Proposals for National Care Service for Scotland

By Eileen McMullan, SFHA Policy Lead

The consultation on the proposals for a National Care Service (NCS), following the recommendations from the Independent Review of Adult Social Care (2021), closed on 2nd November. SFHA submitted our response following consultation with members at several round table discussions. We look forward to hearing the outcome of the consultation in due course.  

The proposals have been described as the ‘biggest public sector reform for decades’. The aim is to ensure everyone who needs it can expect the same standards of care wherever they live in Scotland. The service aims to deliver person-centred care and, at a minimum, will cover adult social care services, but its scope could be extended to other groups. The consultation proposes a broadening of the scope of a National Care Service and covers:  

• Improving care for people 
• The Scope of the National Care Service 
• Reformed Integration Joint Boards: Community Health & Social care Boards 
• Commissioning of services  
• Regulation  
• Valuing People who work in care 

We very much welcomed the opportunity to comment. It was good to see that following the Independent Review of Adult Care, the Scottish Government has prioritised this reform. The proposals have the potential to create a significant shift in the provision of social care and support. They could present new opportunities for organisations across the housing, care, and support sectors to deliver jointly to improve services with people. There is much to be optimistic about in its focus on human rights and improving people’s care experience, but we were hugely disappointed that the proposals failed to recognise the unique contribution of housing in delivering preventative services and supporting independence at home. Perhaps this wasn’t surprising given that the Independent Review of Adult Social Care didn’t pay very much attention to the role of housing as a community anchor, preventing homelessness and supporting independence all over Scotland. However, we know that good joint working across housing, health, and social care has great potential to improve outcomes for people across Scotland. 

Focus on Prevention 

2021 marks the 10th anniversary of the Christie Commission, which made important recommendations on public service reform, including a desire to see a radical shift towards preventative public service delivery. We still haven’t quite got there, but if the Scottish Government aims to shift its focus to prevention, the NCS has the potential to create opportunities for health and social care to work effectively with housing and housing associations. Aligning housing with health and social care will provide opportunities to focus on shared objectives around prevention, supporting independence and tackling homelessness.  

Is it about structural change? 

We have some concerns that the proposals are perhaps overfocussed on structural reform with a risk of losing sight of the need to see improvement of people’s experience of a system that has been identified as too complicated and hard to navigate. We need to avoid the possibility of an overcentralised approach by retaining local flexibility to best meet the needs of local people in their homes and communities. Our preference is to see the initial focus of change on adult social care and preventative support services. There are potential benefits of widening the scope of the National Care Service to include children’s services, community justice, alcohol, and drugs services, but the risk of this scale of change could outweigh the potential benefits. Rather, a more cautious, incremental approach may be preferable, giving local systems the opportunity to embed charge. Having said that, the National care service will need to go further in its vision for care and embrace transformation in the way care and support is delivered, identifying how housing and technology can support people to live as independently as they can.  

So, as we wait for the outcome of the consultation, we hope to see clear messages on how housing aligns with the proposed National Care Service alongside recognition of the strategic importance of accessible housing, housing support, technology, and housing adaptations to ensure that people are supported to live as independently as possible at home. Equally important will be getting clarity on what is meant by preventative services and recognition that the solutions to supporting independence and homelessness sit across the housing, health, and care sectors.