Item 14 - National Care Service
North Lanarkshire Council · 21 September 2022
Back to Health and Social Care Integration Joint Board — 21 September 2022 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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1 REPORT Item No: 14 SUBJECT: National Care Service Bill – Call for Views and Future Planning TO: Integration Joint Board Committee (IJB) Lead Officer for Report: Ross McGuffie, Chief Officer, North HSCP Author(s) of Report Morag Dendy, Head of Planning, Performance and Quality Assurance DATE: 21st September 2022 1. PURPOSE OF REPORT This paper is coming to the Integration Joint Board; For approval For endorsement To note 2. ROUTE TO THE BOARD This paper has been: Prepared Reviewed Endorsed By: The Senior Leadership Team. 3. RECOMMENDATIONS 3.1 The IJB Committee is asked to note the response to the Bill. 3.2 The IJB is asked to note the next steps in the NCS consultation. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 On the 9th August 2021 the Scottish Government launched a consultation on a ‘National Care Service for Scotland’ as its principle response to the Yes No N/A
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2 Independent Review of Adult Social Care (IRASC) which it has commissioned the previous year and which reported in February 2021. 5.2 The National Care Service (Scotland) Bill was introduced to parliament on 20th June, and its accompanying documents on the 21st June, 2022. The Bill seeks to provide a framework for the establishment of a National Care Service within the lifetime of the current parliament. 5.3 The Bill sets out provisions which would enable Ministers to transfer responsibility for social work and social care from local authorities to local care boards reporting to Scottish Ministers. The Bill establishes a National Care service; sets out provision for the processing of health and social care information and sets out provision for the regulation and delivery of social care. It specifically proposes a charter of rights and responsibilities for social care, as well as rights for unpaid breaks for carers, along with visiting rights to adult care homes, both of which may be introduced in advance of other Bill provisions. 5.4 Reflecting the significance of the Bill as the vehicle to facilitate the most significant public sector reform in decades, four Scottish Parliament Committees issued a ‘Call for Views’ on the Bill on the 8th July 2022 with a tight timeline for submission before 2nd September 2022. The Health, Social Care and Sport Committee is leading on the scrutiny of the Bill, with the Finance and Administration; Education, Children and Young People and Local Government, Planning and Housing Committees also considering evidence. 5.5 It is proposed that much of the detail of the National Care Service will be worked through within a process of ‘co-design’ and effectively shaped by secondary legislation/regulation. 5.6 A submission was developed from the North Lanarkshire IJB/HSCP which reiterates the feedback already provided by the IJB through the NCS consultation, with many of the areas previously raised still no clearer. 5.7 The response to the Call for Views is included in appendix 1. 6. CONCLUSIONS 6.1 Views will now be collated by the Parliamentary Committees and the whole Parliament will vote on whether to continue with the Bill in its current form in early 2023, concluding Stage 1 of the process. 6.2 If agreed, MSPs will have the chance to propose amendments to the Bill at Stage 2. 6.3 Finally, the whole Parliament will again vote on whether to pass the final Bill in summer 2023, concluding stage 3 of the process. 8. IMPLICATIONS 8.1 NATIONAL OUTCOMES N/A
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3 8.2 ASSOCIATED MEASURE(S) N/A 8.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 8.4 RISK ASSESSMENT/RISK MANAGEMENT Risk IJB.16 sets out the potential risks around the NCS process destabilising the current system at a time of significant ongoing challenge. 8.5 PEOPLE The paper highlights the response to NCS Bill which was open to all members of the public and the National Care Service will have an impact on all Scottish residents. 8.6 STAKEHOLDER ENGAGEMENT The IJB included all stakeholder members in developing the submission of the IJB response to the consultation. 8.7 INEQUALITIES & FAIRER SCOTLAND DUTY Yes No N/A 9. BACKGROUND PAPER Links to Consultation document are included within the report and were previously circulated. 10. APPENDICES Appendix 1 - National Care Service Bill: Call for Views response CHIEF ACCOUNTABLE OFFICER Members seeking further information about any aspect of this report, please contact; Morag Dendy, Head of Planning, Performance and Quality Assurance.
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3 Appendix 1 A National Care Service for Scotland - Consultation RESPONDENT INFORMATION FORM Please Note this form must be completed and returned with your response. To find out how we handle your personal data, please see our privacy policy: https://www.gov.scot/privacy/ Are you responding as an individual or an organisation? Individual Organisation Full name or organisation’s name Phone number Address Postcode Email The Scottish Government would like your permission to publish your consultation response. Please indicate your publishing preference: Publish response with name Publish response only (without name) Do not publish response North Lanarkshire IJB Kirklands Hospital Fallside Rd Bothwell 01698 752594 G71 8BB DendyM@northlan.gov.uk Information for organisations: The option 'Publish response only (without name)’ is available for individual respondents only. If this option is selected, the organisation name will still be published. If you choose the option 'Do not publish response', your organisation name may still be listed as having responded to the consultation in, for example, the analysis report.
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1 We will share your response internally with other Scottish Government policy teams who may be addressing the issues you discuss. They may wish to contact you again in the future, but we require your permission to do so. Are you content for Scottish Government to contact you again in relation to this consultation exercise? Yes No Organisations – your role Please indicate what role your organisation plays in social care Providing care or support services, private sector Providing care or support services, third sector Independent healthcare contractor Representing or supporting people who access care and support and their families Representing or supporting carers Representing or supporting members of the workforce Local authority Health Board Integration authority Other public sector body Other Would you like to be involved in future engagement work? Yes, I would like to be involved in future engagement work and agreed to be contacted by the Committee in the future.
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3 The Policy Memorandum accompanying the Bill describes its purpose as being “to improve the quality and consistency of social work and social care services in Scotland”. Will the Bill, as introduced, be successful in achieving this purpose? If not, why not? As previously noted, the overarching principles set out are welcomed by the North Lanarkshire IJB. Given the high level nature of the Bill, it is difficult to truly understand its impact. The North Lanarkshire IJB is keen to be involved in future co-design activity and would welcome further information around the opportunities that will be afforded. Given the significant progress made in North Lanarkshire around integration within the current system, there is concern that a significant change programme will inevitably cause the partner bodies to look inwards for a period to address organisational concerns which can impede progress towards a national agenda, and as such improvements will be impacted. This in turn may jeopardise the national strategy to implement The Promise, particularly impacted by the ongoing decisions around whether children and family / justice services are included in the NCS or not. Because the focus of the Bill is around social work and social care, with only functions of community health (NHS staff will not be transferred into the NCS), it is difficult to see where the benefits of integration will be progressed or further realised. One of the main concerns is around the risk of destabilising or even disaggregation of integrated services should only one group of staff transfer to the NCS. In North Lanarkshire, an outcome focussed approach has been a priority with services being delivered through a whole system approach to Self-Directed Support. The number of people supported at home is one of the highest in Scotland, as choice and control is promoted widely alongside innovative approaches in working with communities, and it is currently unclear if this level of choice and control will be protected in the Bill. There are also some risks in considering a rights based, almost consumerist approach to access to support and care without a clearer acknowledgement that not all people are equally able to articulate their needs or aspirations or that these can at times conflict with best interests or the rights of others. Equally the consultation is relatively silent on the impact of poverty, its links with other needs and the role of social work and social care in addressing this. It is important to reflect on the learning from the Public Bodies Act in that commissioning and contracting are not the means to create lasting, consistent change. The successes derived through integration have been driven by local relationships and collaborative whole-system working. Is the Bill the best way to improve the quality and consistency of social work and social care services? If not, what alternative approach should be taken? The Bill at present potentially moves an already challenging governance landscape into something even more complicated, with professions potentially split across different governance and delivery structures (e.g. adult social work and social care in the NCS, children’s and justice SW in local government and NHS staff remaining managed within the NHS). Given the significant progress made within our local system over a number of years, a viable and attractive alternative is to retain a focus on local accountability governed through a single plan such at The Plan for North Lanarkshire, bringing together all local partners with a unified goal. Learning
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3 from the pandemic has already shown the strength and impact that partners coming together working on an agreed collective priority can make. While we are all committed to a strong improvement journey, it is worth noting that complex change programmes take significant time to achieve. The North Lanarkshire SDS journey has taken over 10 years, but has transformed service provision in the area. It is important to recognise the inter-connectedness of the range of services wider than health and social care that impact on health and wellbeing, i.e., housing, employability support, education etc. and the importance of maintaining and improving these connections so services work in tandem to support the best outcomes for people and communities. It is important therefore, that further consideration is given to how these connections can be maintained and strengthened in this new approach to prevent any potential eroding of broader, effective, collective partnership working which improves health and wellbeing. Are there any specific aspects of the Bill which you disagree with or that you would like to see amended? Based on learning from within our local system, it would be good to see a place-based approach more firmly embedded within the Bill. Local people need to be placed firmly at the centre of their own care and support. This also creates an added benefit of providing a far clearer focus on the social and economic determinants of health that drive demand. An uplift in funding through existing arrangements for the local partnership to enable a renewed focus on improved outcomes, which is the expressed aspiration of the Plan for North Lanarkshire, and which enables the improvement model which has been described in this overall response, would be a viable alternative that removes the significant risks of structural change. Social work and social care services are currently in crisis nationally, with waiting times for assessment and support growing, low morale, and long-term structural challenges now manifesting. The Bill risks placing further tension and uncertainty into an already unstable system. The lack of detail on the human resource impact for staff is concerning. Work at a National level to review levels of pay, role standardisation and improved support for building future workforce resilience through funded training and practice would be welcomed as part of a wider solution to the longstanding problem of workforce pressures. The role of Social Work has not been fully represented within these proposals and the analysis of current practice does not reflect the complex interventions that take place with individuals, their families and carers within challenging environments. There is no recognition that the role of Social Work is not merely transactional or that of a gatekeeper to services but is based on developing strong working relationships. The statutory role of Social Work to balance rights, sometimes conflicting rights, and risks is not sufficiently acknowledged. The focus of the Bill is the interface between social work and social care, however, there is no reference to the positive existing work that goes beyond case management with a greater focus on outcomes. The work that Social Workers undertake with those people who are hard to reach, is very much defined by local knowledge and local relationships and not always the provision of a support package. The role social workers play in empowering individuals and their families, working towards
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4 self-actualisation, independence and life without ongoing paid support is hard to define but has the most significant impact on people’s lives. The risk in the consultation is that the criticism of gatekeeping and bureaucracy overlooks and oversimplifies the need for conversations which encourage and raise expectation and ambition. The need to continue to focus on recovery, rehabilitation and reablement are not currently prominent enough in the Bill. The public protection structures, a clearly critical role, are also not fully clear in the Bill. The need for local arrangements is critical in this area, to ensure that this work remains a priority. The work undertaken in North Lanarkshire across the public protection agenda to improve practice and outcomes for people should be recognised and valued. It will be essential that local arrangements such as Chief Officer Groups continue to provide the necessary leadership. There is no reference to the excellent practice and learning that is produced through COGS any reflection on how the impacts on governance nor on how the checks and balances essential to rights based practice within the current system could be addressed within a structure of direct accountability to Scottish Ministers. There is a significant focus placed on structural reform. There is some concern that this poses significant associated risk that, to achieve this, will delay the necessary work to improve and deliver high quality services and outcomes for people. Is there anything additional you would like to see included in the Bill and is anything missing? Given the high level nature of the Bill, there is a lot of additional information required to fully understand the direction of travel. The North Lanarkshire IJB would like to see further information around the expectations of the National Social Work Agency and how this will interface with local arrangements. There is insufficient reference to the importance of recovery, rehabilitation and reablement which needs to remain a focus. There is an over focus on services rather than wider community resources and assets based approaches. Promoting easier access to service based on wants runs the significant risk that more people will end up with service where change responses would promote greater independence and improved quality of life. The current support arrangements from local statutory partners, such as legal support and Chief Social Work Officer duties in local government, are a vital element of current service provision and loss of such support would have a significant impact on the outcomes of vulnerable individuals in our community. The costs of re-provisioning this support in a new entity should not be underestimated. Further clarity on the process to be undertaken around children and justice social work services, including the evidence base against which decisions will be made, would be welcome. The introduction of a single record is a welcome aspiration, but further clarity around how this will be taken forward, timelines and associated costs would be welcome. Given the multiple databases currently used both within the NHS as a single organisation and across local authorities and the complexity of change in this area, it appears highly unlikely that a single record would be achievable within the proposed timeframe for the establishment of the NCS. There is a risk of loss of local intelligence and relationships which are key to supporting providers and investing in organisations that will target local population needs. Work is needed to ensure that smaller, more local provision and providers are not inadvertently disadvantaged in a standardised
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5 approach. Whilst a select range of “once for Scotland” resources for particularly complex and unusual circumstances is supported, significant work is needed to ensure national consistency on thresholds is maintained. The Bill does not cover the emergent Homelessness Prevention Duties for public bodies which seeks to ensure the appropriate care, support and collaborative working required to ensure whole system change. The Scottish Government proposes that the details of many aspects of the proposed National Care Service will be outlined in future secondary legislation rather than being included in the Bill itself. Do you have any comments on this approach? Are there any aspects of the Bill where you would like to have seen more detail in the Bill itself? The approach taken of focusing on a framework primary legislation followed by more detailed secondary legislation leaves a significant level of detail to be worked up through the co-design process and could cause significant uncertainty within local partnerships at a time of high challenge. It is vital that the co-design approach enables genuine engagement with those involved in leading, managing and delivering integrated services. The North Lanarkshire IJB would have liked to have seen more information on the functions to be transferred to the NCS, and the rationale for the different approaches taken. There is significant concern that the approach could risk the disaggregation of integrated services through some local government functions transferring to the NCS, others remaining with local government and health services remaining managed within the NHS. There is no mention of GP contracts transferring to the NCS, which had been a recommendation of the original review. We support the ambition to improve quality and consistency in standards of care however, there is little evidence in the Policy Memorandum regarding how proposals to transfer accountability and centralise powers with Scottish Ministers will lead to an outcome of improved quality and consistency across Scotland. Other centrally directed services under direct control of Ministers such as acute hospitals continue to display significant local variation and inconsistencies. The Bill proposes to give Scottish Ministers powers to transfer a broad range of social care, social work and community health functions to the National Care Service using future secondary legislation. Do you have any views about the services that may or may not be included in the National Care Service, either now or in the future? There needs to be much greater clarity on the delivery and employment arrangements for any NHS functions included in the NCS given the statement that NHS staff will not transfer with associated functions. This includes delivery of community health services providing front line patient care and also leadership, management and strategic planning functions as well as support functions such as premises, IT, administration and commissioning/procurement. The rationale for the different positions taken for social work and NHS functions is not clear and raises significant concerns around the potential impact on existing integrated services and the future for integrated working. We feel that all functions being delegated to a National Care Service should be identified from the outset, as a staggered approach leaves some functions transferring over after the structures and governance arrangements have already been developed. This creates a significant risk for those services transferring as a second tranche from both local and national perspectives (i.e. local Care
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6 Board arrangements being developed that are predominantly focused on adults and the national co- design being equally focused that way). A key principle of any co-design activity has to be around ensuring no negative impacts on public protection arrangements, which is one of the greatest risks faced by the Bill. As noted previously, we need to maintain a degree of flexibility for place based approaches, so communities have an ability to influence the direction of travel to maximise the outcomes for people, while still striving for a degree of consistency across the country. Do you have any general comments on financial implications of the Bill and the proposed creation of a National Care Service for the long-term funding of social care, social work and community healthcare? It is recognised that historic underfunding has impacted on service delivery and development in both social work and social care and there are concerns that the cost of restructuring and set up will both be disruptive to current improvement work and divert investment from those areas where investment is required to meet the desired outcomes of the legislation. There is a huge margin of error within the estimated set up costs as expressed within the financial memorandum and no estimate of, or commitment to the investment required to meet the aspirations of Feeley. It feels inevitable that the creation of another employing body locally, will come with greater backroom costs (e.g. finance, payroll, HR, legal etc) diverting much needed funding from frontline activity. As it stands, there is not enough detailed information to form a view around the affordability of what is being proposed in the Bill and the Financial Memorandum doesn’t include many aspects of future secondary legislation. The legal status, structure and governance arrangements of a National Care Service will lead to a determination around the appropriate VAT status of the organisation. While a VAT neutral position will be sought, the financial risk around this not being secured is vast.