of 48% indicating this was still important. Practical support shows a similar pattern, with higher importance placed on it by staff and providers (40%) and the public (37%) than by community groups (13%). Care being free of charge and choice and control on how care is delivered is also valued relatively evenly across groups, with responses clustered in the mid-30% range, while ‘other’ responses account for a smaller proportion overall (21%). There were a small number of no responses across the three groups. 217
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156 Question 2 - Which of these services do you feel are most integral to people’s care? Responses were received from individual members of the public, staff and providers, and organised community groups. Community group responses were submitted collectively on behalf of groups (10 group submissions representing approximately 165 participants). Staff and Provider responses included a mix of individual and team submissions (135 submissions representing approximately 672 participants). Percentages are therefore presented as the representing participants selecting each option, rather than the proportion of responses. Participants could select more than one option; therefore, percentages do not sum to 100%. Combined results are weighted across all survey submissions. 84% 5% 88% 14% 62% 1% 55% 53% 7% 88% 0% 13% 3% 16% 30% 27% 52% 34% 9% 8% 48% 34% 48% 9% 0% 30% 64% 21% 71% 25% 53% 8% 52% 54% 5% 87% 5% 16% 11% 68% 14% 74% 23% 55% 5% 49% 52% 9% 83% 3% 13% 9% -190% -140% -90% -40% 10% 60% 110% 0% 20% 40% 60% 80% 100% 120% 140% Continence management Day services Eating and drinking Emotional support Getting dressed Housework, making beds, and laundry Medication and treatment Mobility No Response Personal hygiene Shopping and running errands Telecare services like community alarms Transport for appointments or other activities Proportion of respondents (multiple responses permitted) Services of Social Care Which of these services do you feel are most integral to people’s care? Staff and Provider (n=679) Community Group (n=165) Public (n=560) Combined (n=1404) 218
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157 This chart illustrates which specific social care services respondents consider most integral to people’s care, comparing responses from staff and providers, community groups, and the public, alongside a combined overall view. Across all groups, personal hygiene is identified as the most integral service overall, with a combined response of 83%. This is consistently high among staff and providers (88%) and the public (87%), while community groups report a lower proportion (48%). Eating and drinking is also rated as highly integral, particularly by staff and providers (88%) and the public (71%), resulting in a strong combined response of 74%. Community groups again report lower levels at 27%. Continence management shows high importance among staff and providers (84%) and the public (64%), contributing to a combined response of 68%, compared to 16% among community groups. Getting dressed is identified as integral by over half of respondents overall (55%), with higher proportions among staff and providers (62%) and the public (53%) than community groups (34%). Medication and treatment are similar across staff and provider (55%) and public (52%) responses, indicating a broadly shared view of their importance. Community groups is significantly lower at 8%. Mobility shows a relatively equal spread across responses with staff and provider (53%), public (54%) and community groups (48%). Day services and emotional support show more variation between groups, with community groups placing higher importance on emotional support (52%) compared to staff and providers (14%) and the public (25%). Remaining services are less frequently identified as integral across all groups, with a slightly higher proportion of responses from community groups placing higher importance on transport (30%). 219
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158 A small proportion of respondents selected no response, with a combined figure of 9%. 220
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159 Question 3 – How do you feel about prioritising personal care over non personal care when resources are limited? Responses were received from individual members of the public, staff and providers, and organised community groups. Community group responses were submitted collectively on behalf of groups (10 group submissions representing approximately 165 participants). Staff and Provider responses included a mix of individual and team submissions (135 submissions representing approximately 679 participants). Percentages are therefore presented as the representing participants selecting each option, rather than the proportion of responses. Combined results are weighted across all survey submissions. This chart shows how respondents feel about prioritising personal care over non‑personal care when resources are limited, broken down by respondent group (staff and providers, community groups, and the public), alongside a combined overall view. 221
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160 Across all respondents, the combined results show that the majority agree or strongly agree with prioritising personal care. In total, 37% of respondents strongly agree and 35.6% agree, while smaller proportions select neutral (10.4%), disagree (7.2%) or strongly disagree (8.5%). A very small proportion did not respond (1.3%). Staff and providers show the highest levels of agreement, with 40% strongly agreeing and 47% agreeing. Only small proportions of staff and providers selected neutral (4%), disagree (7%) or strongly disagree (2%), and there were no non‑responses recorded for this group. Public responses also show strong agreement, with 40% strongly agreeing and 33% agreeing. Smaller proportions selected neutral (9%), disagree (8%) or strongly disagree (8%), and 3% did not respond. Community group responses are more mixed. While 15% strongly agree, a larger proportion selected neutral (41%) and strongly disagree (38%), compared with other groups. There were no non‑responses were recorded. 222
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161 Question 6 – Out of the following approaches, which should be prioritised to ensure fairness and sustainability of eligibility criteria? Responses were received from individual members of the public, staff and providers, and organised community groups. Community group responses were submitted collectively on behalf of groups (10 group submissions representing approximately 165 participants). Staff and Provider responses included a mix of individual and team submissions (135 submissions representing approximately 679 participants). Percentages are therefore presented as the representing participants selecting each option, rather than the proportion of responses. Combined results are weighted across all survey submissions. 28% 40% 31% 1% 76% 9% 15% 0% 55% 28% 14% 4% 44.4% 31.6% 22.0% 2.0% -30.0% -20.0% -10.0% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 0% 20% 40% 60% 80% 100% 120% 140% Consider individual circumstances case-by-case Focus on those with highest or greatest need Apply consistent thresholds across all services No Response % of survey participants Approach to eligibility critera Out of the following approaches, which should be prioritised to ensure fairness and sustainability of eligibility criteria? Staff and Provider (n=679) Community Group (n=165) Public (n=560) Combined (n=1404) 223
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162 This chart shows which approaches respondents feel should be prioritised to ensure fairness and sustainability of eligibility criteria, broken down by respondent group (staff and providers, community groups, and the public), alongside a combined overall view. Across all respondents, the most commonly prioritised approach overall is considering individual circumstances on a case‑by‑case basis, with a combined response of 44.4%. This approach is particularly strongly supported by community groups (76%) and the public (55%), while a smaller proportion of staff and providers selected this option (28%). Focusing on those with the highest or greatest need is the second most frequently prioritised approach overall, with a combined response of 31.6%. This option is most strongly supported by staff and providers (40%), followed by the public (28%), and to a lesser extent community groups (9%). Applying consistent thresholds across all services is selected by a smaller proportion of respondents overall, with a combined response of 22%. Staff and providers are more likely to prioritise this approach (31%) compared to community groups (15%) and the public (14%). Very small proportions across all groups selected no response, with a combined figure of 2%. 224
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163 Question 10 - How important is it that people get to choose how their own care is organised and delivered? Responses were received from individual members of the public, staff and providers, and organised community groups. Community group responses were submitted collectively on behalf of groups (10 group submissions representing approximately 165 participants). Staff and Provider responses included a mix of individual and team submissions (135 submissions representing approximately 679 participants). Percentages are therefore presented as the representing participants selecting each option, rather than the proportion of responses. Combined results are weighted across all survey submissions. This chart shows how important respondents feel it is that people are able to choose how their own care is organised and delivered, broken down by respondent group (staff and providers, community groups, and the public), alongside a combined overall view. 225
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164 Across all respondents, the combined results show that choice over how care is organised and delivered is important by the majority. Overall, 41.6% of respondents rated this as very important and a further 34.6% as somewhat important. Smaller proportions selected neutral (17.7%), not very important (2.0%) or not important at all (0.3%), with a small proportion providing no response (3.8%). Community groups place the greatest emphasis on this issue, with 72% rating it as very important and a further 19% as somewhat important. No respondents in this group selected neutral, not very important or not important at all, though 9% did not respond. Public responses also show strong support, with 58% rating choice and control as very important and 24% as somewhat important. Smaller proportions selected neutral (10%) or not very important (4%), and very few selected not important at all (1%). Staff and providers show a more mixed distribution of responses. While 21% rated this as very important and 47% as somewhat important, a higher proportion selected neutral (28%) compared to other groups. Very small proportions selected not very important (1%) or provided no response (3%). 226
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165 Question 11 - Should there be limitations placed on choice to reduce costs and ensure sustainability of services? Responses were received from individual members of the public, staff and providers, and organised community groups. Community group responses were submitted collectively on behalf of groups (10 group submissions representing approximately 165 participants). Staff and Provider responses included a mix of individual and team submissions (135 submissions representing approximately 679 participants). Percentages are therefore presented as the representing participants selecting each option, rather than the proportion of responses. Combined results are weighted across all survey submissions. This chart shows respondents’ views on whether limitations should be placed on choice to reduce costs and ensure the sustainability of services, broken down by respondent group (staff and providers, community groups, and the public), alongside a combined overall view. Across all respondents, views are mixed. The combined results show that 46.7% believe limitations should be placed on choice, while 22.9% believe they should not. A further 28.9% are unsure, and a very small proportion provided no response (1.6%). 54% 38% 8% 0% 31% 4% 65% 0% 42% 25% 29% 3% 46.7% 28.9% 22.9% 1.6% -80.0% -60.0% -40.0% -20.0% 0.0% 20.0% 40.0% 60.0% -10% 10% 30% 50% 70% 90% 110% 130% Yes Unsure No No Response % of survey participants Response Option Should there be limitations placed on choice to reduce costs and ensure sustainability of services? Staff and Provider (n=679) Community Group (n=165) Public (n=560) Combined (n=1404) 227
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166 Staff and providers are more likely to support placing limitations on choice, with over half (54%) responding yes. A further 38% are unsure, while only 8% responded no, indicating relatively limited opposition within this group. Public responses also show more support for placing limitations than opposing them, with 42% answering yes. However, a quarter (25%) are unsure and 29% responded no, suggesting greater uncertainty and a wider spread of views among the public. In contrast, community groups are more likely to oppose limitations on choice. Almost two‑thirds (65%) responded no, while 31% supported placing limitations and only 4% were unsure. No respondents in this group selected no response. 228
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167 Question 12 - In times of limited resources, do you feel that cost limits should be placed on individual care packages? Responses were received from individual members of the public, staff and providers, and organised community groups. Community group responses were submitted collectively on behalf of groups (10 group submissions representing approximately 165 participants). Staff and Provider responses included a mix of individual and team submissions (135 submissions representing approximately 679 participants). Percentages are therefore presented as the representing participants selecting each option, rather than the proportion of responses. Combined results are weighted across all survey submissions. This chart presents respondents’ views on whether cost limits should be placed on individual care packages during periods of limited resources, comparing responses from staff and providers, community groups, and the public, alongside a combined overall view. Overall, the combined results show a tendency away from support for cost limits, with higher proportions of respondents disagreeing than agreeing. Just under a quarter of respondents agree overall that cost limits should be applied (combined 23.4% agree, 7.1% strongly agree), while a larger proportion disagree or strongly disagree. 229
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168 Disagreement is particularly pronounced among community groups where 42% strongly disagree, indicating clear opposition to placing cost limits on individual care packages. Staff and providers also show substantial resistance, with 30% disagreeing and 34% strongly disagreeing, compared to 19% agreeing and 5% strongly agreeing. Public responses are more mixed. While 27% of public respondents agree and 12% strongly agree that cost limits should be applied, a combined 37% disagree or strongly disagree. A further 20% of the public select a neutral position, suggesting uncertainty or ambivalence within this group. Across all respondent groups, neutral responses remain notable, particularly among community groups and the public (both at 20%), indicating that a significant minority neither clearly support nor oppose the introduction of cost limits. 230
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169 Question 13 - Should people be charged for or contribute to the cost of non-personal care? Responses were received from individual members of the public, staff and providers, and organised community groups. Community group responses were submitted collectively on behalf of groups (10 group submissions representing approximately 165 participants). Staff and Provider responses included a mix of individual and team submissions (135 submissions representing approximately 679 participants). Percentages are therefore presented as the representing participants selecting each option, rather than the proportion of responses. Combined results are weighted across all survey submissions. This chart shows respondents’ views on whether people should be charged for, or contribute to, the cost of non-personal care, broken down by respondent group (staff and providers, community groups, and the public), alongside a combined overall view. Across all respondents, the combined results show that the majority support charging or contributions for non-personal care. Overall, 73.0% responded yes, while smaller proportions were unsure (10.9%) or responded no (13.4%). A very small proportion provided no response (2.7%). 90% 9% 1% 0% 31% 18% 42% 9% 65% 12% 19% 4% 73.0% 10.9% 13.4% 2.7% -90.0% -70.0% -50.0% -30.0% -10.0% 10.0% 30.0% 50.0% 70.0% 90.0% -10% 10% 30% 50% 70% 90% 110% 130% Yes Unsure No No Response % of survey participants Response Option Should people be charged for or contribute to the cost of non-personal care? Staff and Provider (n=679) Community Group (n=165) Public (n=560) Combined (n=1404) 231
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170 Staff and providers show the strongest support for charging, with 90% responding yes. Only 9% were unsure and 1% responded no, indicating a high level of agreement within this group. Public respondents also show majority support, with 65% responding yes. A further 12% were unsure and 19% responded no, suggesting some variation in views among the public compared to staff and providers. Community group responses differ notably from the other groups. While 31% responded yes, a larger proportion responded no (42%). A further 18% were unsure, and 9% provided no response. 232
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171 Conclusion The findings from this engagement programme highlight the significant challenges faced by North Ayrshire Health and Social Care Partnership as it seeks to deliver safe, equitable and sustainable social care within a challenging financial environment. Participants across all engagement routes recognised the seriousness of the financial pressures and the scale of the projected budget gap yet expressed clear and consistent concerns about the potential consequences of tightening eligibility, reducing support, or introducing cost related limitations. These concerns centred on risks to safety, independence, dignity and long-term wellbeing, particularly for those who are already vulnerable or lack strong support networks. Across public, staff, provider and community group feedback, there was strong agreement that essential personal care, practical assistance, and emotional and social support are strongly interconnected, and that the removal or reduction of “lower-level” supports would likely accelerate deterioration, increase crisis demand and lead to greater system pressure. Participants repeatedly stressed that preventative and early-intervention approaches are vital for maintaining people’s health and for avoiding more costly interventions such as hospital admission or residential care. Engagement feedback also revealed frustration with the current clarity, accessibility and consistency of eligibility criteria, with many respondents describing the process as unclear, difficult to navigate and unevenly applied. Participants indicated this lack of transparency can undermine trust and reinforces perceptions of inequity or a “postcode lottery.” There was a strong call for clearer communication, more accessible information and a more coherent, rights-based approach to decision-making. Views on charging and financial contributions were mixed. While some participants accepted the principle of contributions for certain types of care, many warned of the financial harm such policies could cause, particularly for disabled people and low-income households already facing higher living costs. There was broad agreement that any charging framework must be designed to protect those least able to pay. 233
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172 Participants also stressed the importance of meaningful choice and control over how care is delivered, reflecting legal and ethical expectations embedded in Self-Directed Support. Many warned that limiting choice could erode autonomy and reduce quality of life. Island communities raised distinct concerns about service availability, transport barriers and the disproportionate impact of changes on remote or rural areas, underscoring the need for local context to be considered in future planning. The combined analysis indicates across all respondent groups, personal care and core daily living support are consistently identified as the most important aspects of care, with strong overall support for prioritising personal care when resources are limited. Choice and control over how care is organised is also widely valued, particularly by community groups and the public, although views differ on the extent to which this choice should be limited to manage costs. While there is broad support for charging or contributions for non-personal care, there is clear resistance to placing cost limits on individual care packages, especially among community groups. Overall, the consultation indicates that while participants recognise the need for change, many emphasised the importance of maintaining fairness, transparency, preventative approaches and a focus on dignity within any future decisions. Feedback reflects a range of perspectives on how social care should be delivered, with views highlighting the importance of safeguarding rights, supporting those with higher levels of need, and ensuring that processes remain open and consistent. The information gathered through this consultation offers insight into the priorities, concerns and expectations of those who contributed and may assist the Integration Joint Board in considering options as it moves forward. 234
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173 Appendices Appendix 1 – Completed persona sheets A total of twenty-two persona sheets were completed throughout the in-person events. These gave people a further opportunity to reflect their real-life situations and how future changes may affect them. Persona 1 About Me Gender: Female Age: 59 Locality: ARRAN Are you a service user/ carer/ member of the public: Carer Current care in place (Type of care, hours provided, HSCP/ Private provider): N/A Community based supports (tell us about any community support you access out with formal care such as community groups, friends, family etc...): Not enough support for community groups to run, need qualified community workers not social work staff with no group work experience. If things were to change in the future tell us how this might affect you? I’m already looking to leave this island as my disabilities are getting worse and I not confident of getting a service. My daughter has been assed as needing support but has been told there’s no money to five her a service. Additional information: Personalisation of self-directed support should not be eradicated! People worked hard to introduce it in North Ayrshire, sadly, social workers have been allowed to discourage people from choosing it. Why? – ask them! I have personal knowledge of the above and of where it has improved lives of both disabled person and their carer (spouse) 235
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174 Persona 2 About Me Gender: Female Age: 66 Locality: Arran Are you a service user/ carer/ member of the public: Member of the public Community based supports (tell us about any community support you access out with formal care such as community groups, friends, family etc...): No answer If things were to change in the future tell us how this might affect you? No answer Additional information: Current care in place (Type of care, hours provided, HSCP/ Private provider): As I’m heading towards old age, I have great concern about (If required care) being sent away and mainland to receive care. It is very sad and doesn’t see right that people who were born on Arran are then sent to mainland to die. No family or friends near them. 236
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175 Persona 3 About Me Gender: Female Age: 26 Locality: Arran Are you a service user/ carer/ member of the public: Carer Current care in place (Type of care, hours provided, HSCP/ Private provider): No answer Community based supports (tell us about any community support you access out with formal care such as community groups, friends, family etc...): No answer If things were to change in the future tell us how this might affect you: • Redundancy • Less hours • Less pay • Lack of permanent contracts (more than 30hours) Additional information: No answer 237
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176 Persona 4 About Me Gender: Female Age: 61 Locality: Arran Are you a service user/ carer/ member of the public: Member of the public Current care in place (Type of care, hours provided, HSCP/ Private provider): No answer Community based supports (tell us about any community support you access out with formal care such as community groups, friends, family etc...): No answer If things were to change in the future tell us how this might affect you: No answer Additional information: I fear for the future of our island community. I realise the cuts will happen across the whole of N.A but our island situation adds a whole different dimension to any decisions that are made. PLEASE make any cuts to these frontline services an absolute last resort and explore every other possible area to make savings. I know so many people who are frightened and anxious about what the future holds for them because of these threatened cuts to care services and mainly the cuts proposed at Montrose house. Please prove that people are listened to and reverse this proposal. 238
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177 Persona 5 About Me Gender: Female Age: 32 Locality: Arran Are you a service user/ carer/ member of the public: I should be a service user Current care in place (Type of care, hours provided, HSCP/ Private provider): I attend a carers group, but it only really provides some social support not any actual substantial support. I have my immediate family, but other than then, I have nothing I cannot get out by myself. Community based supports (tell us about any community support you access out with formal care such as community groups, friends, family etc: I have had a SW assessment, agreed a care package and I have NOTHING! It has been nearly 4 years since I first made contact with SW, and I still have no support in place. My health and wellbeing are suffering. If things were to change in the future tell us how this might affect you: Well, it sounds like things will only get worse for me, my health and my life are at risk as it that of my family, as those who love and care for me. Additional information: I’m considering leaving Arran even though it was my mother’s dream to live here, and I thought u could have a better life, but there just isn’t the support or services for me here. I’ve been told there is no money for my care. This has been a deeply upsetting experience. 239
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178 Persona 6 About Me Gender: Female Age: 68 Locality: Arran Are you a service user/ carer/ member of the public: Ex staff on island Current care in place (Type of care, hours provided, HSCP/ Private provider): N/A Community based supports (tell us about any community support you access out with formal care such as community groups, friends, family etc...): N/A If things were to change in the future tell us how this might affect you: I am getting older and currently less services on Arran for more needy people than 10-15 years ago Additional information: If vacancies were advertised via local social media or local press and application process i.e. NOT via a portal was simplifies it would result in more applicants from local people ad people needing to come from the mainland and be accommodated – reducing cost. To have buildings like Montrose house undersized is nonsense. Arran should be assessed on its own needs and allowed to recruit and employ locally. The lack of staff is due to the lack if awareness of vacancies & NACS lack of will to make changes, changes in the way things are done not cost needed. 240
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179 Persona 7 About Me Gender: Female Age: 56 Locality: Kildonan Are you a service user/ carer/ member of the public: Member of the publics/community garden ranger/are in mind tutor Current care in place (Type of care, hours provided, HSCP/ Private provider): Community groups Community based supports (tell us about any community support you access out with formal care such as community groups, friends, family etc: None If things were to change in the future tell us how this might affect you: If I get old, then I want to stay on Arran and be able to access help. Additional information: Use more green prescribing. Ask the residents to contact Scottish government to ask for more funding for social care services. Arran residents should remain on island. 241
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180 Persona 8 About Me Gender: Female Age: Not completed Locality: Arran Are you a service user/ carer/ member of the public: Member of the public Current care in place (Type of care, hours provided, HSCP/ Private provider): No answer Community based supports (tell us about any community support you access out with formal care such as community groups, friends, family etc…: No answer If things were to change in the future tell us how this might affect you: No answer Additional information: From personal family experience 242
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181 Persona 9 About Me Gender: Female Age: 27 Locality: Brodick Are you a service user/ carer/ member of the public: member of the public Current care in place (Type of care, hours provided, HSCP/ Private provider): He died on the mainland last month Community based supports (tell us about any community support you access out with formal care such as community groups, friends, family etc : Local online forms If things were to change in the future tell us how this might affect you: it’s life or death for islanders Additional information: 243
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182 About Me 10 Gender: Female Age: 68/69 Locality: Arran Are you a service user/ carer/ member of the public: Member of the public Current care in place (Type of care, hours provided, HSCP/ Private provider): N/A Community based supports (tell us about any community support you access out with formal care such as community groups, friends, family etc N/A If things were to change in the future tell us how this might affect you: Obviously both myself and my husband are older, he is 72 I’m 68-69 this year. Potentially at least one of us could need social care before too long. However, my main concern is for people now! Additional information: I’m concerned about the effects of further cuts to care for people’s safety and wellbeing. If you cut even one of the services provided you will put people into the position of being unsafe. I am also concerned about the impact on NHS – early intervention prevents further pressure on the health service. Have people with complex needs been given adequate opportunity to engage with this survey? And with appropriate support. What do you propose to do about people whose care is cut – e.g. transport will they just not be able to attend appointments or will it add further pressure to the thirds sector organisation (funding implications) I’m concerned about the effects on unpaid carers who already are 56% more likely to be in poverty than non-carers. Some may have to stop working to look after their loved one – potential to increase the benefit bill. I’m concerned for social workers who will (and probably are already) unable to fulfil their code of practice – imposing ethical stress on them. NAC are in breach of statutory legislation for delivery of social care if they continue with their inhumane cuts. As an authority is NAC not concerned that they are ignoring statutory legislation? Courage is required by NAHSCP to bang on the door of NAC demand more funding for HSCP instead of allowing the most vulnerable to be affected innocent people! 244
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183 Persona 11 About Me Gender: Female Age: 80 Locality: Arran Are you a service user/ carer/ member of the public: Member of the public Current care in place (Type of care, hours provided, HSCP/ Private provider): No answer Community based supports (tell us about any community support you access out with formal care such as community groups, friends, family etc…: No answer If things were to change in the future tell us how this might affect you: More access to personal care needed – wouldn’t mind paying for it, also came to discuss Montrose house 245
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184 Persona 12 About Me Gender: Male Age: 78 Locality: Shiskine Are you a service user/ carer/ member of the public: member of the public Current care in place (Type of care, hours provided, HSCP/ Private provider): No answer Community based supports (tell us about any community support you access out with formal care such as community groups, friends, family etc…: No answer If things were to change in the future tell us how this might affect you: Keep Montrose house at 30 beds not ifs no buts. 246
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185 Persona 13 About Me Gender: Female Age: 66 Locality: Arran Are you a service user/ carer/ member of the public: Member of the public Current care in place (Type of care, hours provided, HSCP/ Private provider): none Community based supports (tell us about any community support you access out with formal care such as community groups, friends, family etc: None at the moment If things were to change in the future tell us how this might affect you: would I be able to access care if financial needs were identified – who decides whether I would require care would I be involved in the decision if I couldn’t afford it what would be my options Additional information: who decides ‘thresholds’ define vulnerability – different people would have different views as to what this means. I would like to be involved in my ‘care package’ how would my decisions be considered. I would at all times like to remain on Arran who would this be achieved if the proposed cuts top Montrose house are carried out. Would my voice be heard? I fear for the future of care on Arran 247
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186 Persona 14 About Me Gender: Female Age: 51 Locality: Arran Are you a service user/ carer/ member of the public: Member of the public Current care in place (Type of care, hours provided, HSCP/ Private provider): No answer Community based supports (tell us about any community support you access out with formal care such as community groups, friends, family etc …: No answer If things were to change in the future tell us how this might affect you: No answer Additional information: Increased capacity is needed in Montrose house. I have known elderly people who there has not been space for in Montrose house and have had to spend the end of their life in a care home on the mainland, away from family and friends. Most elderly friends are unable to travel to mainland to visit, and family have problems visiting them on the mainland due to ongoing ferry problems, Also takes most of a day to travel from Arran to visit someone on the mainland, whereas if they were in Montrose house there is not a lot of travel involved in visiting a friend/relative. ‘Stronach’ the day care centre that was built into Montrose house specifically to provide day care for elder has a fantastic facility for my grandparents, it enabled both to carry on living at home while going to day care 3 days per week, being fed, given activities to do, meeting up with peers from around the island, these 3 days of being cared for and given a break was enough to stop them from needing to go into residential care. If my mum requires to go into residential care eventually, and there is not space in Montrose house, she will end up on the mainland away from all her family and friends and as to many others would be a very sad end to her life which has been spent on Arran. 248
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187 Persona 15 About Me Gender: Female Age: 71 Locality: Arran Are you a service user/ carer/ member of the public: Member of the public Current care in place (Type of care, hours provided, HSCP/ Private provider): none Community based supports (tell us about any community support you access out with formal care such as community groups, friends, family etc: none If things were to change in the future tell us how this might affect you: very concerned re provision of day care currently available so in budgets will servery impact services. I have lived here all my life and was hopefully that care would be available in my advancing years. No care home providing for any numbers of islanders. Additional information: Over current age demographics on the island greatly exceeds most other areas and a huge majority of the elderly have relocated here and do not love family support. Why in it that budgets cannot meet the needs of the most vulnerable on the island and can people approach to have this dangerous situation addressed. 249
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188 Persona 16 About Me Gender: Female Age: 76 Locality: Arran Are you a service user/ carer/ member of the public: Member of the public Current care in place (Type of care, hours provided, HSCP/ Private provider): N/A Community based supports (tell us about any community support you access out with formal care such as community groups, friends, family etc: Volunteer family If things were to change in the future tell us how this might affect you: it’s very frightening 250
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189 Persona 17 About Me Gender: Female Age: 80 Locality: Arran Are you a service user/ carer/ member of the public: Member of the public Current care in place (Type of care, hours provided, HSCP/ Private provider): N/A Community based supports (tell us about any community support you access out with formal care such as community groups, friends, family etc …: N/A If things were to change in the future tell us how this might affect you: If locals can’t get a bed in Montrose house, they will be devasted to have to go to mainland. Montrose house should be fully used. 251
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190 Persona 18 About Me Gender: Female Age: 62 Locality: Arran Are you a service user/ carer/ member of the public – Carer for mother with vascular dementia and mobility issues plus arthritis Current care in place (Type of care, hours provided, HSCP/ Private provider): care at home - morning ½ hr – evening 15mins. Alert pendant – medication, food, hydration/washing/dressing. All other care provided by me and no dementia support available Community based supports (tell us about any community support you access out with formal care such as community groups, friends, family etc: Friendship café – when able to, for escorting – driving mum to café (needs escorted). If things were to change in the future tell us how this might affect you: it would be dreadful as mums' dementia deteriorate if no extra help available, for lunch & bedtime visit. Also, if no places available at Montrose house, awful, distressing for us all. Lived on Arran for 60years with family connection home after the war. Also, if anything happens to me! Additional information: it was so hard to get the care at home, had to be at crisis point for mum, GP stepped in. I gave up working full time to cope. / Direct payments (which never happen) were monitored but there would have been nobody to employ on the west side of the island anyways, so not good on the island. Definitely felt like they were quite happy to let me do it all, even though I was struggling and ended up with my ow health issues – cancer. So the stress was very difficult. The team in place – local ladies, now great. 252
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191 Persona 19 About Me Gender: Male Age: 13 Locality: Irvine Are you a service user/ carer/ member of the public: Service user Current care in place (Type of care, hours provided, HSCP/ Private provider): Young person’s support worker (Scott) 1 hour per week, disabilities team: SW, family care. Out of school mainstream – autism Community based supports (tell us about any community support you access out with formal care such as community groups, friends, family etc : Fullarton Connexions on a Friday night (run by the church) been attending for a year. Duke of Edinburgh award and group in Kilwinning Jump. If things were to change in the future tell us how this might affect you: Happy with level and current support wouldn’t want less. 253
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192 Persona 20 About Me Gender: Male Age: 46 Locality: Broomlands Are you a service user/ carer/ member of the public: Service user Current care in place (Type of care, hours provided, HSCP/ Private provider): SDS & ILF Budgets. 72 hours per week – 3 personal assistants, community alarm through the night. Community based supports (tell us about any community support you access out with formal care such as community groups, friends, family etc : community hub, Ardeer on a Tuesday (dancing, bingo, pool table) If things were to change in the future tell us how this might affect you: Mental health would be affected. People could become more unwell and need more support. Additional information: Nil 254
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193 Persona 21 About Me Gender: Male Age: 60 Locality: Isle Of Arran Are you a service user/ carer/ member of the public: Member of the public Current care in place (Type of care, hours provided, HSCP/ Private provider): One council run facility Community based supports (tell us about any community support you access out with formal care such as community groups, friends, family etc: Family and Medical If things were to change in the future tell us how this might affect you: I may have to leave the island if there are an insufficient amount of places Additional information: The demographic populous of the island has a higher proportion of retired compared to averages/percentages of other north ayrshire villages and towns. 255
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194 Persona 22 About Me Gender: Female Age: 58 Locality: Arran Are you a service user/ carer/ member of the public: Member of the public Current care in place (Type of care, hours provided, HSCP/ Private provider): night. Community based supports (tell us about any community support you access out with formal care such as community groups, friends, family etc: No answer If things were to change in the future tell us how this might affect you: If neither of us can drive, how will we get to the mainland appointments & on island. If one of us goes into care, how can we care for them if they're on the mainland. Do not cut beds at Montrose house. Additional information: 256
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195 Appendix 2 – In person event Posters 257
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1 Delivering Social Care Services Within Budget Phase 2 – Policy Proposal Consultation Final Report March 2026 Appendix 2 265
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2 Table of Contents Executive Summary .................................................................................................. 3 Introduction ............................................................................................................ 5 Methodology ........................................................................................................... 6 Public Online Survey ......................................................................................... 6 Data Management and Analysis ......................................................................... 6 Ethical Considerations ...................................................................................... 7 Sample ................................................................................................................... 7 Limitations of the Data .......................................................................................... 7 Findings .................................................................................................................. 8 Proposal 1: Changing Eligibility – Support Only for People at Critical Risk .................. 8 Proposal 2: Best Value Care Funding Framework ................................................... 20 Proposal 3: Prioritising Personal Care ................................................................... 29 Conclusion ............................................................................................................ 36 Appendices ........................................................................................................... 37 Appendix 1: Survey ............................................................................................. 37 Appendix 2: Letter to residents ............................................................................ 44 266
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3 Executive Summary North Ayrshire Health and Social Care Partnership undertook a second phase of public engagement to inform decision‑making regarding changes to social care services in response to significant and ongoing financial pressures. This Phase 2 consultation focused on gathering views on three policy proposals that will be considered by the Integration Joint Board in March 2026, and on identifying ways in which the potential impact of these proposals could be mitigated should they be implemented. In total, 2,285 responses were received, providing a substantial body of qualitative and quantitative evidence. Views varied across the three proposals: • Proposal 1 (Changing eligibility to support only people at Critical Risk) received the lowest level of public support, with a clear majority of respondents indicating that they did not consider it an acceptable measure in light of the current financial position. While some respondents acknowledged the financial realities, there was widespread concern about the loss of preventative and early‑intervention support, and the risk of increased crisis demand in the longer term. • Proposal 2 (Best Value Care Funding Framework) generated more mixed views. While a significant proportion of respondents supported the principle of funding the most cost‑effective option, many expressed concerns about how “best value” would be defined and applied in practice. Respondents stressed the need for safeguards to protect quality, choice, equity, and those on low incomes. • Proposal 3 (Prioritising personal care) received the highest level of support overall, although a substantial minority remained opposed. Respondents broadly accepted the need to prioritise essential personal care but raised strong concerns about the removal of non‑personal care supports that are widely viewed as preventative, particularly in relation to isolation, carer breakdown, and deterioration in health and wellbeing. Across all three proposals, there was significant consistency in the mitigating actions suggested by respondents. Key themes included: 267
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4 • Importance of protecting early intervention and prevention • Ensuring assessments are individual, holistic, timely and fair • Strengthening support for unpaid carers • Maximising the use of reablement • Technology‑enabled care and medication aids • Improving communication and meaningful signposting • Ensuring community and third‑sector capacity is in place before reliance on alternatives to statutory services increases Respondents also repeatedly highlighted the need for transparency, clear communication, equity across communities (including rural and island areas), and robust safeguards to avoid unintended consequences such as increased hospital admissions, carer breakdown, or the creation of a two‑tier care system. Many expressed the view that longer‑term sustainability requires system‑wide solutions, including better alignment of health and social care funding and increased national investment in social care. The evidence set out in this report is intended to support decision-making by the Integration Joint Board. 268
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5 Introduction As part of its ongoing commitment to open, transparent, and inclusive decision making, North Ayrshire Health and Social Care Partnership (NAHSCP) undertook a follow‑up programme of engagement to build on the findings of its earlier consultation on the future of social care services. This second phase focused specifically on understanding the general public’s views on three proposed policy options that are being considered for decision by the Integration Joint Board in March 2026 and invited suggestions on how the impact of these proposals could be lessened should they be implemented. The follow-up engagement was created specifically because participants from the initial consultation wanted the chance to give feedback on proposals that were easier to understand and more clearly defined once they had been developed. Against a backdrop of sustained financial and operational pressures, the earlier phase of engagement explored broad priorities and concerns about the future of care provision, while this subsequent phase provided an opportunity to consider the potential implications of specific policy choices in greater detail. Phase two of the consultation therefore focused solely on the three policy proposals currently under consideration. The proposals were presented alongside clear and accessible information about the context in which they have been developed, including rising demand for services, increasing costs, and the Partnership’s projected budget gap. Both phases intended to support informed discussion and honest reflection on the difficult decisions facing health and social care partnerships. To ensure wide awareness and accessibility, a letter was issued by the Partnership to every household in North Ayrshire, outlining the financial challenges faced and inviting residents to take part in the consultation. This report sets out what we heard through the follow‑up engagement. It summarises areas of agreement and concern, alongside the views and suggestions offered by participants on how the impact of the proposals might be mitigated in relation to each of the three policy options. The findings are intended to inform deliberation by the Integration Joint Board and to help ensure that decisions taken in March 2026 are 269
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6 grounded in the views and experiences of the people who rely on, deliver and support health and social care services across North Ayrshire. Methodology Public Online Survey A public survey (Appendix 1) was made available online via Microsoft Forms between 10 February and 25 February 2026. The survey gathered a combination of closed and open‑ended responses, focusing specifically on the three policy proposals being taken forward for consideration by the Integration Joint Board. The survey link was promoted through organisational social media channels, community networks, and partner agencies to encourage broad participation across North Ayrshire. To support wide awareness of the consultation, each household in North Ayrshire (approximately 70,000) received a letter outlining the financial context facing the Partnership and inviting residents to take part. The letter included instructions on how to participate by scanning a QR code or accessing the survey via a web link. Information about the consultation period and participation options were also shared through local newspapers. To ensure accessibility for individuals without digital access, or for those who preferred a non‑digital format, paper copies of the survey were made available through local libraries and could also be requested directly from the Strategic Planning and Equalities Team. Contact details were provided in all consultation communications. The North Ayrshire Carers Gateway telephone number was also included in all consultation materials to support unpaid carers to complete the survey by telephone. When people who were not unpaid carers asked for help, the Partnership provided support by offering to conduct the survey over the phone. Data Management and Analysis Responses gathered via Microsoft Forms were securely exported to Excel for analysis. Paper-based responses were manually entered into the digital dataset to ensure completeness and consistency across all formats. Quantitative data were summarised 270
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7 using charts, while qualitative responses were analysed thematically to identify suggested mitigations to the proposals. Comments that did not include direct or indirect suggestions for mitigations were excluded from the analysis. This approach ensured the findings focused on actionable recommendations and directly informed consideration of how the proposals could be refined or implemented more safely. Mitigation responses were subject to thematic analysis. Initial coding was undertaken by identifying recurring suggestions within the data, which were then grouped into broader categories reflecting common concerns and proposed interventions. Any discrepancies in coding were resolved collaboratively to ensure consistency and reliability, resulting in the identification of overarching themes that represent participants’ recommendations. Ethical Considerations Participation across all engagement activities was voluntary, and all responses were anonymous. Background information provided in the letter and in all communications supported participants to give informed and meaningful feedback. Sample A total number of 2285 participants took part in the Phase 2 consultation. Limitations of the Data The findings are based on qualitative analysis of free-text consultation responses and reflect the views of those who chose to engage. As a result, the data may be subject to self-selection bias and may not represent the full range of perspectives across all service users, carers, staff, or communities. Responses varied in length, clarity and focus, and not all comments directly addressed the question of mitigation. The analysis captures suggested actions rather than perceived impacts or personal testimonies. The findings therefore provide valuable qualitative insight and should be considered alongside other evidence sources, including service data, equality impact assessments, and professional judgement. 271
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8 Findings Proposal 1: Changing Eligibility – Support Only for People at Critical Risk The Partnership are proposing to change who can receive funded social care support. Under this proposal, we would only be able to provide support to people who are at Critical Risk. This is the highest tier of the National eligibility framework, prioritising immediate, intensive support for critical health and wellbeing needs. Question 1 - Do you agree that the above proposal is an acceptable measure in light of our current financial position? Responses indicate that most participants did not consider the proposal an acceptable measure in light of the current financial position. A clear majority selected “No” (1,401; 61%), while “Yes” was selected by 558 respondents (25%). Smaller proportions selected “Neutral” (168; 7%) or “Unsure” (158; 7%). Overall, the distribution shows that opposition to the proposal was the prevailing view, although around a quarter of respondents expressed agreement and a further minority were neutral or uncertain. 272
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9 Question 2- Do you have any suggestions on how we might lessen the impact of this proposal? In response to the question of how the impact of the proposal could be lessened, respondents identified a broad range of comments and mitigating actions, with a strong emphasis on maintaining safety, dignity, and sustainability within a context of financial constraint. While views varied on specific mechanisms, there was consistent recognition that the impacts of a critical risk only approach could be moderated through a combination of preventative measures, person-centred and timely assessment processes, strengthened support for unpaid carers, effective use of reablement and technology, improved communication and signposting, and greater operational efficiency. Respondents highlighted the importance of aligning systems and funding across health, social care, and community partners, strengthening third sector and community capacity, and ensuring equity for rural, island and marginalised populations. A summary of the identified themes are detailed below. Protect Early Intervention & Prevention / Community Support Hubs Respondents consistently suggested that the impact of the proposal could be mitigated by retaining a level of early intervention and preventative support, particularly for people with low to substantial needs who are at risk of deterioration. This included maintaining access to short‑term support, reablement, preventative reviews, equipment, adaptations and carer support to prevent escalation to crisis. Many responses proposed investing in community‑based alternatives to statutory care, including strengthened partnerships with voluntary and third‑sector organisations, community connectors, and technology‑enabled care. These approaches were viewed as lower‑cost ways to monitor wellbeing, reduce isolation and provide early help before situations become critical. A recurring mitigation was the development or expansion of local community support hubs, offering advice, early help, social connection and signposting in an accessible setting. Respondents emphasised that hubs should be properly resourced, quality‑assured and staffed by people with strong local knowledge, rather than operating as a “tick‑box” service. 273
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10 Additional mitigations included phased or transitional arrangements for those losing services, clear early‑help pathways, and rapid reassessment routes where needs escalate. Individualised Holistic Assessments & Reviews (including families & CAH staff) Respondents consistently suggested that the impact of the proposal could be mitigated by ensuring all assessments and reviews are conducted on a case-by-case basis, reflecting the individual’s full circumstances rather than relying on rigid categories or thresholds. Assessments should be holistic, considering physical health, mental wellbeing, cognitive ability, quality of life, cultural factors, and the reliability and capacity of family or informal support networks. Mitigations included greater involvement of families, unpaid carers and Care at Home staff in assessments and reviews, recognising that frontline carers often have the most “Recognising the role of early intervention in reducing long-term demand and cost” “Preventative social support/clinics avoid critical or life-threatening risk. Focus should be on early prevention, allocated behaviour clinics, clubs, social gatherings that can take place with limited staff but with therapeutic outputs.” “Introduction of an early intervention hub – staff available to signpost with up‑to‑date, accurate information” “Support groups at health centres where seniors can go for self-help ideas. Learning preventative measures.” “My suggestion is that Social Work/support hubs should be opened in each locality to provide advice/support to vulnerable people that this new exclusion criteria will create.” “Everyone is an individual and should be assessed as such. Taking personal and family responsibility into account” “Why are the reviews not done with the person's usual carer as well as social worker that way you get a true reflection of the needs of the individual.” “Where appropriate, family members or informal carers should be included in discussions from the outset so they can contribute to planning, highlight any concerns, and prepare for any additional responsibilities.” “It needs to be on a case by case basis and encompass the needs of the individual. This will be hard but ultimately what the service users need.” “” 274
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11 accurate understanding of how individuals manage day-to-day. Joint reviews involving social workers and usual care staff are seen as a way to ensure decisions are evidence-based, fair and proportionate. Robust, Faster, Fairer and Consistent Assessments Respondents suggested that the impact of the proposal could be mitigated by ensuring assessments are undertaken earlier, completed more quickly, and applied consistently. This included reducing delays at initial assessment, decision-making, appeals and reassessment stages, particularly where risk is escalating. Other areas identified were the use of standardised, fair and transparent assessment criteria, supported by face-to-face assessments where appropriate, clear risk evaluation, and documented plans for rapid re-entry to services if circumstances change. Regular review and reassessment were seen as essential to reflect changing needs and avoid reliance on outdated assessments. Many respondents emphasised the need for early and preventative assessment, supported by effective triage and joined-up working with health and community services, to prevent deterioration into crisis. Ensuring adequate capacity and resources for timely assessments is viewed as critical to protecting vulnerable individuals, unpaid carers and the wider health and care system. Benefits Maximisation / Family Support Respondents suggested mitigating the impact of the proposal by ensuring all individuals are supported to maximise their income, including proactive help to claim relevant disability and carer benefits. Embedding benefits checks within assessments was seen as a key way to help people fund lower‑level support independently where appropriate. “Assessments need to be carried out as much as possible to prevent those going into crisis.” “The assessment tool will be key to the implementation of this proposal.” “Assessments should be reviewed regularly to ensure any changes are taken account of.” 275
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12 Many respondents also highlighted the role of families and informal support networks, suggesting greater involvement in everyday tasks where this is realistic and sustainable. Mitigations included assessing family capacity fairly, encouraging support without penalising families, and reducing rather than removing care where informal support is available. Overall, respondents stressed the importance of combining benefits maximisation with realistic, supported family involvement, while ensuring safeguards and clear routes back into services if informal support is unavailable or breaks down. Effective Communication & Signposting to Community Supports Respondents emphasised that clear, accessible and consistent communication is critical if people below the “critical” threshold are not to be left unsupported. Information on eligibility, available alternatives and routes back into support must be easy to understand and widely available in multiple formats. Signposting must be meaningful and not limited to leaflets or referrals. Respondents stressed the need for person-to-person advice from staff with strong local knowledge who can actively guide individuals and carers to appropriate community, voluntary, private and benefits-based supports. There was concern that unclear messaging or referral to overstretched or unsuitable services risks people falling through the gaps. “Help/advice should always be available when families first start negotiating the care system.” “Supporting families early would reduce pressure on statutory services later.” “Encourage more natural supports family/friends’ involvement with tasks such as shopping meal prep and household chores” “Enlist family support by teaching simple caring tasks not requiring trained staff. Give family carers confidence to care with less support. “ “Help eligible people apply for benefits, that can help purchase support in home.” “Perhaps a public campaign to encourage family input at this level would be helpful. We live in a society where those who are vulnerable are seen as the responsibility of the state, but at a lower level families need to recognise that they need to support loved ones” 276
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13 Effective signposting therefore requires well-trained staff, clear pathways across services, and confidence that alternative supports are able to meet identified needs. Carer Support & Respite as a Preventer of Breakdown Respondents consistently highlighted that the impact of the proposal could be mitigated by protecting and strengthening support for unpaid carers, recognising that carer breakdown is a key driver of crisis, hospital admission and long‑term care placement. Maintaining access to Adult Carer Support Plans, preventative support and respite was viewed as one of the most effective and cost‑efficient ways to prevent escalation. Suggested mitigations include ensuring respite remains available regardless of the cared‑for person’s eligibility, expanding flexible respite options (including care homes, overnight support and short breaks), and providing clearer information and guidance to carers about available support. Respondents stress that even small amounts of respite can significantly reduce burnout and sustain caring arrangements. “Providing clear pathways for people who fall below the threshold, so they are not left without meaningful support.” “Signposting relies on the individual being able to take that step.” “Guidance and pathways must be communicated and given freely.” “Work with primary care to ensure alternative signposting.” “Any signposting to charities etc needs to be clear and the help offered needs to be useful.” “The proposed advice, information, or signposting would have to be robust, comprehensive and available person to person, and available on an on-going basis to all users and potential users of the HSCP service.” 277
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14 Additional mitigations include early identification of carer strain within assessments, rapid reassessment routes when carers are struggling, and stronger links with community, voluntary and third‑sector supports. Reablement, TEC & Medication Aids Respondents suggested mitigating the impact of the proposal by increasing the use of short‑term reablement, TEC and medication aids as alternatives to ongoing care packages. These approaches are viewed as cost‑effective ways to maintain safety, promote independence and reduce unnecessary face‑to‑face care. Key mitigations included expanding reablement services to support recovery, enable self‑management and reduce long‑term dependency, particularly following illness, injury or hospital discharge. Regular reviews were seen as essential to ensure support reduces appropriately as independence improves. There was strong support for wider deployment of TEC, including medication prompts, automated dispensers, sensors, telephone or video check‑ins and remote monitoring, to provide reassurance and early warning while reducing routine visits. Medication‑only visits are identified as a priority for review, with community pharmacy input and use of medication aids where safe, ensuring support remains available if needs change. “Maintain access to Adult Carer Support Plans and preventative respite regardless of the cared-for person’s eligibility, recognising that supporting the carer is the most cost-effective way to prevent a total care at home breakdown.” “Invest in carer support and respite, as supporting unpaid carers helps prevent breakdown and more costly interventions.” “Carry out more assessments through self-directed care, more reablement services promoting independence which should cut back on services required full time.” “Proactively deploy TEC—such as smart sensors and automated medication dispensers—for those in the ‘Substantial’ risk category to provide a low-cost safety net and early warning system.” “Medication only visits to be reassessed by community pharmacy team for medication review and introduce medication aids for individuals to self-medicate.” 278
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15 Reassessment and Appropriate Packages / Operational Efficiency Respondents suggested mitigating the impact of the proposal through regular, structured reassessment of care packages to ensure support remains necessary, proportionate and outcome‑focused. Frequent reviews were seen as essential to reflect changing needs, reduce outdated or unnecessary support, and redirect resources to those at highest risk. Key mitigations included involving Care at Home staff alongside social workers in reviews, as frontline carers are well placed to identify visits that are no longer required or could be safely reduced. Many respondents emphasised the importance of scaling back or reducing care gradually, rather than abrupt withdrawal, with clear routes for rapid reassessment if needs escalate. Operational efficiencies suggested include reducing non‑essential visits, improving auditing and oversight of care delivery, streamlining overlapping teams, and improving scheduling and rota management. Strengthen Third Sector & Community Capacity Respondents suggested that the impact of the proposal could be mitigated by strengthening the capacity, sustainability and coordination of third‑sector and community services before relying on signposting as an alternative to statutory support. There was strong concern that signposting alone was ineffective unless community services are adequately resourced, accessible and able to meet increased demand. Key mitigations included investing in third‑sector organisations, both financially and through professional support, training and clearer referral pathways, to enable them to deliver preventative and lower‑level support safely. Respondents also highlighted the “Review care packages regularly to see if clients still need what they are getting.” “Reduce support where it is no longer required and reinvest in prevention.” “Care needs change over time so it would be important to have frequent reassessment.” “Why are the reviews not done with the person's usual carer as well as social worker… that way you get a true reflection of the needs of the individual and I am sure many visits could be scaled back.” 279
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16 importance of better partnership working, shared understanding of eligibility criteria, and improved communication between statutory services and community providers to avoid duplication and unmet need. Many responses emphasised the potential of community‑based solutions, such as befriending, social groups, micro‑enterprises, volunteering, and use of local facilities as hubs. Revisit Funding Options & System Alignment (HSCP / NAC / SG) Respondents argue that mitigation requires looking beyond service cuts to system‑wide funding alignment. There was support for considering NHS and council budgets together, as prevention in social care reduces costs elsewhere. Respondents explicitly called for seeking additional national funding, lobbying Scottish Government and elected representatives, and ensuring funding decisions reflect whole‑system impacts, rather than siloed budgets across health and local government. Respondents also suggested reprioritising existing council spending, improving efficiency, and considering progressive funding mechanisms, such as targeted council tax increases or contributions from those able to pay, to protect essential social care services. Charging / Means Testing for Non‑Critical Support A minority of respondents suggested that charging or means‑testing for non‑critical support could mitigate impact while preserving early intervention. Charging was viewed “Strengthen partnerships with voluntary and community organisations before signposting.” “Look at what existing third sector organisations are doing in their local communities and support them better either financially or creating pathways of care so that they can deliver more universal and tier 2 types of support.” “Make the business case that it is more expensive to wait until a situation is life-threatening… Ensure NHS & council budgets are considered in the round, not in silos, to optimise outcomes” “The only viable long term solution is for HSCP funding to be increased.” 280
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17 as preferable to withdrawing lower‑level support entirely, particularly where individuals have income, savings or relevant benefits. Mitigations included linking contributions to ability to pay, embedding charging discussions within assessments, and providing clear information on what care is chargeable and how benefits may be used to support costs. Safeguards were emphasised to ensure charging does not cause hardship or place vulnerable people at risk. Reduce Staffing / Wage Bill Considerations Some respondents suggested mitigating the impact of the proposal by reviewing staffing structures and wage costs, with a strong emphasis on reducing expenditure away from frontline delivery. Many respondents called for streamlining management layers, reducing senior and duplicate roles, and cutting administrative overheads, to protect direct care services for vulnerable people. Mitigations included restructuring top‑heavy management models, freezing or reducing senior pay, reviewing pension and expenses, and reallocating savings to frontline care staff and preventative services. Respondents argued that savings should be made top‑down rather than bottom‑up, ensuring carers and service users are not disproportionately affected. “Savings should come from management and agency spend, not frontline prevention.” “Reduce top‑heavy management rather than early intervention.” “Start from the top, less pen pushers more community workers.” “Seek review of how services are managed and trim down executive posts to save money for delivery of services rather than reducing service provision.” “ “Consider means‑tested charging for non‑critical needs.” “Some people could contribute financially to maintain preventative support.” “If a person receives state disability benefits, then that money should go towards their care at home… Make sure people are claiming benefits and send them a bill for the care.” 281
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18 Management & Organisational Efficiency / Service Redesign Respondents also suggested mitigating the impact of the proposal by redesigning services and improving organisational efficiency, including streamlining management structures, reducing duplication across teams and services, and redesigning delivery models to maximise time spent on direct care rather than administration or travel. There was strong emphasis on service integration and smarter delivery, such as better coordination across Ayrshire councils, improved partnership working with health and community services, and redesigning visit patterns to reduce inefficiency. Respondents also highlighted the need to learn from better‑performing local authorities, adopt more flexible and locality‑based models, and make better use of technology, hubs and preventative approaches. Equity, Inclusion & Rural / Island Impacts Respondents suggested mitigating the impact of the proposal by ensuring equitable access to support across all communities, particularly for rural, island and lower‑population areas, where alternatives to statutory services are limited. There was concern that a critical‑risk‑only model may disproportionately disadvantage people who face geographic isolation, limited transport, or reduced service availability. Key mitigations included maintaining preventative pathways, adapting assessments to recognise hidden or unexpressed risk, and ensuring services are culturally sensitive and inclusive, particularly for minority ethnic, faith‑based and less vocal communities. Respondents also stress the importance of monitoring equality impacts, spreading “Stop creating teams that are doing the same job. Streamline services so there is no crossover with several teams doing the same job.” “Simplify pathways and focus on outcomes for individuals.” “Seek review of how services are managed and trim down executive posts to save money for delivery of services rather than reducing service provision.” 282
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19 resources fairly across localities, and ensuring community alternatives are genuinely accessible before reducing statutory provision. Clear Communication, Expectations & Guidance Respondents consistently emphasised that the impact of the proposal could be mitigated through clear, honest and accessible communication with service users, carers, staff and the wider public. This included providing clear eligibility criteria, explaining what support is available, what is changing, and why decisions are being made. “Clear expectations and guidance are essential if services are withdrawn.” “People need to know where to go and what help is realistically available.” ““Honest, truthful explanation to the public of what is and what is not available and the reason for this.” “Open and consistent communication with service users… most of the backlash is usually about poor communication and an explanation that all abilities can understand.” “Spread costs fairly between lower populated areas rather than the best care being in high populated areas.” “Restricting support risks excluding people with hidden or less visible distress.” “Spread costs fairly between lower populated areas rather than the best care being in high populated areas.” 283
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20 Proposal 2: Best Value Care Funding Framework When a person’s needs are assessed, there can be different ways to meet their outcomes. Under this proposal, following an assessment of need in line with eligibility criteria, the HSCP would only fund the most cost-effective option. Question 1 - Do you agree that the above proposal is an acceptable measure in light of our current financial position? Responses to this question show a more mixed view on whether the proposal is an acceptable measure in light of the current financial position. Just under half of respondents agreed with the proposal (963; 42%), while a substantial proportion disagreed (869; 38%). A further 271 respondents (12%) selected “Neutral”, and 182 respondents (8%) indicated they were “Unsure”. While agreement was the single largest response category, overall, more people selected an option that was not obviously in direct favour of the proposal. 284
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21 Question 2- Do you have any suggestions on how we might lessen the impact of this proposal? A wide range of themes, comments and potential mitigating actions were identified by respondents in relation to reducing the impact of the proposal and are detailed below. Managing existing budgets / reallocation of funds from staff costs Respondents expressed the view that before implementing any changes that reduce services or increase the financial burden on vulnerable people, the HSCP and the wider council should first look inward at how existing resources are being used. This theme reflected a perception that inefficiencies, duplicated roles, and high management salaries are contributing to the financial pressures facing social care. Respondents questioned whether the current staffing structure particularly at senior and managerial levels is justified or aligned with frontline need. Some felt that the system had become top-heavy, with too many layers of management and administration, while essential frontline roles remain overstretched and underpaid. Participants highlighted a tension between requesting service users to contribute more while senior staff continue to receive high wages, bonuses, or annual increments. Respondents emphasised that streamlining management, reducing non-essential posts, reviewing bonuses, and re-directing savings to frontline delivery could significantly reduce the deficit without harming the most vulnerable. Others called for an external or independent review of spending. Build/explore alternatives and capacity Respondents highlighted the need for the HSCP to develop additional capacity within community and home-based services as a key mitigation to Proposal 2. They expressed concern that “best value” cannot be delivered if there are simply too few providers, too few care home places, or too little diversity in support models to offer meaningful choice. Participants indicated that the current market constraints including workforce shortages, “The wage structure in the council needs to be examined… those at the high end of the scale are receiving too much of the NAC budgets.” 285
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22 fragile provider sustainability, and rural service gaps, limit the HSCP’s ability to apply a cost-efficiency framework without compromising quality. Respondents emphasised that building capacity does not just mean “more of the same,” requiring a range of ways outcomes are to be met, such as support for families, enhancing reablement, reviewing the use of data, strengthening technology-enabled care (TEC), and creating cluster housing or sheltered care alternatives. Respondents also suggested the need for investment in community groups, third-sector supports and volunteers whom they felt could provide some of the care gaps identified. There was also strong recognition that the HSCP cannot reduce demand for high-cost services without bolstering preventative services. One participant suggested the need to change the overall care approach used by the HSCP and suggested consideration of the ‘Buurtzog model of care’ as an alternative. Regular assessment reviews and right-sized care packages Another mitigation was the need for regular reassessment of care packages. Respondents felt this would ensure that support remains appropriate, is adjusted as needs change, and does not create long-term dependency where it is not necessary. They emphasised that some packages currently include outdated or unnecessary elements and that improved review processes could help free capacity while maintaining fairness and safety. “More regular assessments to assess need and improve independence as far as possible” “When carrying out assessments, ensure that care packages aren’t put in place for those who really don’t need them, as happens at present” “look at cluster care models / along lines of previous sheltered care models with increased technology options.” “Drop in day centres for those who are capable to live alone but occasionally need help rather than a daily carer.” 286
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23 Means-testing and fair contributions A recurring theme across responses was the view that financial contributions should be based on ability to pay rather than a blanket approach. This was seen as a way to prevent inequity, maintain access to essential care, and avoid penalising people simply because of their financial position. Respondents also highlighted that contributions should always be proportionate, transparent, and sensitive to individual circumstances to avoid reinforcing disadvantage. Transparency and clear communication about costs and charges Across responses, individuals highlighted the need for full transparency about care costs, how decisions are made, and what choices individuals actually have. Some called for early communication, clear written information, and consistent messaging to avoid confusion and reduce anxiety. Respondents emphasised that people often do not understand the cost of care or the implications of various options, and that timely, honest communication would help mitigate distress. Maximising benefits and providing financial advice Respondents emphasised the importance of ensuring that people receive all benefits they are entitled to, such as Attendance Allowance, DLA/PIP, or pension credit. They suggested that proactive benefits checks and clear financial guidance could significantly reduce financial strain on individuals and help bridge gaps if a “top-up” model is introduced. Several also noted that without financial education and advocacy, service “Be honest and straightforward with service users and families, tell them the cost of care” “All costs etc clearly explained to Service User to allow them to choose” “Perhaps care at home could be means tested, so that the care is going to those that need it the most.” “People who can afford to pay for care at home services themselves, should contribute to the cost” 287
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24 users may experience “financial shock.” Strong early-stage guidance was viewed as essential to ensuring fairness and informed decision-making. Participants’ Views on Seeking Additional Government Funding A recurring theme across responses was the belief that North Ayrshire HSCP should press both the Scottish Government and the UK Government to increase funding for social care, rather than reducing services or shifting costs onto individuals. Many respondents argued that the financial pressures driving the Best Value proposal was National level underfunding, not local inefficiency, and felt the HSCP should be more assertive in challenging this. Respondents expressed frustration that social care is being expected to deliver more with less, despite being an essential public service supporting some of the most vulnerable people in the community. They emphasised that the root cause of the deficit cannot be solved locally if National funding remains insufficient. There was also a strong sense that older adults, disabled people, and those with long- term conditions who have often contributed throughout their lives through tax and national insurance should not have to pay more because of National budget decisions. Ensuring dignity, equity, and safe care was viewed as a government responsibility, and many respondents felt that ongoing cuts contradict this principle. In addition, some respondents stated that the HSCP should challenge Scottish Government spending priorities, including how social care funding is allocated across councils, or encourage a different National taxation model. “Provide families with independent financial advocacy or clear 'top-up' guides early in the process. This prevents 'financial shock' and helps families make informed decisions about their ability to sustain additional costs long-term.” 288
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25 Strengthening signposting and public information Respondents stressed that people need accessible, up-to-date information about care options, top-up arrangements, benefits, and alternative supports. Without effective signposting, individuals may feel disempowered or confused when faced with complex choices. Clear, consistent information was framed as a key mitigation that reduces anxiety and helps people navigate their options. Quality safeguards Respondents expressed concern that “best value” could be interpreted narrowly as “least expensive.” They argued that quality, safety, and suitability must remain central to decision-making. Respondents stressed that the framework must include robust quality assurance processes, clear service standards, and oversight mechanisms that prevent unsuitable or unsafe care from being selected purely because it is lower cost. “The Scottish/National government must be made to accept the fact that H&SC has been underfunded for too long and must be given a greater priority and thereby a greater budget.” “go back to Scottish government and demand sufficient funding to provide dignity and choice in old age.” “The Westminster and Holyrood governments should introduce a long overdue progressive tax regime for billionaires and millionaires to fund what needs funding properly.” “I think we need to ensure that information is clear to the public” “Service users will need to be contacted at the earliest convenience in regard to the best value plan” “The family made aware of cutbacks and communication is vital” 289
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26 Clear definition and consistent use of ‘Best Value’ Many noted that “best value” is currently vague and risks being applied inconsistently or unfairly. Respondents requested a clear, publicly accessible definition that balances cost with quality, dignity, rights, and long-term outcomes. Explaining how decisions are made and what criteria are used was seen as essential to public trust. Monitoring and regulating provider fees Respondents noted that market conditions should not be allowed to push up prices or lead to inconsistent quality. Regular cost benchmarking, monitoring framework rates, and evaluating provider sustainability were seen as key safeguards. Without oversight, respondents were concerned that the “best value” approach could collapse and providers could withdraw or increase fees beyond what users can afford. Protecting those on low incomes Respondents frequently highlighted that individuals on low or fixed incomes risk being disproportionately affected. They called for safeguards to ensure no one is denied appropriate support because they cannot afford top-ups, and for financial assessments that are sensitive, accurate, and supportive. “Being transparent about how “best value” decisions are made” “Explain how "best value" is defined and applied” “Best value" mantra only works where need is identified, where there are pro-active attempts to encourage people to seek help with realistic attempts to provide that help.” “The provider of care should be under CONSTANT review” “Providers should have a charging cap and be regularly assessed for standards” “Those least able to pay should be given financial assistance if circumstances suggest that the best value option would be detrimental to them.” “This is only good if people have the income to make the difference. There needs to be protection for those with low income.” 290
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27 Considering more in-house provision or reducing reliance on high-cost external providers Some respondents argued that building internal capacity, employing more in-house staff, or reducing dependency on outsourced care may offer better value in the long term. This was viewed as a measure to stabilise the market and maintain consistent standards across services. Addressing rural and remote inequity People in Arran and other rural areas emphasised risks linked to limited provider choice, lack of care home places, and higher service delivery costs. Respondents stressed that the Best Value approach must reflect these realities, ensuring rural communities are not disadvantaged or forced into inappropriate care settings due to geographical constraints. Safeguarding against a two-tier system A concern raised, was the risk of creating a two-tier care system: one for people who can afford to pay extra and a more limited one for those who cannot. Suggestions to mitigate this included protections for low-income households and clearer guidance on affordability. “Stop using agency workers - the Recruitment Agency will bleed you dry. If you must use an Agency, make sure they are paid THE SAME RATE as your permanent staff - this is crucial” “Employ own permanent care staff rather than Agencies and outsourcing.” “I believe many H&SCP have outsourced their carers and what guarantee would there be that rates would be increased with inflation/cost of living etc.” “specific consideration needed for remote and rural areas where costs are potentially highest but with no less levels of need” “My concerns are we may end up with a two tier care system” “You need to avoid the postcode lottery approach to care” 291
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28 Appeals, exceptions, and flexibility To preserve fairness, respondents highlighted the need for a transparent appeals process and exceptions framework for cases where the lowest-cost option does not meet a person’s needs. Respondents suggested that a fair exceptions process would ensure that choice, safety, and clinical or psychological needs are considered. Protecting independence – avoiding default moves to care homes Respondents raised concerns about the proposal’s example of offering a care home place when care at home surpasses a certain number of hours. Mitigations could be linked to improved holistic care and assessment, enhanced community supports, technology-enabled care, and more flexible care-at-home arrangements. “Exceptional Circumstances Clause: Maintain a clear, transparent 'Appeals' or 'Exceptions' process for cases where the cheapest option is demonstrably unsuitable due to specific clinical or psychological needs.” “you will need a robust, ideally independent, appeal process to challenge decisions where the care recipient or carers strongly feel that the cheapest option is inappropriate to their needs” “Setting a specific criteria such as 28 days seems random and should only be used as a guide dependant on the individual circumstances” “I think there needs to be much more information and consideration to the needs of someone living in their own home who receives more than 28 hours of support. Forcing someone out of their home, particularly someone with a learning disability, is denying them of their rights.” 292
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29 Proposal 3: Prioritising Personal Care We want to focus our limited resources on the types of support that are most essential for people’s health and safety. Under critical eligibility criteria we will prioritise meeting personal care needs first and re-consider what constitutes a non-personal care need and the level of support which is offered. Question 1 - Do you agree that the above proposal is an acceptable measure in light of our current financial position? Responses to this question indicate that nearly half of respondents considered the proposal to be acceptable in light of the current financial position. A total of 1,056 respondents (47%) selected “Yes”, while 832 respondents (36%) disagreed. Smaller proportions selected “Neutral” (250; 11%) or “Unsure” (137; 6%). Overall, the findings show that while agreement was the single largest response category, more people selected an option that was not obviously in direct favour of the proposal. 293
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30 Question 2- Do you have any suggestions on how we might lessen the impact of this proposal? A broad spectrum of comments and mitigating actions were suggested by respondents to help reduce the impact of the proposal. Financial & budgetary mitigation Respondents argued that funding shortfalls should be addressed through financial reforms rather than cutting care. Respondents proposed various financial solutions including increasing council tax, cutting management costs, improving efficiency, using disability benefits, or applying means-testing or contributions of those that can afford it. Across responses, individuals indicate that prevention saves money, and removing services now will only “cost more in the long run.” Service Considerations / Review – Different Ways of Working Respondents highlighted a wide range of ideas for reviewing services and redesigning how support is delivered, emphasising efficiency, better coordination, and realistic models of care. A recurring theme was the need to review existing care packages to ensure support levels genuinely reflect current need. Others suggested better rota planning and reducing travel time. Several respondents encouraged the HSCP to explore alternative models, such as cluster-based support, increased use of technology and creation of more community support such as, lunch clubs, mobile shops, and volunteer shopping. “they should be accessing Attendance/Disability Allowance to pay for non-personal care needs.” “People should be encouraged to apply for benefits which could assist with social care.” “Review care packages regularly to see if clients need what they are getting it would free up space on rota's.” “Consider different ways of providing support – cluster care models… technology options.” 294
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31 Efficient / Robust / Individual / Holistic assessment Respondents emphasised that assessments must be robust, individual, and grounded in real-life circumstances, rather than applying blanket rules or rigid criteria that fail to reflect people’s true needs. Some stressed that “it needs to be on a case-by-case basis” and that people’s situations are “not the same,” making one-size-fits-all approaches unsafe and unfair. They also highlighted the importance of assessments being accurate and holistic, with some stating current processes can become “a tick-box exercise” that does not capture the reality of daily life. Participants called for regular reviews to ensure packages remain appropriate. Use of voluntary, 3rd Sector & community solutions, with safeguards in place / ensure sufficient providers Respondents indicated they were open to greater involvement from voluntary organisations, community groups, and third-sector providers, recognising that these supports could complement statutory services. However, they consistently stressed that such alternatives must be reliable, safe, and properly supported, noting concerns about capacity, consistency, safeguarding and long-term sustainability. Several respondents highlighted that community, and voluntary services are already “stretched” and may not be able to cope with an influx of referrals if statutory services withdraw support. Others emphasised that any shift toward community alternatives must include strong quality assurance, stating that community groups must be monitored to “make sure it is actually working and meeting the needs” rather than assuming they can automatically fill gaps. “Be holistic, not just a tick‑box exercise” “Blanket policies go against legislation… assessment must be individual.” 295
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32 Implementation in stages with clear communication & signposting Where respondents could accept reductions, they strongly urged a phased, well-communicated transition with early information, warm handovers, and proactive reassessment. Unpaid carers must be explicitly protected and prioritised Respondents highlighted that removing non-personal care, day services, and respite will lead to carer burnout, breakdown of home-based care, and increased demand for institutional or emergency services. Respondents indicated that there needed to be strengthening of areas such as respite and day services which they felt contributed to early intervention. They also requested more clarity around what alternative supports might be, whilst others stressed the need to protect access to carer support plans. “British Red Cross could potentially support more non personal care needs perhaps asking for volunteers to do weekly shopping trips etc” “Strengthen the link between GP practices and local community hubs to ensure that those losing 'social access' support are connected to local clubs or befriending services to combat isolation” “buddy schemes for cup of tea can help lessen loneliness but today social media also helps in this regard” “A phased approach… to ensure changes are safe, well-managed, and person-centred.” “Ensure clear communication and signposting so changes don’t feel abrupt.” “Carers are already at breaking point… taking support away is disgusting and cruel beyond measure.” “Respite… is a lifeline for carers. Removing this will have a huge negative impact.” 296
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33 Family support / education Respondents acknowledged a role for families (where available and appropriate) but stressed the need for support, education, and fairness, noting not all families can help. False economy – reducing non-personal care will increase costs over time Respondents warned that removing preventative supports leads to higher long-term expenditure through crisis responses, hospital admissions, bed blocking, and greater package costs later. Day services and respite are critical, not discretionary Respondents stressed that day opportunities and respite provided structure, routine, mental health support, social connection, and enable carers to sustain their role. Removing them was viewed as dangerous. “Encourage families to take some responsibility.” “Family support should be part of the assessment—but not assumed.” “Educate families… many expect carers to do tasks they should do themselves.” “Prevention will be considerably cheaper than waiting until the situation becomes critical.” “Surely earlier support and intervention would prevent life threatening or high risk situations… and reduce the chances of hospital admissions.” “Day services are a lifeline… without this some people don’t see anyone week to week.” “Planned respite allows unpaid carers to sustain their role… removing it risks emergency situations.” 297
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34 Some non-personal care is viewed as preventative and/or essential, not optional - strengthen prevention Respondents stressed that non-personal care such as shopping, housework, food preparation, community access, domestic support and day services, were not an “optional extra” but a core part of prevention. Respondents highlighted that these supports keep people safe, socially connected, mentally well, and able to remain at home. Mitigations included the request to retain some non-personal care where it clearly prevents deterioration, or someone has no alternative network. Others included the retention of community access and day services, providing alternatives or partial solutions rather than withdrawing support completely and consideration of partial contributions rather than full removal. Respondents also requested there be a recognition of the link between non-personal care and safety. Community Alarm / telecare viewed as vital – should be classed as personal care Community alarms and telecare were repeatedly described as essential safety supports, not “optional extras.” Many respondents stated that withdrawing them could lead to severe harm or death. Better use of these were suggested as mitigation. “Domestic support, shopping, food preparation, community access… are not optional extras… they prevent deterioration, isolation, carer breakdown and crisis.” “Work with charitable / non-profit providers to support people’s choices.” “If a person cannot acquire shopping, they will not be able to eat… this is a priority.” “Make greater use of technology for monitoring, reminders and wellbeing checks.” “Surely the use of Telecare and Alert helps to reduce the amount of support a person needs so should be deemed as being cost effective. 298
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35 Ensure equity across all groups (including islands, Learning Disabilities, those living alone, families) Respondents stressed that the proposals risk disproportionately harming vulnerable groups, including rural/island residents, people with learning disabilities, those living alone, and families without networks. Mitigations included maintaining fairness in service provision and avoiding a two tier system, protect island communities through realistic service planning and protecting specific groups such as learning disabilities through tailored consideration. Transparency & consultation Respondents expressed frustration about lack of transparency, clarity of definitions, and concerns around the consultation process. “Arran has only one care home… people could be forced off the island.” “Ensure equity across all user groups particularly ensuring older adults receive fair access so should be deemed as being cost effective.” “Environmental factors can massively impact on health so there should not be a choice between them. Both must be considered” “The consultation has not been issued to service users… smacks of a cynical cost-cutting exercise.” “Language is vague and meaningless… needs to be clearer.” 299
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36 Conclusion The Phase 2 consultation highlights the complexity and sensitivity of the proposed changes to social care delivery in North Ayrshire. Respondents consistently warned that restricting support to Critical Risk alone, prioritising cost over prevention, or withdrawing non-personal care without adequate safeguards risks accelerating deterioration, increasing hospital admissions, and placing unsustainable pressure on unpaid carers and communities. Participants did not identify a single solution to the financial challenge. Instead, they articulated a clear set of mitigating principles: protect early intervention, assess people holistically and fairly, support carers proactively, use reablement and technology to promote independence, improve operational efficiency before reducing care, and ensure equity across all communities. Effective communication, structured implementation phases, and the establishment of feasible alternative solutions were regarded as critical measures to mitigate confusion, reduce anxiety, and avoid inadvertent negative consequences. The findings reinforce that decisions taken by the Integration Joint Board must be informed not only by immediate budget pressures, but by long-term system impacts across health, social care, families and communities. Respondents expect NAHSCP to consider the whole system, including NHS pressures, third-sector capacity, rural and island realities, and the cumulative effect of change on those who rely on support. 300
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37 Appendices Appendix 1: Survey Phase 2 Delivering Social Care Services Within Budget: Policy Proposal Consultation North Ayrshire Health and Social Care Partnership (NAHSCP) recently ran a 6-week consultation to gather the thoughts of residents, community groups, staff, and partner organisations on their priorities around how the HSCP delivers social care services within budget. We are currently facing significant financial pressures, with demand for our services continuing to rise at an unprecedented rate. With the cost of providing these services also increasing - and funding not keeping pace with these additional challenges – we are facing a forecast budget deficit of around £14m in 2026-27. As a follow-up to the initial consultation, we are now asking all North Ayrshire residents to take part in a short survey, where you can share your views on a number of proposed changes to social care services that are currently being considered. These combined changes are significant and will impact on the care people are offered currently and in the future. Results from this additional survey will be analysed over the coming weeks, with a final report on findings from both this and the previous consultation being presented to North Ayrshire Integration Joint Board in mid-March for consideration when setting the budget for 2026-27. We would like to take this opportunity to thank you in advance for your feedback. Your views will be invaluable as we work towards ensuring support remains available for our most vulnerable residents. The survey will close on Wednesday 25 February. If you need help to do this, please ask a friend, neighbour, family member or carer to assist. If you require any additional support or a paper copy, please email StrategicPlanningHSCP@north-ayrshire.gov.uk Paper copies are also available on request from all North Ayrshire libraries. Staff at Carers Gateway North Ayrshire will be available to support unpaid carers to fill out the survey over the phone. You can call the Carers Gateway on 01294 311333. 301
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38 Proposal 1: Changing Eligibility – Support Only for People at Critical Risk We are proposing to change who can receive funded social care support. Under this proposal, we would only be able to provide support to people who are at Critical Risk. This is the highest tier of the national eligibility framework, prioritising immediate, intensive support for critical health and wellbeing needs. Key Aspects of Critical Risk: • Life-Threatening Risk: The individual’s safety, health, or independence is in severe danger. • Essential Task Failure: Inability to manage vital, daily personal care or basic domestic activities, leading to immediate danger. • Abuse or Neglect: High risk of abuse, or severe neglect is present or suspected. • Caregiver Breakdown: The carer is experiencing severe physical or mental health difficulties that pose a life-threatening risk to themselves or the person being cared for. • High-Intensity Need: Services are usually required immediately or on an emergency basis. WHAT DOES THIS MEAN IN PRACTICE? • We would no longer be able to provide preventative or early help services. • Support would only be offered when an assessment shows there is a life- threatening or urgent risk. • People with lower-level needs would be given advice, information, or signposted to community services instead. This change is being considered because the HSCP must ensure limited resources go to those with the most urgent and serious needs. 302
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39 1. Do you agree that the above proposal is an acceptable measure in light of our current financial position? *This question is mandatory* (Please underline, circle or highlight your answer) Yes Neutral No Unsure 2. Do you have any suggestions on how we might lessen the impact of this proposal? (Please use text box below) 303
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40 Proposal 2: Best Value Care Funding Framework When a person’s needs are assessed, there can be different ways to meet their outcomes. Under this proposal, following an assessment of need in line with eligibility criteria, the HSCP would only fund the most cost-effective option. WHAT DOES THIS MEAN IN PRACTICE? • People will still have choice about the type of care they prefer. • However, public funding would only cover the option that provides best value for the Partnership. • For example, for Older People’s Services, where care at home needs are in excess of 28 hours per week, a care home may be offered instead, or • For example, where a chosen care provider charges fees in excess of HSCP approved rates, the service user may choose to independently fund the difference. • If someone prefers a more expensive option, they can still choose it — but would need to pay the difference themselves (self-fund or top-up). We will continue to assess needs based on choice and preference but will also take into consideration the most cost effective way of meeting an individual’s outcomes. This may not be a service user’s first choice. The aim is to make sure we can continue to support people with the highest needs while managing rising costs. 3. Do you agree that the above proposal is an acceptable measure in light of our current financial position? *This question is mandatory* (Please underline, circle or highlight your answer) Yes Neutral No Unsure 304
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41 4. Do you have any suggestions on how we might lessen the impact of this proposal? (Please use text box below) 305
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42 Proposal 3: Prioritising Personal Care We want to focus our limited resources on the types of support that are most essential for people’s health and safety. Under critical eligibility criteria we will prioritise meeting personal care needs first and re-consider what constitutes a non-personal care need and the level of support which is offered. An assessment of need in line with Critical eligibility criteria would be undertaken with consideration of those non-personal care supports that are necessary to address high risks only. • Personal Care includes - Personal hygiene, getting dressed, eating and diet, mobility, continence management, medication and treatment. • Non-Personal Care includes – Domestic support, shopping, community access and transport, day services, telecare services like community alarms, food preparation and provision. WHAT DOES THIS MEAN IN PRACTICE? · • We would prioritise personal care, such as help with washing, dressing, eating, and other tasks needed to stay safe and well. • We would only provide non personal care (e.g., housework, shopping, community access) if not providing it would create a significant and immediate risk. • For example, routine provision of domestic support, shopping and support for community access will no longer be funded unless an individual has no alternative support network and there is a high risk to an individual’s safety. • For example, only those with a critical need and level of risk will be offered a placement at a Day Service and planned respite may be reduced and targeted towards individuals who require emergency or high-risk respite provision. • People would still have choice, but if a support need is not deemed essential for their safety or health, they may be asked to self-fund that part of their care. This approach ensures that limited resources are directed towards individuals with the most immediate and critical needs. 306
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43 5. Do you agree that the above proposal is an acceptable measure in light of our current financial position? *This question is mandatory* (Please underline, circle or highlight your answer) Yes Neutral No Unsure 6. Do you have any suggestions on how we might lessen the impact of this proposal?(Please use text box below) 307
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44 Appendix 2: Letter to residents DIRECTOR (North Ayrshire Health & Social Care Partnership): Caroline Cameron 5th Floor, West Wing, Cunninghame House, Irvine KA12 8EE / Tel: (01294) 317700 Our Ref: CC/KA Dear North Ayrshire Resident. IMPORTANT UPDATE ON PROPOSALS FOR SOCIAL CARE SERVICES You may be aware that North Ayrshire Health and Social Care Partnership (NAHSCP) recently ran a 6-week consultation to gather the thoughts of residents, community groups, staff, and partner organisations on their priorities around how the HSCP delivers social care services within budget. The HSCP is responsible for a wide range of community and hospital-based health and social care services for all ages. The partnership is currently facing significant financial pressures, with demand for our services continuing to rise at an unprecedented rate. With the cost of providing these services also increasing - and funding not keeping pace with these additional challenges – we are now facing a forecast budget deficit of around £14m in 2026-27. As a follow-up to our previous consultation, we are now asking all North Ayrshire residents to take part in a short survey, where you can share your views on a number of proposed changes to social care services that are currently being considered. These combined changes are significant and will impact on the care people are offered currently and in the future. The three main proposals we are seeking views on are: Proposal 1 - Changing Eligibility - Support Only for People at Critical Risk: We are proposing to provide funded social care only to people assessed as being at Critical Risk - meaning someone is at immediate or imminent risk of serious harm, neglect, or losing the ability to live safely and independently. The HSCP would no longer fund preventative or early help services for people with substantial, moderate or low needs, however they will still receive advice, information or signposting to community services. Proposal 2 - Best Value Care Funding Framework: 308
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45 When someone is assessed as needing care, there may be different ways to meet those needs. Under this proposal, the HSCP would fund the most cost-effective option that still meets the person’s assessed needs and outcomes. People will still have choice, but public funding would cover only the least costly option. If someone prefers a more expensive option, they can still choose it, but would need to top up or self fund. Proposal 3 - Prioritising Personal Care: HSCP‑funded support would focus on essential personal care (such as help with washing, dressing, eating and staying safe). Non‑personal care (such as domestic support, shopping, community access and social supports) would only be provided where not doing so would create a significant and immediate risk. Personal care becomes the priority for funding, with individuals able to self-fund additional supports if they wish. Any changes to current and future care packages would require an individual assessment of need to be undertaken. Difficult decisions lie ahead as North Ayrshire Integration Joint Board (the legal decision-making body for the HSCP) works to balance the budget for the coming financial year. These challenges are being faced not only by North Ayrshire HSCP, but by health and social care partnerships across the country. This is not a position that we want to be in, and we understand that the proposals outlined could negatively affect those who use our services, or may need to use our services in the future. Therefore, we are particularly keen to hear your suggestions on how we can lessen the impact that these proposals could potentially have. Results from this additional survey will be analysed over the coming weeks, with a final report on findings from both this and the previous consultation being presented to North Ayrshire Integration Joint Board in mid-March for consideration when setting the budget for 2026-27. To take part, scan the QR code or visit https://tinyurl.com/5ym43cxc The survey will close on Wednesday 25th February. If you need help to do this, please ask a friend, neighbour, family member or carer to assist. If you require any additional support or a paper copy, please email StrategicPlanningHSCP@north- ayrshire.gov.uk. Paper copies are also available on request from all North Ayrshire libraries. Staff at Carers Gateway North Ayrshire will be available to support unpaid carers to fill out the survey over the phone. You can call the Carers Gateway on 01294 311333. We would like to take this opportunity to thank you in advance for your feedback. Your views will be invaluable as we work towards ensuring support remains available for our most vulnerable residents. 309
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46 Yours sincerely, Caroline Cameron Caroline Cameron Director – Health and Social Care Partnership 310
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NORTH AYRSHIRE Health and Social Care Partnership WORKING TOGETHER IN PARTNERSHIP North Ayrshire Council NHS Ayrshire & Arran TSI North Ayrshire Scottish Care Delivering care together Eligibility Policy Critical Only Access to Funded Adult Social Work and Social Care Services (including Best Value Care Funding Framework) March 2026 Approved By Date Review Date Integration Joint Board 13/03/26 January 2027 Important note: A “critical-only” threshold can be used as a resource-allocation policy for funded ongoing supports, but it cannot remove or dilute statutory duties to assess, make inquiries, protect, and offer SDS options when an eligible need is being met. The Social Work (Scotland) Act 1968 s12A establishes a two-stage process: assess needs, then decide whether needs call for services (the “eligibility decision” stage). A full Equality and Children’s Rights Impact Assessment (EQCRIA) has been carried out on this Policy and is published. Appendix 3 311
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NORTH AYRSHIRE Health and Social Care Partnership WORKING TOGETHER IN PARTNERSHIP North Ayrshire Council NHS Ayrshire & Arran TSI North Ayrshire Scottish Care Delivering care together A) Eligibility Policy: Critical-Only Access to Funded Adult Social Work Services 1.1 Purpose This policy sets out how the HSCP will: • meet statutory duties to receive referrals, provide information, undertake needs assessment, and make adult protection inquiries; and • allocate funded ongoing adult social care services only where assessed risks meet the “Critical” band of the national eligibility risk framework. 1.2 Scope This policy applies to: • Adults (18+) seeking community care/social care support, including those eligible for SDS arrangements. • Unpaid carers: carer assessment/support follows Carers (Scotland) Act 2016 duties and local carer eligibility criteria (this policy does not restrict ACSP/YCS duties). • Adult Support and Protection (ASP): all adult protection concerns will be progressed under ASP procedures regardless of funding eligibility. Out of scope: • Children’s services eligibility thresholds (set locally; not within national adult eligibility framework). 1.3 Legal and policy framework • Social Work (Scotland) Act 1968 s12A (as amended): duty to assess needs and then decide whether those needs call for services (eligibility decision). • Social Care (Self-directed Support) (Scotland) Act 2013 SDS is underpinned by human-rights-based principles and requires offering four SDS options when arranging eligible support. • Adult Support and Protection (Scotland) Act 2007: duty to make inquiries where the council knows or believes it may need to intervene to protect an adult from harm; investigative powers support those inquiries. • Carers (Scotland) Act 2016 duty to offer and prepare ACSP/YCS for identified carers regardless of whether needs are expected to meet local eligibility criteria. • National Eligibility Framework bands (Critical/Substantial/Moderate/Low) used widely in Scotland and referenced in Scottish Government Guidance 312
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NORTH AYRSHIRE Health and Social Care Partnership WORKING TOGETHER IN PARTNERSHIP North Ayrshire Council NHS Ayrshire & Arran TSI North Ayrshire Scottish Care Delivering care together (National Standards Eligibility Criteria and Waiting Times for the Personal and Nursing Care of Older People). Other relevant legislation includes: • The NHS and Community Care Act 1990 • Community Care and Health (Scotland) Act 2002 • Chronically Sick and Disabled Persons Act 1970 • Mental Health (Care and Treatment) (Scotland) Act 2003 • Adults with Incapacity (Scotland) Act 2000 • The Regulation of Care (Scotland) Act 2001 • Children (Scotland) Act 1995 • Data Protection Act 2018 • Freedom of Information (Scotland) Act 2002 • The Human Rights Act 1998 and Equality Legislation • The Equality Act 2010 • The Mental Health (Scotland) Act 2015 Other related policies and mechanisms include: • Single Shared Assessment Form/Specialist Assessment Forms • Social Work Care Plan & any reviews therein • High Cost Care Package Group • Adult Resource Allocation Group • Care and Risk Management Procedures • Non Residential Charging Policy This Policy represents a departure from national guidance. It has however been prepared, and should be interpreted, according to the statutory duties to which the HSCP is subject in the provision of relevant services. 1.4 Policy statement 1. We will assess any adult who appears to need community care services. The main duty to provide community care services derives from Section 12A of the Social Work (Scotland) 1968 Act: "Where it appears to the local authority that any person for whom they are under a duty, or have a power, to provide community care services may be in need of any such services the local authority shall: 313
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NORTH AYRSHIRE Health and Social Care Partnership WORKING TOGETHER IN PARTNERSHIP North Ayrshire Council NHS Ayrshire & Arran TSI North Ayrshire Scottish Care Delivering care together • Make an assessment of the needs of that person for those services; and • Decide, having regard to the results of that assessment, whether the needs of the person being assessed call for the provision of any such services, taking account of: o Care provided by [an adult or young] carer o The views of the person whose needs are being assessed (provided that there is a wish, or as the case may be a capacity, to express a view)”. 2. The Equalities Act 2010 was passed on 8 April 2010. The Act protects the following characteristics (referred to in the Act as “protected characteristics”): • Age • Disability • Gender reassignment • Marriage and civil partnership • Pregnancy and maternity • Race • Religion or belief • Sex • Sexual orientation. The Act prohibits discrimination (whether direct or indirect) against people who possess one of the protected characteristics. 3. Although assessments of need are carried out on an individual and person‑centred basis (and eligible services provided accordingly), the HSCP also has a responsibility to ensure that levels of support are applied fairly and consistently for everyone. 4. We will determine eligibility using a transparent risk-based approach and will provide funded ongoing services only where risks meet the “Critical” band. Services will be provided in line with the HSCP’s best value framework recognising the HSCP can only fund services to a certain value. Assessments consider both personal and non-personal care needs, with eligibility criteria aligned to Critical needs for all aspects of support. 5. Where needs do not meet the “Critical” threshold, we will: o provide information, advice, and signposting, o consider unfunded supports (community assets, third sector, universal services), and 314
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NORTH AYRSHIRE Health and Social Care Partnership WORKING TOGETHER IN PARTNERSHIP North Ayrshire Council NHS Ayrshire & Arran TSI North Ayrshire Scottish Care Delivering care together o provide short-term, time-limited interventions only where necessary to manage imminent escalation and/or fulfil statutory protection duties. 6. Adult protection duties supersede eligibility: any concerns that an adult may be at risk of harm will be managed under ASP procedures regardless of eligibility for funded services. 7. Where an eligible need is to be met by the HSCP, the person must be supported to make an informed SDS choice among the four options, and the process must be involvement-, choice- and collaboration-based. 8. This Policy will take effect from 1st April 2026 and shall apply to all new community care assessments commenced after that date. In respect of existing service users, this Policy shall apply at the next review undertaken in respect of the service user’s care package, occurring after 1st April 2026. 9. The HSCP reserves the right to depart from this Policy in exceptional circumstances, taking account of the range of its relevant legal duties. 1.5 Definitions By Eligibility criteria we mean statements describing conditions for access to funded services following assessment. By Critical Risk we mean the presence of indicators that there are major risks to an individual’s independent living or health and well-being and likely to call for the immediate or imminent provision of social care services such as: • immediate/likely danger to life or serious deterioration in health/safety; • serious self-neglect or inability to carry out vital personal care where no safe alternative exists; • severe risk of abuse/harm or exploitation requiring urgent protective action; • breakdown of essential care/support arrangements leading to unsafe situation; • immediate risk of admission to hospital/care home that could be avoided only through urgent provision of support. The critical risk decision test for practitioners including professional reasoning: A person is likely to meet Critical where evidence shows: 1. Major risk to health, safety, or ability to live independently AND 2. The risk requires immediate/imminent intervention. 315
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NORTH AYRSHIRE Health and Social Care Partnership WORKING TOGETHER IN PARTNERSHIP North Ayrshire Council NHS Ayrshire & Arran TSI North Ayrshire Scottish Care Delivering care together 3. Local frameworks describe “critical” as major/life-threatening harm, danger, or inability to manage vital personal care/domestic tasks creating major harm or danger. For reference the national eligibility descriptors in full are: • Critical Risk: Indicates that there are major risks to an individual’s independent living or health and well-being and likely to call for the immediate or imminent provision of social care services. • Substantial Risk: Indicates that there are significant risks to an individual’s independence or health and wellbeing and likely to call for the immediate or imminent provision of social care services. • Moderate Risk: Indicates that there are some risks to an individual’s independence or health and wellbeing. These may call for the provision of some social care services managed and prioritised on an on-going basis or they may simply be manageable over the foreseeable future without service provision, with appropriate arrangements for review. • Low Risk: Indicates that there may be some quality of life issues, but low risks to an individual’s independence or health and wellbeing with very limited, if any, requirement for the provision of social care services. There may be some need for alternative support or advice and appropriate arrangements for review over the foreseeable future or longer term. Local authorities can set their own specific eligibility criteria, although they are expected to align with the national framework, taking into account available resources and costs. 1.6 Principles The HSCP takes a person-centred, outcomes-based approach to needs assessment and support planning. Not all assessed needs will meet eligibility criteria for statutory funding. Normally, only outcomes that are assessed as critical can be allocated funding for support. Outcomes not associated with eligible needs will be used to inform and shape how eligible support is best provided and the design of future services. Assessments and decisions will: • be person-centred, outcome-focused, and proportionate; • be rights-based and aligned with SDS statutory principles (dignity, participation, involvement, informed choice, collaboration); 316
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NORTH AYRSHIRE Health and Social Care Partnership WORKING TOGETHER IN PARTNERSHIP North Ayrshire Council NHS Ayrshire & Arran TSI North Ayrshire Scottish Care Delivering care together • be strengths/asset-informed, considering informal supports and community resources first (without assuming family/carers must provide); • recognise carers’ rights to ACSP/YCS and separate eligibility framework; • prioritise risk management and protection where ASP duties apply. 1.7 Decision-making framework (Critical-only) After assessment, practitioners will record via direct input or the use of assistive technology tools: • identified needs, outcomes, risks (severity + urgency), and protective factors; • consideration of options to reduce risk without funded services; • whether risk meets Critical threshold now, or is likely to become Critical imminently without time-limited intervention; • whether any ASP inquiry duty is triggered. Eligibility outcome categories: • Eligible – Critical: Funded support arranged (SDS options offered and recorded). • Not eligible – Below Critical: No funded ongoing service; provide information/advice, prevention supports, and safety plan. • Protection route: ASP inquiry/investigation and protection planning (may include services irrespective of general eligibility where required to protect). • Urgent interim: time-limited support while completing assessment or arranging critical support (e.g., emergency arrangements). (Document rationale and timescale.) When the person is not eligible for funded service (Substantial/Moderate/Low) Aim: provide a meaningful social work response that prevents deterioration and supports rights. Scottish guidance recognises eligibility criteria as a way to target greatest need, while also recognising low-level interventions that can halt deterioration in less urgent need. 317
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NORTH AYRSHIRE Health and Social Care Partnership WORKING TOGETHER IN PARTNERSHIP North Ayrshire Council NHS Ayrshire & Arran TSI North Ayrshire Scottish Care Delivering care together As a minimum every person should receive (must do): 1. Information and advice tailored to the person’s situation 2. Signposting/referral to universal and community supports (third sector, peer support, befriending, welfare benefits, housing, OT/adaptations route, community alarms) 3. Carer support pathway Referral to North Ayrshire Carers Gateway or provide contact/web details for this service. 4. Risk management / safety plan proportionate to the concerns (especially self- neglect, falls risk, domestic abuse, exploitation) 5. Review trigger and re-contact route (including “what changes would warrant reassessment”) 6. Advocacy where communication/capacity barriers exist or where rights may be compromised (especially in ASP contexts). 1.8 Application of Self Directed Support The partnership’s SDS policy will apply. 1.9 Review and appeal • Outcomes from the assessment will be provided direct to the resident and / or their family. This feedback will provide a written decision summary including: assessed needs, risk banding rationale, what will/won’t be provided, and how to request review/complaint • Reviews occur when: risk changes, circumstances change, safeguarding concerns arise, or at an agreed review date for those receiving funded support. Statutory guidance states "The authority should aim to conduct reviews within a maximum period of 12 months. It should consider the review as a means by which to prevent crisis or to respond and adapt to the supported person‘s life." 1.9 Recording and quality assurance Minimum record: • The single shared assessment must be completed on Eclipse with the relevant team manager decision and any review date recorded. • Any decision taken from funding groups will also be recorded on Eclipse. • Where criteria to receive service is met but the service is unavailable the individual will be subject to ongoing monitoring. 318
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NORTH AYRSHIRE Health and Social Care Partnership WORKING TOGETHER IN PARTNERSHIP North Ayrshire Council NHS Ayrshire & Arran TSI North Ayrshire Scottish Care Delivering care together Governance: • Robust auditing framework to be introduced to consider “below critical” decisions, repeat contacts, and any escalation to ASP/hospital admission • The unmet needs group remains the primary governing body of risk management in adult services. • Serious incidents are subject to other governance in the shape of o Duty of Candour o CSWO Notifiable Incidents o Care Inspectorate Notifications B) Best Value Care Funding Framework 1. Purpose and Context The Best Value Care Funding Framework sets out how the HSCP will ensure publicly funded social care is allocated in a fair, consistent and financially sustainable way. It supports the IJB’s duty to deliver essential care within significant budget constraints and rising service demand. The HSCP will continue to assess needs based on choice and preference but will also take into consideration the most cost-effective way of meeting an individual’s outcomes, this may not be a service user’s first choice. 2. Core Principle of Best Value When an individual’s needs are assessed, there may be several ways to meet their outcomes. Under this framework, the HSCP will fund the most cost-effective option that still meets the person’s assessed needs and outcomes. Choice remains, but public funding is capped at the level of the cost-effective option. 3. Eligibility and Assessment Requirements • All funded support must align with the outcomes identified through a formal needs assessment. • Funded support option or alternative must be available. • Support must meet needs that fall within the national eligibility framework. • Support is focused on those assessed as being at Critical Risk, ensuring finite resources are directed to immediate health, safety and independence needs. 319
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NORTH AYRSHIRE Health and Social Care Partnership WORKING TOGETHER IN PARTNERSHIP North Ayrshire Council NHS Ayrshire & Arran TSI North Ayrshire Scottish Care Delivering care together 4. Determining the Cost-Effective Option During the assessment process, when multiple options are identified, and available, which meet the assessed outcomes: • The HSCP will identify the option that provides best value, considering cost, quality, safety and sustainability. • If an individual prefers a more expensive option, they may choose to pay the difference between the HSCP-funded option and their preferred option. • The application of this Policy cannot directly alter any choices legally exercisable by service users, or their designated legal proxy. Illustrative Examples: • High Care at Home hours: A care home placement (or cost equivalent) may be offered where it would meet relevant need and be more cost-effective. • Provider choice: Where someone selects a provider above the HSCP’s approved rate, they may self-fund the additional cost. 5. Safeguards and Quality Standards The framework ensures: • Options funded by HSCP must still meet quality, regulatory and safety standards. • Application of best value must not compromise essential personal care or create unsafe situations. • Consideration of market capacity—recognising that shortages in providers or placements may limit available options and require system-level mitigations. 6. Equity, Transparency and Consistency • Decisions will be made using consistent criteria and communicated clearly to individuals and carers. • The framework supports fair allocation of finite public resources across all eligible service users and communities. • It ensures clarity on when HSCP funding applies and when individuals may self-fund. 320
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NORTH AYRSHIRE Health and Social Care Partnership WORKING TOGETHER IN PARTNERSHIP North Ayrshire Council NHS Ayrshire & Arran TSI North Ayrshire Scottish Care Delivering care together 7. Implementation and Review • The framework is part of a broader set of budgetary measures required to ensure the most effective use of social care resources and to ensure a fair and equitable provision of resources. • Policy will be reviewed regularly to ensure alignment with demand, market conditions, statutory duties and community feedback. 321
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NORTH AYRSHIRE Health and Social Care Partnership WORKING TOGETHER IN PARTNERSHIP North Ayrshire Council NHS Ayrshire & Arran TSI North Ayrshire Scottish Care Delivering care together FURTHER INFORMATION: 1. National Eligibility Framework: National Eligibility Framework bands (Critical/Substantial/Moderate/Low) used widely in Scotland and referenced in Scottish Government publications. • Critical Risk: Individuals have major risks to their independent living, health, or well-being, likely requiring immediate social care services. • Substantial Risk: Individuals have significant risks to their independence or health and well-being, and will likely require social care services within a shorter timeframe. • Moderate Risk: Individuals have some risks to their independence or health, which may require ongoing services or manageable support over time. • Low Risk: Individuals may have quality of life issues, but with low risks to their independence or health and very limited need for social care services, often manageable with advice. Those in the "moderate" or "low" risk categories may receive less direct support, with an emphasis on preventative advice, community-based services, or support from other organisations. Local authorities can set their own specific eligibility criteria, although they are expected to align with the national framework, taking into account available resources and costs. The national critical eligibility criteria for social care identify individuals at immediate or imminent, life-threatening risk of harm, neglect, or loss of independence. It is the highest tier of the national eligibility framework, prioritising immediate, intensive support for critical health and wellbeing needs. Key Aspects of Critical Risk: Life-Threatening Risk: The individual’s safety, health, or independence is in severe danger. Essential Task Failure: Inability to manage vital, daily personal care or basic domestic activities, leading to immediate danger. Abuse or Neglect: High risk of abuse, or severe neglect is present or suspected. Caregiver Breakdown: The carer is experiencing severe physical or mental health difficulties that pose a life-threatening risk to themselves or the person being cared for. High-Intensity Need: Services are usually required immediately or on an emergency basis 322
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NORTH AYRSHIRE Health and Social Care Partnership WORKING TOGETHER IN PARTNERSHIP North Ayrshire Council NHS Ayrshire & Arran TSI North Ayrshire Scottish Care Delivering care together 2. Illustration of how Social Care Support is accessed: • At Step 2 – Critical risk test and eligibility criteria will be applied, if individual meets critical risk threshold move onto Step 3 • At Step 4 – Best Value Care Funding Framework will be considered, with the option that provides best value being recommended for funding 323
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Version: 7.0 [Type here] North Ayrshire Council Equality & Children’s Rights Impact Assessment (Full Form) Please Note: Before you begin, is this version the most up to date? You can download the most recent version on Connects. Screenings and ECRIAs should be included with relevant Committee Reports and may be published on our website. Introduction This form will assist in carrying out an Equality Impact Assessment and where appropriate, Socio-Economic, Children’s Rights, Island Communities and Consumer Duty Impacts of new, revised and existing policies and practices. Guidance on how to complete assessments is given in the Council’s Equality and Children’s Rights Impact Assessment Toolkit. The form is mandatory and must be published on the Council website once the policy or practice has been approved. 1. General Details 1.1 Directorate/Service: HSCP: Section: Cross Service 1.2 Name of Policy, Practice of Proposal being assessed: Eligibility Criteria for Social Care Services Please delete whichever statements are not applicable from the highlighted text below: This is a new proposal. 1.3 List of participants in the assessment Stuart MacMillan, Principal Manager Scott Hunter, Chief Social Work Officer Kerry Logan, Head of Service Thelma Bowers, Head of Service Elizabeth Stewart, Head of Service Caroline Cameron, Director North Ayrshire Council Policy and Performance Team North Ayrshire Council Legal Services Team Appendix 4 324
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Version: 7.0 [Type here] 1.4 Manager responsible for the impact assessment Name: Stuart MacMillan Designation: Principal Manager 1.5 Timetable (should be started during the development phase of the proposal) Date Assessment Started: 6 December 2025 Interim Review Date: 2 February 2026 Final sign off by Director at the end of the form. 2. Aims and Relevance 2.1 What is the purpose of the policy practice or proposal? North Ayrshire Health and Social Care Partnership (NAHSCP) is responsible for a wide range of community and hospital-based health and social care services for all ages, including social work, children and family services, adult and older people’s services, mental health and addictions services, justice services, learning disability services and Allied Health Profession services (such as physiotherapy and occupational therapy). The Partnership is currently facing significant financial pressures, with demand for and complexity of services continuing to rise at an unprecedented rate. With the cost of providing these services also increasing and funding not keeping pace with these additional challenges, the Partnership is facing a significant budget deficit in 2026- 27. Unfortunately, this presents significant challenges for the North Ayrshire Integration Joint Board (IJB) as it works to achieve a balanced budget for the forthcoming financial year(s). These pressures are not unique to NAHSCP and reflect the wider financial constraints being experienced across by health and social care partnerships nationally. A range of other options have been considered in the preparatory work for budget setting throughout 2025/2026 budget year. The IJB is being asked to consider a further £1.577m of savings proposals for social care services alongside the proposals detailed in this impact assessment. These are detailed in the IJB Finance report. This has taken into consideration service areas where previous saving and service reductions have been agreed and implemented, and further areas of service delivery in the Social Work and Social Care system including (but not limited to): • Assessment and Care Management (access to care and support) • Public Protection functions • Risk Management • Rehabilitation Services • Residential and Respite and Day Care Services 325
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Version: 7.0 [Type here] • Early Intervention Services • Community Alarm and Telecare Response services Following review of all of the options considered this proposal is being brought forward in the context of sustained and unprecedented financial pressures, rising demand and increasing complexity of need across adult social care services. The Partnership recognises that moving to a Critical Risk eligibility threshold represents a significant shift away from preventative and early intervention approaches and carries inherent risks for individuals, families and communities. It is acknowledged that restricting access to funded support may result in deterioration of need before intervention, increased reliance on informal care, and greater pressure on other public services. However, in the absence of sufficient funding to meet current and projected demand, the Partnership must prioritise its statutory duties to those at greatest and most immediate risk of serious harm. This proposal is therefore advanced as a measure of last resort, alongside strengthened governance, monitoring and mitigation arrangements to limit avoidable harm wherever possible. Proposal 1: Changing Eligibility – Support Only for People at Critical Risk NAHSCP is proposing to change who can receive funded social care support. Under this proposal, the Partnership would only be able to provide support to people who are assessed as being at Critical Risk. This means people who are at immediate or imminent risk of serious harm, severe neglect, or losing their ability to live safely and independently would be prioritised for formal care and support. This change is being considered because the HSCP must ensure that its limited resources are focused on people with the most urgent and serious needs. The national eligibility descriptors in full are: • Critical Risk: Indicates that there are major risks to an individual’s independent living or health and well-being and likely to call for the immediate or imminent provision of social care services. • Substantial Risk: Indicates that there are significant risks to an individual’s independence or health and wellbeing and likely to call for the immediate or imminent provision of social care services. • Moderate Risk: Indicates that there are some risks to an individual’s independence or health and wellbeing. These may call for the provision of some social care services managed and prioritised on an on-going basis or they may simply be manageable over the foreseeable future without service provision, with appropriate arrangements for review. • Low Risk: Indicates that there may be some quality of life issues, but low risks to an individual’s independence or health and wellbeing with very limited, if any, requirement for the provision of social care services. There may be some need for alternative support or advice and appropriate arrangements for review over the foreseeable future or longer term. 326
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Version: 7.0 [Type here] Local authorities can set their own specific eligibility criteria, although they are expected to align with the national framework, taking into account available resources and costs. By Critical Risk we mean the presence of indicators that there are major risks to an individual’s independent living or health and well-being and likely to call for the immediate or imminent provision of social care services such as: • immediate/likely danger to life or serious deterioration in health/safety; • serious self-neglect or inability to carry out vital personal care where no safe alternative exists; • severe risk of abuse/harm or exploitation requiring urgent protective action; • breakdown of essential care/support arrangements leading to unsafe situation; • immediate risk of admission to hospital/care home that could be avoided only through urgent provision of support. In practice, this will mean: • NAHSCP would no longer be able to provide the current level or activity of preventative and/or early help services using HSCP funding. • Assessments will be based on professional judgement, evidence of current risk, and the likely consequences of not providing formal support. • Support would only be provided where a needs assessment demonstrates there is a life threatening or urgent risk. • People with any needs that are assessed as being below the critical threshold and considered to have substantial, moderate or low levels of risk would be offered advice, information, and signposting to community or voluntary services instead of funded care. • People who have been assessed as below the Critical risk threshold may still experience significant difficulty; however, in the context of limited resources, funded support will be prioritised for those where the absence of intervention presents the most immediate and serious risk. Proposal 2: Best Value Care Funding Framework When a person’s needs are assessed, there can be different ways to meet their outcomes. Under this proposal, following an assessment of need in line with eligibility criteria, the HSCP would only fund the most cost-effective option. In line with the Social Work (Scotland) 1968 Act, Section 12A, the Partnership will continue to assess any adult who appears to need community care services. Following this assessment, the Partnership will consider the outcome and whether the assessed needs of the adult require the provision of any services. The assessment will continue to consider the views of the person whose needs are being assessed and under the new proposal will also take into consideration the most cost effective way of meeting an individual’s outcomes. This may not be a service user’s 327
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Version: 7.0 [Type here] first choice. The aim is to ensure that the Partnership can continue to support people with the highest care needs whilst managing finite resources. In practice, this will mean: • People will continue to retain choice about their preference of care. • However, public funding will only cover the option that provides best value for the Partnership. • For example (1), for Older People’s Services, where care at home needs are greater than the equivalent, a care home may be offered instead. • For example (2), where a chosen care provider charges fees in excess of NAHSCP approved rates, the service user will have the option to independently fund the difference in these costs. • If someone prefers a more expensive option, they can still choose this — however they will need to pay the difference (self-fund or top-up). Proposal 3: Prioritising Personal Care This proposal will focus our limited resources on the types of support that are most essential for people’s immediate health and safety. In implementing Proposal 1 (Critical eligibility criteria), by default of the nature of support the Partnership will prioritise Critical personal care needs first. The Partnership will review and re- consider what constitutes a non-personal care need and the level of support which is offered. An assessment of need in line with Critical eligibility criteria would be undertaken with consideration of those non-personal care supports only that are necessary to address high risks only. • Personal Care includes - Personal hygiene, dietary support, mobility, continence management, medication and treatment. • Non-Personal Care includes – Domestic support, shopping, technology such as telecare and community alarms and social support such as day services, community access and transport. In practice, this will mean: • Under critical eligibility criteria the Partnership will prioritise resources for the provision of personal care, such as help with hygiene and showering/bathing, getting dressed, medication and treatment, continence care and mobility assistance including the use of mechanical and manual aids. • The Partnership will only provide non-personal care supports (e.g., housework, shopping, community access) where this has been assessed as a critical risk and if not providing it would present and immediate risk to the person’s health and safety. 328
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Version: 7.0 [Type here] • For example (1), routine provision of domestic support, shopping and support for community access will no longer be funded unless an individual has no alternative support network and there is a high risk to an individual’s safety. • For example (2), only those with a critical need and level of risk will be offered a placement at a Day Service and planned respite may be reduced and targeted towards individuals who require emergency or high risk respite provision. • People would still have choice, however if a support need is not deemed essential for their safety or health, they may be asked to self-fund that part of their care. The Partnership recognises that preventative and early intervention support plays a critical role in maintaining independence and reducing crisis demand. Under these (3) proposals, NAHSCP funded preventative services will be significantly reduced due to financial constraints. While this increases the risk of deterioration for some people, statutory safeguarding duties, crisis responses and professional oversight will remain in place. Advice, information, advocacy and signposting will be provided to support people to access alternative community based or voluntary sector support where available. The Partnership acknowledges that community and third sector capacity is also constrained and will monitor the impact of increased demand on these services as part of ongoing implementation and review. One ECRIA is completed to capture the combined effects of each impact area. The HSCP is aware of the cross-cutting and accumulated impact of the three proposals and these are captured in more detail in section 8. By assessing all 3 proposals in one ECRIA, the combined consequences can be captured: separate ECRIAs could risk fragmenting these effects and missing some of the system- wide impacts that the HSCP is keen to highlight. Moreover, one single ECRIA enables greater coherence in setting out the mitigations that can be presented and the full level of measures open to the HSCP to lessen the impact of the proposals. 3. Equality and Diversity 3.1 What evidence were you able to access about the relevant needs of protected groups as outlined in section 3.3 below (Please include your sources – links to equality providers and evidence can be found in both the toolkit and the Promoting Equality Page on Connects). There has been collection and analysis from a wide range of data and information sources: 1. Health & Social Care Partnership Strategic Needs Assessment [published online in March 2026]. 329
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Version: 7.0 [Type here] 2. Feedback received from recent engagement activities with North Ayrshire residents which is cited throughout the ECRIA 3. Scottish Census 2022 [https://www.scotlandscensus.gov.uk/] 4. Scottish Index of Multiple Deprivation [Scottish Index of Multiple Deprivation 2020 - gov.scot] 5. National Records of Scotland Population Estimates [Mid-2024 population estimates - National Records of Scotland (NRS)] 6. North Ayrshire Local Authority Profile [Nomis - Official Census and Labour Market Statistics] 7. Health & Social Care Partnership – various internal information and data. Existing data and research The NAHSCP produces a significant amount of data and research which supports the development of strategic plans. This is detailed extensively in the Strategic Needs Assessment which was updated in 2025. The needs assessment contains the following information regarding protected characteristics: male and female population; age groups; racial demographics, religious demographics, LBGT population, long-term conditions, learning disability population, mental health information by age and sex, children’s mental health information, substance use information by age and sex, unpaid carer information by age and sex, care home resident information by age and sex, fall and hip fracture information in older people, information about pregnancy and maternity, information about children’s care, child poverty data, and homelessness information. Some key highlights from this are set out below: • North Ayrshire has an ageing population, with around 24% of residents being over the age of 66 • There has been a 15% rise in the number of over 66s living in North Ayrshire since 2014, and by 2040 it is projected that 30% of residents will fall into that age group, meaning that demand for these services will continue to rise. • As well as having an ageing population, North Ayrshire has some additional challenges that are increasing demand for services, including the impact of poverty on health and wellbeing. • North Ayrshire has one of the highest levels of economic inactivity in Scotland. Over 40% of residents live in the most deprived areas of North Ayrshire, which is double the national average. 24.3% of children are currently living in poverty. • North Ayrshire has one of the lowest Healthy Life Expectancy levels in Scotland, with the average adult remaining in full health until just 52 years old. • Over 28% of people in North Ayrshire are living with a long term health condition, which is 6% higher than the Scottish average. At the same time, social care costs are rising due to increased demand, higher operating costs and workforce pressures. Individual care package costs have increased significantly due to cost inflation. For example, an Older 330
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Version: 7.0 [Type here] People’s Care Home Placement in 2015/16 cost £609 per week. This has increased to £1,013 per week currently – a 66% increase over a 10-year period. 3.2 Are there any gaps in your evidence or areas of uncertainty? There are two specific areas of uncertainty which will continue to impact on the HSCP: • Demand for services: with the current demographic challenges and trends experienced over recent years, there could be further increase in demand for social care services. The nature and complexity of this type of demand cannot be fully predicted thereby adding to the uncertainty. • Future funding: the Health and Social Care Partnership is funded by local authority and NHS. The level of funding received by the Partnership therefore depends on budget decisions made elsewhere. 3.3 From the list of protected characteristic groups identified in section 3.3, please identify any potential positive and negative impacts on any of these protected characteristics. Protected Characteristic Impact on the Protected Characteristic? (yes, no, not applicable) Please Explain (Positive or Negative or Neutral) Age - Older people, children and young people – please identify which categories will be affected Yes Negative: Proposal 1 is most likely to have a negative impact on older people and adults with long‑term conditions as they are more likely to rely on low‑level or preventative support to maintain independence. Removal of support for individuals assessed as at ‘Substantial risk’ may result in deterioration, increased crisis presentations, or earlier loss of independence. North Ayrshire’s ageing demographic profile indicates that the older age population will grow over the coming years so the likelihood of demand from older people could further outweigh resources available. Disability - Physical and Learning Yes Negative: People with a Physical and/or Learning Disability often depend on ongoing low‑level support 331
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Version: 7.0 [Type here] Protected Characteristic Impact on the Protected Characteristic? (yes, no, not applicable) Please Explain (Positive or Negative or Neutral) to live safely in the community. Delaying support until needs become critical may disproportionately affect this group of people, with risks escalating cumulatively rather than suddenly. It is anticipated that Proposal 1 and Proposal 3 will likely impact those with disabilities most. Evidence from recent engagement found concern that increasing costs for disabled people could be detrimental as people with disabilities already face disproportionate financial pressures. Feedback from the engagement also highlighted potential negative impact on people with disabilities should non-personal care be removed, highlighting that for individuals with disabilities personal and non- personal care is often inter- connected. Gender reassignment - When a person is living in a gender other than their birth gender. Not applicable Neutral - No direct positive or negative impact identified Pregnancy and Maternity Yes Negative: Pregnant women or new parents with additional needs may not meet the Critical Risk threshold and may therefore not qualify for funded support under this proposal. Race, ethnicity, colour, nationality or national origins (including gypsy/ travellers, refugees and asylum seekers) No Neutral - No direct positive or negative impact identified 332
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Version: 7.0 [Type here] Protected Characteristic Impact on the Protected Characteristic? (yes, no, not applicable) Please Explain (Positive or Negative or Neutral) Religion or belief (includes religious and philosophical beliefs, including no belief) No Neutral - No direct positive or negative impact identified Sex - Women and Men Yes Negative. Proposals 1 and 3 are likely to impact women in a negative way. In moving to Critical risk only, it is likely that additional caring responsibilities will be created for families and friends of those who fall within the Substantial risk category. Research and data evidence that women are more likely to be unpaid carers. There are 17,222 unpaid carers in North Ayrshire, almost 60% of which are women. Reducing preventative support may increase the caring burden and risk of carer breakdown before the critical threshold is reached. Impact of the policy is also likely to result in employment effects, as individuals leave the labour market to care for those who are affected by the proposals: given the gender split of unpaid carers, this would likely have a disproportionate impact on women. Sexual Orientation – such as lesbian, gay and bisexual people. Yes Negative: It isn’t anticipated that any one proposal is likely to have a more acute impact on this group over another. Some individuals may rely more heavily on statutory services due to limited informal support networks. Evidence from the public engagement highlighted that particularly older LGBT+ people may face greater risk of isolation should there be less support networks available to them. Evidence was 333
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Version: 7.0 [Type here] Protected Characteristic Impact on the Protected Characteristic? (yes, no, not applicable) Please Explain (Positive or Negative or Neutral) received that choice was particularly important for LGBT+ individuals and communities, and any reduction in this could have negative impacts. Marriage and Civil Partnership - this includes same sex couples No Neutral - No direct positive or negative impact identified Human Rights Yes Negative: While the proposal does not remove statutory safeguarding or emergency duties, restricting funded support to those at Critical Risk increases the likelihood that people experience harm, loss of independence, or distress before intervention occurs. Groups such as adults with a disability, older people, carers, and care‑experienced individuals are more likely to rely on preventative support. Proposal 1 is likely to have an impact on this protected characteristic as restricting support to Critical Risk may disproportionately affect these groups. Evidence from the public engagement can be used to support this as feedback from respondents highlighted the impact on people with disabilities, in particular, their autonomy and dignity. There could be potential impact or reference to Article 8: Respect for your private and family life, home and correspondence; and Article 14: Protection from discrimination in respect of these rights and freedoms. 334
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Version: 7.0 [Type here] Protected Characteristic Impact on the Protected Characteristic? (yes, no, not applicable) Please Explain (Positive or Negative or Neutral) Care Experienced - This term refers to anyone who is currently in care or has been for any length of time regardless of their age and includes Kinship Care (other family members); Looked After at Home (with support from social work); Residential Care; Foster Care; Secure Care; Adoption. Yes Negative. Proposal 1 and Proposal 3 are likely to impact this group most. People in care or with care experience are likely to have fewer informal support networks, therefore increasing reliance on early intervention initiatives. Engagement feedback highlighted that people without strong advocacy or support networks may be undetected if thresholds rise. Other - Homelessness, ex-offenders, carers, part-time workers Yes Negative Carers: Carers are likely to be significantly impacted by the proposal. Restricting funding of formal supports to those deemed to be at critical risk will remove access to supports for those who have been assessed at substantial, moderate or low need. This will increase reliance on carers and informal supports. Part-time workers: As the overall amount of social care will reduce as a result of the proposals, there may be employment effects as providers of social care adjust workforce. This may have a negative impact on part- time workers. 3.4 Describe any consultation or engagement undertaken, including details of the groups involved and the methods used. The HSCP undertook the first phase of public engagement during December 2025 and January 2026. The aims of this engagement were to inform the public of the significant issues facing the HSCP and to seek views and feedback from the public on the situation. 335
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Version: 7.0 [Type here] To engage with the community effectively and gather a wide range of feedback, various methods were implemented. People (including members of the public and the workforce) have participated through online survey(s), facilitated group sessions within teams, groups or organisations, and via the locality public drop-in sessions where NAHSCP representatives were in attendance to discuss and answer any questions. Facilitation packs containing briefings, discussion guides and templates to gather feedback were provided to HSCP senior staff to complete with teams, Providers, Community development staff, Third Sector partners (via Third Sector Interface (TSI), Disability forums, Advocacy organisations and Carers Gateway. All locality partners – Police Scotland, Scottish Fire and Rescue, KA Leisure, NHS Ayrshire and Arran, Head Teachers and community representatives for each locality were contacted directly via email to encourage participation and feedback. A stakeholder mapping exercise was completed which identified groups of interest and those who may experience disproportionate impacts. Facilitation packs were then sent to Community development staff who support these groups and they were asked to facilitate sessions. In total, 1,538 people took part in Phase 1 of the engagement: • 560 members of the public completed the survey (online submissions and paper copies). • 679 staff and providers were represented in the responses (online submissions and facilitation packs). • 165 community group members were represented in the responses (online submissions and facilitation packs). This was part of 10 community group responses. • 134 people attended the drop in events across the six localities. The events took place at the following dates and times: • 07 Jan 2026– Fullarton Connexions, Irvine • 07 Jan 2026 – Kilwinning Sports Club, Kilwinning • 08 Jan 2026 – Brodick Hall, Arran • 13 Jan 2026 – Hayocks Community Hall, Stevenston • 14 Jan 2026 – Bridgend Community Centre, Kilbirnie • 15 Jan 2026 – Clarks Memorial Church, Largs Engagement – Feedback and Information (Phase 1) Phase 1 of the public engagement took place during December 2025 and January 2026. The aims of this engagement were to inform the public of the significant issues facing NAHSCP and to seek views and feedback from the public. The survey in this engagement exercise asked a number of questions, including: 336
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Version: 7.0 [Type here] • How could introducing cost limits or raising care thresholds for care packages affect people who use services? • What additional support might be needed for vulnerable people? Qualitative responses to these questions from the public, staff, providers and organisations have provided evidence to support this review, with the following themes existing in the responses: • Risk of people not receiving the essential care they need. • Concerns about detrimental impact on equality, rights and dignity. • Increased pressure on unpaid carers and families. • Concerns about affordability, financial hardship and cost-of-living. • Risk of system level consequences, such as greater pressure on hospital systems. While surveys were submitted anonymously, they were grouped into public, staff/provider and community groups responses. Analysis of how each group responded to the survey is provided in the final report. Community Groups responses highlighted a number of potential impacts: • Limiting choice could disproportionately harm individuals with the fewest alternative supports and/or people with complex needs • Increasing thresholds could worsen inequalities and create local variation in access to care, with people in deprived areas suffering most • Withdrawing services from people who would otherwise receive public funding to support their needs would inevitably lead to individuals being missed or ‘falling through the cracks’, missing out on alternative support and being left worse off • Separating personal from non-personal care was not possible for many individuals, particularly those with disabilities, where these types of support are often interconnected. Engagement – Feedback and Information (Phase 2) A second phase of engagement took place in February 2026. Following the Scottish Government’s Budget Settlement announcement, NAHSCP required to develop proposals which would ensure that it would fulfil its statutory duty of setting a balanced budget. Three proposals were outlined and the public asked their views on the proposals: • An online survey went live on 10 February 2026, providing the public with the opportunity to state if they agreed with each proposal in light of the challenges that are currently being faced, and also provide suggestions on how the impact of each proposal could be lessened. • A letter was sent to every household1 in North Ayrshire providing details of the proposals and information on how to input into the engagement. 1 Based on Council Tax addresses 337
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Version: 7.0 [Type here] Both engagement initiatives were publicised and communicated through a range of methods including the Health and Social Care Partnership website, social media as well as local media press releases. A full analysis of the responses and data will be presented along with the proposals at Integrated Joint Board on 13 March 2026. Questions 3.5 to 3.7 refer to the ‘Three Key needs (or aims) of the Equality Duty’ 3.5 Which aspects of the policy eliminate unlawful discrimination, harassment and victimisation? None. 338
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Version: 7.0 [Type here] 3.6 Which aspects of the policy advance equality of opportunity between people who share a relevant protected characteristic and those who do not? None. 3.7 Which aspects of the policy foster good relations between people who share a protected characteristic and those who do not? (Does it tackle prejudice and promote a better understanding of equality issues). None. 3.8 If you have identified any negative impacts of your proposal how will you mitigate these? The assessment has identified significant negative impacts for a number of protected characteristic groups, particularly older people, adults with a disability, women, carers and people experiencing socio-economic disadvantage. The Partnership recognises that not all negative impacts can be fully mitigated within existing resources. Mitigation has carefully considered feedback gathered during the engagement and consultation will therefore focus on limiting avoidable harm, ensuring fairness and consistency in decision making, and maintaining professional oversight of risk. Actions will include: • Maintaining and protecting access to preventative and early intervention supports including, but not limited to, reablement and rehabilitation services (such as the Dirrans Centre, Dementia Support and Day Services, Intermediate Care and Reablement Services, and Respite supports) and the supports available though the Carers Centre. • Clear and consistent application of Critical Risk criteria, supported by staff training and practitioner guidance. • Robust assessment, review and escalation processes, including escalation routes for change in needs. • Person centred and outcome focussed individual assessment. • Strong links to Advocacy and Third Sector groups. • Proactive identification of carers at risk of breakdown, with clear carers support pathways. • Information, advice and signposting including a newly developed Directory of Services. • Phased and/or transitional support where there are service delivery changes as a result of the policy. 339
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Version: 7.0 [Type here] • Ensure continued best practice for maximising income via Money Smart team. • Expansion in the promotion of Technology Enabled Care and digital resources. • Strengthened governance and audit of funding decisions to ensure equity and transparency. • Robust arrangements for risk management and public protection including oversight of unmet need. • Ongoing monitoring of equality impacts, with findings reported to the Integration Joint Board. 3.9 Is the policy or practice intended to promote equality by permitting positive action or lead to positive outcomes for people based on a protected characteristic? No. 4. Section 4 – The Fairer Scotland Duty The Fairer Scotland Duty (‘the Duty’), Part 1 of the Equality Act 2010 places a legal responsibility on the Council to actively consider (‘pay due regard to’) how we can reduce inequalities of outcome caused by socio-economic disadvantage when making decisions. 4.1 Does the proposal have the potential to have a significant impact on inequalities of outcome caused by socio-economic disadvantage? (Consider low income; low wealth; material deprivation; area deprivation; communities of place or interest, socio-economic background). Please delete whichever statement is not applicable from the highlighted text below: Yes, the proposal does have the potential to have a significant impact on inequalities of outcome caused by socio-economic disadvantage. If Yes please provide more information under any of the below headings (4.2 to 4.6) which are relevant, highlighting any evidence and sources of evidence used to inform your information. 4.2 Low Income/Income Poverty: Cannot afford to maintain regular payments such as bills, food and clothing • People on lower incomes may be less able to self fund alternative care options, including non-personal care. • North Ayrshire experiences high levels of deprivation and poverty. The Scottish Index of Multiple Deprivation 2020 identified 52 of North Ayrshire’s 186 data zones as being among the 15% most deprived in Scotland, a slight increase from 2016. 340
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Version: 7.0 [Type here] • Child poverty in North Ayrshire currently stands at 24.3%. 4.3 Low/and or no wealth: Having enough money to meet basic living costs and pay bills but have no savings to pay for any unexpected spends and no provision for the future. • Removal of some preventative and early intervention support risks increasing inequality and crisis demand in more deprived communities. • North Ayrshire’s economic situation suggests that many areas of society would be less resilient when faced with an unexpected spend or demand on income. • In 2023, the percentage of workless households in North Ayrshire was 24.7%, significantly higher than the Scottish average of 17.4% 4.4 Material Deprivation: Being unable to access basic goods and services, i.e. financial products like life insurance, repair/replace broken electrical goods, warm home, leisure/hobbies • The proposal will prioritise those at critical risk. Individuals who rely on preventative social care support are likely to be impacted by the proposal. 4.5 Area Deprivation: Where you live (rural areas), where you work (accessibility of transport. • Removal of previously funded support will apply across the North Ayrshire locality and is not directly area specific however the resulting impact of the changes in the proposal may restrict choice to those in more rural locations where there is not the same supply of alternative support services. 4.6 If impacts have been identified how will these be mitigated or explored in more detail? (please outline below) The Partnership recognises that individuals experiencing socioeconomic disadvantage will be disproportionately affected by this proposal and may have limited ability to self-fund alternative support. While the NAHSCP is not resourced to directly mitigate financial hardship, actions will be taken to reduce additional disadvantage where possible. This includes income maximisation support, advice and advocacy, clear information on alternative supports, and prioritisation of risk assessment for individuals experiencing multiple disadvantages. 341
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Version: 7.0 [Type here] 5. Section 5 – Children’s Rights When considering the Children’s Right’s Impact process, some of the key considerations include any evidence, research and consultation (specifically including any consultation or engagement with young people). 5.1 Are any Children’s Rights impacted by this proposal? (please refer to Appendix 1 of this document, where the Children’s Rights Articles have been matched against the Getting It Right For Every Child (GIRFEC) wellbeing indicators. This is solely to make it easier to identify which rights might be impacted on; the Rights are the key element of this section). Please delete whichever statement is not applicable from the highlighted text below: Yes, there are Children’s Rights impacted by this proposal. 5.2 Please indicate, if possible, how many children and young people (nearest estimate) are likely to be affected by the policy or measure? The proposal primarily relates to the eligibility of adults for Social Services support and does not directly determine children’s access to care. However, some children may experience indirect impacts where they are part of a household in which an adult’s support arrangements change. In these circumstances, potential effects relate to children’s wellbeing within the home environment rather than any restriction on their own rights to protection, assessment or support which remain safeguarded under statutory duties. It is not possible to quantify how many children may be indirectly affected as this will depend directly on individual household circumstances. 5.3 Are some children and young people more likely to be affected than others? Please delete whichever statement is not applicable from the highlighted text below: Yes, some children and young people are more likely to be affected than others. If, Yes what groups? (Consider protected characteristics – for example disabled young people, LGBT etc.) • Children living with adults who have disabilities, long‑term conditions or significant care needs, where changes to adult support could affect daily routines, stability or household functioning. • Young carers, who may face increased caring responsibilities if an adult’s support is reduced or altered. • Children in households experiencing poverty, stress or instability, where adult support contributes to maintaining family resilience. 342
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Version: 7.0 [Type here] • Children affected by parental mental health issues, substance use or complex vulnerabilities, where adult intervention helps maintain safety, structure or emotional availability. • Children in single‑adult households, where a reduction in support may have a more pronounced impact on household capacity. Should adult support be reduced or withdrawn under the revised criteria, children in those households could be disproportionately affected. This may manifest through disruptions to school attendance, reduced opportunities for participation in social and community activities, or decreased stability and routine within the home environment. 5.4 What Children’s Rights are likely to be affected by the policy/proposal? Please refer to Table 2 (Appendix 1) ‘Links between Wellbeing Indicators and Articles of the UNCRC’ and insert the relevant rights and indicators in the table below. As this proposal relates to the eligibility of adults for support, it does not directly affect children’s access to care or their statutory right to assessment, protection and support. Any impact on children’s rights would therefore be indirect arising only where a child lives in a household where an adult’s support arrangements change because of proposed changes. As such the Children’s rights which are most likely to be indirectly affected relate to children’s wellbeing within the home environment. Wellbeing indicator (for example, safe, healthy etc.) Children’s Right (for example, 22 – refugee children) Safe, Healthy, Nurtured Article 3 – Best interests of the child. (Household changes could affect wellbeing and daily life). Nurtured, Respected Article 5 – Parental guidance. (Adult capacity to provide guidance may be affected). Safe, Nurtured Article 19 – Protection from harm, abuse and neglect. (Reduced adult support may heighten vulnerability in some households). 343
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Version: 7.0 [Type here] Wellbeing indicator (for example, safe, healthy etc.) Children’s Right (for example, 22 – refugee children) Healthy, Included Article 23 - Rights of disabled children. (indirect effects if disabled children rely on adults who themselves require support) Included, Nurtured Article 27 - Adequate standard of living. (Indirect effects on household stability or finances). Achieving, Included Article 29 - Education and development. (Disruption at home could affect learning and participation). Included, Respected Article 30 – Cultural and community participation – could affect ability to engage in cultural/community life. 5.5 What likely impact will the policy/proposal have on Children’s Rights and Wellbeing? Either Positive, Negative or Neutral. Children Rights Negative Other Protected Characteristics Click or tap here to enter text. 5.6 Describe any consultation or engagement that has taken place with young people? The engagement activity for this proposal is set out in section 3.4. While no direct consultation has taken place with young people, individuals of all ages have been invited to participate in the surveys. 5.7 If negative impacts are identified how will these be mitigated either fully or in part? Detailed in Section 3.8 344
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Version: 7.0 [Type here] 6. Section 6 – Island Communities Impact (or Island Proofing) Island Proofing is about considering the particular needs and circumstances of island communities when public sector organisations exercise their functions and make decisions. This has been added to the process of assessing the Council Plan and includes a range of issues such as access to services, digital connectivity, employment and access to education, transport and access to goods and services. 6.1 Do the intended outcomes of the proposal potentially differ or have a different impact for our Island Communities? Please delete whichever statement is not applicable from the highlighted text below: No, the intended outcomes of the proposal do not potentially differ or have a different impact for our Island Communities. 6.2 Please describe the potential impacts for our Island Communities. The impacts of the policy will be the same for island communities as the impact on mainland communities. 6.3 Please explain if the impacts are different for communities on different islands? Not applicable 6.4 What consultation or engagement has taken place with our Island Communities? Island communities have been able to participate in the engagement as described in section 3.4. 6.5 How will you address any potential barriers or wider impacts for our Island Communities as identified through this assessment? No specific additional barriers or differential impacts for Island Communities have been identified through this assessment. The intended outcomes of the proposal are anticipated to be the same for island and mainland communities. However, the HSCP will continue to ensure that any potential impacts for Island Communities are considered through existing governance, assessment and monitoring arrangements. This will include ensuring that assessment, advice, information and signposting processes are accessible and responsive to individual circumstances, including geography, access to services and digital connectivity. Where individuals living in Island Communities are assessed as being at Critical Risk, statutory duties will continue to apply, and access to support will be determined through the same professional assessment processes as for 345
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Version: 7.0 [Type here] mainland communities. Ongoing engagement with partner agencies and Third Sector organisations will support awareness of any emerging issues specific to Island Communities. 346
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Version: 7.0 [Type here] 7. Section 7 – The Consumer Duty The Consumer Duty is about the impact of Council proposals on consumers in Scotland. A Consumer is an individual or a small business that purchases, uses or receives goods or services in Scotland, that are supplied either by a business or a public body – please see What is the Consumer Duty. 7.1 Will your proposal impact on consumers? Please delete whichever statement is not applicable from the highlighted text below: Yes, the proposal will impact on consumers. 7.2 What are the impacts, if any, on consumers in general? Is it likely that consumers will experience harm because of this proposal? Yes. The proposal engages Consumer Duty principles due to changes in access to funded support. While the policy proposal focuses resources on those at critical risk, the impact will be to reduce the support available for those assessed below this level of need. The impact on consumers could be: • Feeling of there being a lack of choice • Support no longer being available, despite it being so in previous years • Increased risk if signposting is not effective Advice, information and signposting will need to be clear, accessible, and responsive to individual circumstances. Robust assessment, communication, and escalation arrangements will be in place to ensure people are treated fairly. 7.3 Describe the impacts if any, on consumers in vulnerable circumstances. Is it likely that consumers in vulnerable circumstances* will experience harm because of this proposal? (please include any relevant evidence or engagement with consumers) *Vulnerable circumstances may be temporary in nature and may or may not arise as a resulted of a consumer’s protected characteristics. For more information, please see page 31 of Consumer Scotland’s draft guidance on the consumer duty. Yes, it is likely that consumers in vulnerable circumstances could experience harm as a result of this proposal. Vulnerable consumers are defined as consumers who, by reason of their circumstances or characteristics: a) May have significantly fewer or less favourable options as consumers than a typical consumer, or b) Are otherwise at a significantly greater risk of: (i) harm being caused to their interests as consumers, or (ii) harm caused to those interests being more substantial, than would be the case for a typical consumer. 347
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Version: 7.0 [Type here] As this proposal involves reducing publicly funded social care, vulnerable consumers are likely to be adversely affected. For example, people on low incomes may be less able to self fund alternative support, increasing reliance on crisis responses rather than early intervention. Evidence from the recent public engagement highlights the impact on individuals with disabilities in that the proposals will impact the level of choice and control they have in the support they can receive. Further feedback from residents included the possibility of disabled people being pushed further into poverty if unable to receive public funded support and care. 7.4 Describe any consultation and engagement that has taken place with consumers around your proposal. Engagement activity with consumers of social care services is set out in section 3.5. 7.5 What alternative proposals could improve outcomes for consumers and/or reduce harm to consumers? How do these compare to the original proposal? The social care system is split into three broad areas to deliver services: 1. Core Social work functions (£29m budget); this includes public protection, risk management, social work teams across service access, children, adult, older people, mental health and addictions services, statutory duties to deliver the Mental Health Act, MAPPA and other areas 2. Social Care Alternative Models (£12m); including residential respite care, day services, early interventions services, rehabilitation and commissioned services such as advocacy and carers centre 3. Individual Social Care Packages (£115m); this includes a mixed model of delivery of both in-house and commissioned services, adult’s services (learning disabilities, physical disabilities and mental health), older people (care at home and care homes). The HSCP has already identified operational savings of £1.577m that will come from across the system of social work and social care. Alternative proposals therefore have been explored to the proposals set out in this ECRIA. The HSCP will continue to identify further areas where efficiencies can be achieved, but no further alternatives have been identified to the value that will deliver the necessary savings to meet statutory functions and deliver a balanced budget. 348
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Version: 7.0 [Type here] 8. Section 8 – Crosscutting Impacts 8.1 Have any cross-cutting impacts been identified from other Council Services or Partner Agencies (multiple discrimination or accumulated effects on a protected characteristic group through multiple proposals or existing decisions)? Yes. Cross-cutting impacts are anticipated as a result of the cumulative effect of this proposal alongside existing pressures, policies and service changes across other Council Services and partner agencies. These impacts are likely to result in accumulated disadvantage for some protected characteristic groups, particularly where individuals are affected by more than one service change or reduction in preventative support This may include: • Unpaid carers: the reduction of funded support, in addition to wider cost of living pressures and workforce participation challenges, may lead to additional stress and negative impact on unpaid carers, and particularly women and female young carers. • Housing Services / Homelessness Services: if individuals are unable to maintain independent living due to the withdrawal of low-level or preventative support, this may increase the risk of housing instability or tenancy breakdown. This may impact on disabled people, older people and those experiencing poverty most acutely. • Socio-Economic impacts: where individuals affected by these proposed policies are currently experiencing socio-economic disadvantage, the impact is likely to be compounded. For example, people on low incomes may be less able to self-fund alternative support, increasing reliance on crisis responses rather than early intervention. • NHS: increased pressure on NHS services, such as primary care and acute hospital services are likely as removing preventative social care support could lead to increased crisis intervention and hospital admissions • Third Sector and Community Organisations: these organisations may experience increased demand as individuals who are no longer able to access support are signposted elsewhere. This may impact such organisations who already have capacity limits and exacerbate inequalities for individuals without advocacy support. 8.2 If Crosscutting issues have been identified with other Services, what discussion/interaction has taken place to mitigate any potential negative impacts of accumulated proposals? Discussion and engagement have taken place across HSCP services and with partner agencies as part of the development of the proposals and the associated engagement activity. This has included internal discussion with senior managers across Adult Services, Children’s Services and Strategic Planning, as well as engagement with NHS partners, Third Sector organisations, advocacy services and carers organisations through the public engagement process. 349
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Version: 7.0 [Type here] Engagement responses highlighted concerns regarding increased pressure on health services, housing services, unpaid carers and Third Sector organisations, which have informed the identification of cross-cutting impacts within this assessment. Ongoing interaction with partner agencies will continue as proposals are refined and implemented, including through established governance and partnership arrangements. This will support coordination across services, clear referral and escalation pathways, and the monitoring of cumulative impacts on individuals and protected characteristic groups. Mitigation will be supported through continued joint working, clear communication and guidance for staff, strong links with advocacy and Third Sector partners, and ongoing monitoring and reporting to the Integration Joint Board to identify and respond to emerging cross-cutting impacts. 9. Section 9 – Outcome of the Assessment 9.1 Please detail the outcome of the assessment: Please delete whichever outcomes are not applicable from the highlighted text below: a) Continue the policy: the Impact Assessment identifies the potential for adverse impact or missed opportunities to promote equality. Set out the justifications for continuing with it in section 9.3. For the most important policies and proposals, compelling reasons will be needed. 9.2 For Outcome 2. in section 9.1 above - please detail recommendations, including any action required to address negative impacts identified or to better promote equality. Not applicable. 9.3 If Outcome 3 is chosen from section 9.1 above, please outline the justifications for continuing the policy/procedure. The North Ayrshire Health and Social Care Partnership is experiencing unprecedented financial pressures, driven by rising demand, increasing complexity of need, workforce pressures and significant cost inflation, alongside funding that has not kept pace with these challenges. As a result, the Partnership faces a significant budget deficit in 2026–27, and has a statutory duty to set a balanced budget. Continuing the policy is considered necessary to ensure that limited available resources are prioritised for individuals assessed as being at immediate or imminent risk of serious harm, severe neglect, or loss of ability to live safely and independently. This approach enables the HSCP to continue meeting its core statutory safeguarding and emergency duties, while focusing support on those with the most urgent and critical needs. 350
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Version: 7.0 [Type here] The policy is being continued because there are no viable alternative options that would allow the Partnership to meet its financial and statutory obligations while maintaining support for those at the highest levels of risk. The decision reflects the difficult but necessary trade-offs required in the current financial context, and the commitment of the HSCP to continue monitoring impacts and responding to emerging risks through established governance arrangements. Professional advisors recognise the challenges in moving to this position and risks associated with the Policy, however in the absence of any further funding to stabilise and fund services for future years, there is an acceptance that spend must reduce and a focus on supporting and managing the risk of our most vulnerable residents must take precedence. The Policy is recommended to the IJB as this will allow for the reductions in care provision to be implemented in a carefully managed basis which - protects statutory duties, ensures those most vulnerable and with the most critical needs are prioritised to access services, preserves options for individual choice, will be underpinned by an individual assessment of risk and need and supports a fair and equitable implementation of changes to funded care arrangements. 9.4 Please state the key issues, recommendations and future actions arising from the Integrated Impact Assessment. The Integrated Impact Assessment has identified that the proposals are likely to result in significant negative impacts for some individuals and protected characteristic groups. The key issues identified, include • Increased risk of deterioration, crisis and loss of independence, particularly for older people, disabled people, people with long term conditions and those who currently rely on low level or preventative support. • Disproportionate impacts on people with disabilities, unpaid carers (particularly women), people on low incomes, and care experienced individuals, due to increased reliance on informal support and reduced access to funded services. • Human rights impacts, including potential impacts on dignity, autonomy and the right to independent living, as restricting access to preventative support increases the likelihood of harm occurring before intervention. • Children’s Rights impacts, particularly for children living in households where parents have additional support needs, children who are already young carers, or children who may take on caring responsibilities as a result of reduced adult support. • Socioeconomic impacts, with people on lower incomes less able to self- fund alternative care or support, increasing the risk of inequality, poverty and crisis led intervention. • Cross-cutting system impacts, including increased pressure on unpaid carers, Third Sector organisations, housing services and NHS services, as individuals who no longer meet eligibility thresholds are signposted elsewhere or present at crisis point. 351
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Version: 7.0 [Type here] The assessment also recognises that not all negative impacts can be fully mitigated, given the scale of financial pressures and the statutory requirement to prioritise resources for those at the highest levels of risk. In light of the identified impacts, the assessment recommends that, if the policy is continued, the following actions are implemented to reduce harm where possible: • Ensure clear, consistent and well communicated eligibility criteria, supported by staff training and guidance to promote fair and proportionate decision making. • Maintain robust governance and oversight of assessment, funding and review decisions to ensure consistency and transparency. • Ensure timely, high quality care assessments and reviews, with a strong focus on risk identification and escalation. • Strengthen links to advocacy, carers’ services, Third Sector and community support, particularly for individuals who no longer qualify for funded care. • Ensure clear advice, information and signposting, tailored to individual circumstances, including income, geography, digital access and support networks. • Maintain a focus on reablement, rehabilitation and Technology Enabled Care, where appropriate and consistent with eligibility criteria. • Provide phased or transitional support, where possible, for individuals affected by changes to service provision. • Continue to support income maximisation through services such as the Money Smart team, to mitigate financial impacts. The HSCP will undertake the following future actions to monitor and respond to the impacts of the policy: • Ongoing monitoring of equality, socio-economic, human rights and children’s rights impacts, using existing performance, finance and service data. • Regular monitoring of referral demand, unmet need, assessment outcomes, waiting times and carer impacts, reported through established governance structures. • Quarterly review through HSCP governance arrangements, with regular updates provided to the Integration Joint Board on implementation and emerging impacts. • Continued engagement with partners, including NHS, Third Sector, advocacy organisations and carers’ services, to identify system-wide pressures and cumulative impacts. 352
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Version: 7.0 [Type here] • Use of service user and stakeholder feedback to inform future review, refinement and mitigation activity. 353
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Version: 7.0 [Type here] 10. Section 10 – Monitoring 10.1 Describe how you will monitor the impact of this policy for example, performance indicators, actions, other monitoring arrangements, who will monitor progress, criteria used to measure if outcomes are achieved, timescales including any future reviews of the impact of the proposal and where this will be recorded. Monitoring will focus on identifying unintended harm, escalation of risk and disproportionate impacts on protected characteristic groups. Key indicators will include waiting times, unmet need, carer demand, service user feedback, safeguarding concerns and unplanned hospital admissions. Monitoring information will be reviewed quarterly through HSCP governance structures and reported to the Integration Joint Board. Where evidence indicates significant unintended consequences or escalating harm, the Partnership will consider whether changes to implementation or further mitigations are required. A range of indicators will be used to monitor the impact of the proposal. A selection of these are detailed below however further indicators across service delivery will be monitored and reviewed: Performance and Audit Committee indicators: • Number of people waiting for assessment. • Number of people on the waiting list for a Care at Home service in the Community. Other indicators that will be measured and tracked: • Number of carers registered with the Carers Gateway Service • Total number of people receiving a care assessment • Outcomes from all care assessments and reviews as tracked by existing systems • Adult Support and Protection activity • Referral demand and Unmet Need • Finance reporting • Service User feedback and engagement This will be monitored on a quarterly basis through existing Governance structures within the HSCP. In addition, regular updates will be provided to the Integrated Joint Board on the implementation of the proposal and evidence of impact. 11. Section 11 – Sign Off 11.1 Head of Service approval of the impact assessment. Name: Caroline Cameron 354
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Version: 7.0 [Type here] Title: HSCP Director Date: 9 March 2026 12. Section 12 – Publication 12.1 Following approval by Head of Service, completed Impact Assessments are published on our Council’s External Website. Please email: equalities@north-ayrshire.gov.uk 355
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Version: 7.0 [Type here] Appendix 1 - GIRFEC Wellbeing Indicators and Children’s Rights Table 1 - GIRFEC Wellbeing Indicators Indicator Description Safe Protected from abuse, neglect and harm Healthy Having the best possible standards of physical and mental health; support to make healthy, safe choices Achieving Accomplishing goals and thereby boosting skills, confidence and self-esteem; ‘being all they can be’. Nurtured Having a loving and stimulating place to live and grow Active Having opportunities to take part in a wide range of activities Respected Being enabled to understand their world, being given a voice, being listened to, and being involved in the decisions that affect their wellbeing. Responsible Taking an active role within their home, school and community. Included Being a full member of the communities in which they live and learn; receiving help and guidance to overcome inequalities. 356
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Version: 7.0 [Type here] Articles of the UNCRC matched against the GIRFEC indicators Summary of the UNCRC Articles from 1 – 54 (UNICEF) Table 2 - Links between Wellbeing Indicators and Articles of the UNCRC *Please note in general the use of the term Governments, includes public sector organisations such as the Council, some articles will have stronger relevance for the work of the Council than others. Wellbeing Indicator – Safe There are 12 relevant articles of the UNCRC (Rights of the Child) linked to the Safe indicator. Article 9 – Separation from parents Children must not be separated from their parents against their will unless it is in their best interests (for example, if a parent is hurting or neglecting a child). Children whose parents have separated have the right to stay in contact with both parents, unless this could cause them harm. Article 10 – Family reunification Governments must respond quickly and sympathetically if a child or their parents apply to live together in the same country. If a child’s parents live apart in different countries, the child has the right to visit and keep in contact with both of them. Article 11 - Abduction and non-return of children Governments must do everything they can to stop children being taken out of their own country illegally by their parents or other relatives or being prevented from returning home. Article 19 - Protection from violence, abuse and neglect Governments must do all they can to ensure that children are protected from all forms of violence, abuse, neglect and bad treatment by their parents or anyone else who looks after them. Children and Young People have the right to be kept safe from harm. They must be given proper care by those looking after them. Article 22 - Refugee children If a child is seeking refuge or has refugee status, governments must provide them with appropriate protection and assistance to help them enjoy all the rights in the Convention. Governments must help refugee children who are separated from their parents to be reunited with them. Children and Young People have the right to special help and be allowed to live somewhere that is safe if they are a refugee. 357
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Version: 7.0 [Type here] Article 32 - Child labour Governments must protect children from economic exploitation and work that is dangerous or might harm their health, development or education. Governments must set a minimum age for children to work and ensure that work conditions are safe and appropriate. If they are under 16 there are laws about where, when and for how long they can work. Article 33 - Drug abuse Governments must protect children from the illegal use of drugs and from being involved in the production or distribution of drugs. Article 34 - Sexual exploitation Governments must protect children from all forms of sexual abuse and exploitation. Children and Young People have the right to never be pressurised or forced into doing anything sexual. They have the right to be protected from it. Article 35 - Abduction, sale and trafficking Governments must protect children from being abducted, sold or moved illegally to a different place in or outside their country for the purpose of exploitation. People should never make them do anything against their will, like marry someone for instance. Article 36 - Other forms of exploitation Governments must protect children from all other forms of exploitation, for example the exploitation of children for political activities, by the media or for medical research. Children and Young People have the right to be protected from being taken advantage of in any way. Article 37 - Inhumane treatment and detention Children and Young People have the right to be treated with respect. If they have committed a crime children should be arrested, detained or imprisoned only as a last resort and for the shortest time possible. They must be treated with respect and care and be able to keep in contact with their family. Children must not be put in prison with adults. They should not be imprisoned unless it is absolutely necessary and they will get legal help. Article 38 - War and armed conflicts Governments must not allow children under the age of 15 to take part in war or join the armed forces. Governments must do everything they can to protect and care for children affected by war and armed conflicts. In Scotland, they have to be 16 to join the armed forces and are not normally allowed to fight until they are 18. 358
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Version: 7.0 [Type here] Wellbeing Indicator – Healthy There are four relevant articles of the UNCRC (Rights of the Child) linked to the Healthy indicator. Article 3 – Best interests of the child The best interests of the child must be a top priority in all decisions and actions that affect children. Children and Young People have the right to have their interests considered if a decision is being made by any person about them. What is best for them is what matters. Article 6 – Life, survival and development Every child has the right to life. Governments must do all they can to ensure that children survive and develop to their full potential. Children and Young People have the right to be kept safe from harm, they have the right to be alive, survive and develop through life. Article 24 - Health and health services Every child has the right to the best possible health. Governments must provide good quality health care, clean water, nutritious food, and a clean environment and education on health and well-being so that children can stay healthy. Children and Young People have the right to be given good healthcare (if they are ill) so they can get well again. They have the right to live in a safe, healthy environment with good food and clean drinking water. Article 39 - Recovery and rehabilitation of child victims Children who have experienced neglect, abuse, exploitation, torture or who are victims of war must receive special support to help them recover their health, dignity, self-respect and social life. 359
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Version: 7.0 [Type here] Wellbeing Indicator – Achieving There are four relevant articles of the UNCRC (Rights of the Child) linked to the Achieving indicator. Article 4 – Implementation of the Convention Governments must do all they can to make sure every child can enjoy their rights by creating systems and passing laws that promote and protect Children’s Rights. Children and Young People have the right to have their rights protected and an environment where they can grow up safe. Article 18 - Parental responsibilities and state assistance Both parents share responsibility for bringing up their child and should always consider what is best for the child. Governments must support parents by creating support services for children and giving parents the help they need to raise their children. Article 28 - Right to education Every child has the right to an education. Primary education must be free and different forms of secondary education must be available to every child. Discipline in schools must respect children’s dignity and their rights. Richer countries must help poorer countries achieve this. In Scotland education is free and children three years old+ are entitled to a free nursery place. Some 2 year olds may be eligible for free care depending on family circumstances, such as level of income. Article 29 - Goals of education Education must develop every child’s personality, talents and abilities to the full. It must encourage the child’s respect for human rights, as well as respect for their parents, their own and other cultures, and the environment. It must help to prepare them for adult life. 360
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Version: 7.0 [Type here] Wellbeing Indicator – Nurtured There are eight relevant articles of the UNCRC (Rights of the Child) linked to the Nurtured indicator. Article 4 – Implementation of the Convention Governments must do all they can to make sure every child can enjoy their rights by creating systems and passing laws that promote and protect children’s rights Children and Young People have the right to have their rights protected and an environment where they can grow up safe. Article 5 - Parental guidance and a child’s evolving capacities Every child has the right to be registered at birth, to have a name and nationality, and, as far as possible, to know and be cared for by their parents. Children and Young People have the right to their parents being responsible to guide them through their childhood and help them learn how to use their rights. Article 9 – Separation from parents Children must not be separated from their parents against their will unless it is in their best interests (for example, if a parent is hurting or neglecting a child). Children whose parents have separated have the right to stay in contact with both parents, unless this could cause them harm. Article 10 – Family reunification Governments must respond quickly and sympathetically if a child or their parents apply to live together in the same country. If a child’s parents live apart in different countries, the child has the right to visit and keep in contact with both of them. Article 18 - Parental responsibilities and state assistance Both parents share responsibility for bringing up their child and should always consider what is best for the child. Governments must support parents by creating support services for children and giving parents the help they need to raise their children. Article 20 - Children deprived of a family If a child cannot be looked after by their immediate family, the government must give them special protection and assistance. This includes making sure the child is provided with alternative care that is continuous and respects the child’s culture, language and religion. Children and Young People have the right to special care if they can’t live with their parents. They may be looked after by other members of their family or by a different family. 361
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Version: 7.0 [Type here] Article 21 - Adoption Governments must oversee the process of adoption to make sure it is safe, lawful and that it prioritises children’s best interests. Children should only be adopted outside of their country if they cannot be placed with a family in their own country. Article 25 - Review of treatment in care If a child has been placed away from home for the purpose of care or protection (for example, with a foster family, in hospital, a care home or somewhere else away from home), they have the right to a regular review of their treatment, the way they are cared for and their wider circumstances to help make sure they are still getting what’s best for them. Article 27 - Adequate standard of living Every child has the right to a standard of living that is good enough to meet their physical and social needs and support their development. Governments must help families who cannot afford to provide this. Children and Young People have the right to a safe place to live, food, clothing and to take part in things they enjoy. 362
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Version: 7.0 [Type here] Wellbeing Indicator – Active There are eight relevant articles of the UNCRC (Rights of the Child) linked to the Nurtured indicator. Article 3 - Best interests of the child The best interests of the child must be a top priority in all decisions and actions that affect children. Children and Young People have the right to have their interests considered if a decision is being made by any person about them. What is best for them is what matters. Article 23 - Children with disabilities A child with a disability has the right to live a full and decent life with dignity and, as far as possible, independence and to play an active part in the community. Governments must do all they can to support children with a disability and their families. Children and Young People have the right to have special help to make sure they can join in with things if they have any form of disability. Article 31 - Leisure, play and culture Children and Young People have the right to rest, play and have the chance to join a wide range of artistic and cultural activities. It is really important to they have a balance in their life. 363
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Version: 7.0 [Type here] Wellbeing Indicator – Respected There are 12 relevant articles of the UNCRC (Rights of the Child) linked to the Nurtured indicator. Article 2 - Non-discrimination The convention that applies to everyone under the age of 18, regardless of circumstances. Article 3 - Best interests of the child The best interests of the child must be a top priority in all decisions and actions that affect children. Children and Young People have the right to have their interests considered if a decision is being made by any person about them. What is best for them is what matters. Article 4 – Implementation of the Convention Governments must do all they can to make sure every child can enjoy their rights by creating systems and passing laws that promote and protect children’s rights. Children and Young People have the right to have their rights protected and an environment where they can grow up safe. Article 5 - Parental guidance and a child’s evolving capacities Every child has the right to be registered at birth, to have a name and nationality, and, as far as possible, to know and be cared for by their parents. Children and Young People have the right to their parents being responsible to guide them through their childhood and help them learn how to use their rights. Article 8 - Protection and preservation of identity Every child has the right to an identity. Governments must respect and protect that right, and prevent the child’s name, nationality or family relationships from being changed unlawfully. Children and Young People have the right to know who they are – official records should be kept. If they are over 16 years old and adopted, they can try to find out who their birth parents are. Article 12 - Respect for the views of the child Every child has the right to express their views, feelings and wishes in all matters affecting them, and to have their views considered and taken seriously. This right applies at all times, for example during immigration proceedings, housing decisions or the child’s day-to-day home life. Children and Young People have the right to speak up and have their opinions listened to and be taken seriously by adults on things that affect them. 364
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Version: 7.0 [Type here] Article 13 - Freedom of expression Every child must be free to express their thoughts and opinions and to access all kinds of information, as long as it is within the law. Children and Young People have the right to say whatever they believe as long as it does not harm or offend other people. They also have the responsibility to respect the rights and freedom of others. Article 14 - Freedom of thought, belief and religion Every child has the right to think and believe what they choose and also to practise their religion, as long as they are not stopping other people from enjoying their rights. Governments must respect the rights and responsibilities of parents to guide their child as they grow up. Children and Young People have the right to choose their own religion and beliefs. Their parents should help them think about this. Article 16 - Right to privacy Every child has the right to privacy. The law should protect the child’s private, family and home life, including protecting children from unlawful attacks that harm their reputation. They shouldn’t have their personal letters opened or anyone listening in to their personal phone calls. Article 17 - Access to information; mass media Every child has the right to reliable information from a variety of sources, and Governments should encourage the media to provide information that children can understand. Governments must help protect children from materials that could harm them. Children and Young People have the right to access information which is important to their wellbeing. Adults should help them find information they are looking for and make sure it’s not harmful. Article 18 - Parental responsibilities and state assistance Both parents share responsibility for bringing up their child and should always consider what is best for the child. Governments must support parents by creating support services for children and giving parents the help they need to raise their children. Article 30 - The right to learn and use the language, customs and religion of their family Every child has the right to learn and use the language, customs and religion of their family, whether or not these are shared by the majority of the people in the country where they live. 365
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Version: 7.0 [Type here] Wellbeing Indicator – Responsible There are five relevant articles of the UNCRC (Rights of the Child) linked to the Responsible indicator. Article 3 - Best interests of the child The best interests of the child must be a top priority in all decisions and actions that affect children. Children and Young People have the right to have their interests considered if a decision is being made by any person about them. What is best for them is what matters. Article 12 - Respect for the views of the child Every child has the right to express their views, feelings and wishes in all matters affecting them, and to have their views considered and taken seriously. This right applies at all times, for example during immigration proceedings, housing decisions or the child’s day-to-day home life. Children and Young People have the right to speak up and have their opinions listened to and be taken seriously by adults on things that affect them. Article 14 - Freedom of thought, conscience and religion Every child has the right to think and believe what they choose and also to practise their religion, as long as they are not stopping other people from enjoying their rights. Governments must respect the rights and responsibilities of parents to guide their child as they grow up. Children and Young People have the right to choose their own religion and beliefs. Their parents should help them think about this. Article 15 - Freedom of association Every child has the right to meet with other children and to join groups and organisations, as long as this does not stop other people from enjoying their rights. Article 40 - Juvenile justice A child accused or guilty of breaking the law must be treated with dignity and respect. They have the right to legal assistance and a fair trial that takes account of their age. Governments must set a minimum age for children to be tried in a criminal court and manage a justice system that enables children who have been in conflict with the law to reintegrate into society. Children and Young People have the right to be given legal assistance if they have committed a crime. The Convention also states that they should only be sent to prison if they have committed a serious crime. 366
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Version: 7.0 [Type here] Wellbeing Indicator – Included There are five relevant articles of the UNCRC (Rights of the Child) linked to the Included indicator. Article 3 - Best interests of the child The best interests of the child must be a top priority in all decisions and actions that affect children. Children and Young People have the right to have their interests considered if a decision is being made by any person about them. What is best for them is what matters. Article 6 - Life, survival and development Every child has the right to life. Governments must do all they can to ensure that children survive and develop to their full potential. Children and Young People have the right to be kept safe from harm, they have the right to be alive, survive and develop through life. Article 18 - Parental responsibilities and state assistance Both parents share responsibility for bringing up their child and should always consider what is best for the child. Governments must support parents by creating support services for children and giving parents the help they need to raise their children. Article 23 - Children with disabilities A child with a disability has the right to live a full and decent life with dignity and, as far as possible, independence and to play an active part in the community. Governments must do all they can to support children with a disability and their families. Children and Young People have the right to have special help to make sure they can join in with things if they have any form of disability. Article 26 - Social security Every child has the right to benefit from social security. Governments must provide social security, including financial support and other benefits, to families in need of assistance. Article 27 - Adequate standard of living Every child has the right to a standard of living that is good enough to meet their physical and social needs and support their development. Governments must help families who cannot afford to provide this. Children and Young People have the right to a safe place to live, food, clothing and to take part in things they enjoy. 367
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