Radical Proposals for Adult Social Care in Scotland
If not now, when? And if not us – who?
Last week saw the publication of the much-anticipated Adult Social Care Review in Scotland led by Derek Feeley, a former Scottish Government Director General for Health and Social Care and Chief Executive of NHS Scotland.
The report is wide ranging with 53 recommendations which cover social care practice, structural change, workforce and funding implications.
The definition of Social Care is to be welcomed and based on key values of human rights, wellbeing, independent living and equity.
“Everyone in Scotland will get the social care support they need to live their lives as they choose and to be active citizens. We will all work together to promote and ensure human rights, wellbeing, independent living and equity.“
In terms of practice recommendations there are clear synergies with the NDTI Community Led Support programme and also the revised standards for Self Directed Support (Scotland’s legal framework for personalisation) that are currently being finalised.
The report is informed by views from people with lived experience and other key stakeholders some of whom described an over bureaucratic process which was difficult and complicated to access and an assessment process often based on a deficit model. These are similar themes that have been found in many areas who have embarked on the Community Led Support programme.
Although there is no direct reference in the report to the Community Led support programme there is reference to community led approaches and many of the recommendations in the report promote the important principles that all participants of the Community Led Support adhere to. These include community engagement, co-production, early intervention and support and the importance of strength-based conversations. In many areas it has also been advocated that eligibility criteria should be replaced with a focus in prevention.
Of course, a coproduction and supportive process involving good conversations with people needing support should replace assessment processes that make decisions over people’s heads. It must also enable a full exploration of all self-directed support options that does not start from the basis of available funding. Giving people as much choice and control over their support and care is critical.
People must be able to access support at the point they feel they need it, including for advice and signposting to local community-based resources and help, and for barriers to this, such as the current eligibility criteria and charging regime, to be fundamentally reformed and removed, to allow a greater emphasis on prevention and early intervention.
Informal, community-based services and supports must be encouraged, supported and funded to respond appropriately to the needs of local citizens, including for preventative and low-level support.
We know this works – our growing reports and case examples from the community led support programme prove this.
The report proposes a different process for commissioning which is based on collaboration, participation and human rights and also very much in line with the principles of CLS.
“A shift from competitive to collaborative commissioning must take place and alternatives to competitive tendering developed and implemented at pace. Commissioning and procurement decisions must focus on the person’s needs, not solely be driven by budget limitations.“
Investment in the social care workforce is also at the forefront of the recommendations in relation to pay and conditions as well as investment in skills and development.
What will prompt further debate is the proposal for a National Care Service similar to the NHS with responsibility for strategic planning, improvements and inspection. There are also proposals for more responsibilities to be given to Integration Joint Boards.
“The National Care Service’s driving focus should be improvements in the consistency and quality of care and support experienced by service users, their families and carers and improvements in the conditions of employment, training and development of the workforce.“
If implemented the role of Local Authorities will inevitably be diminished and it is not clear what the implications this would have on children’s services or criminal justice services and also the important broader links with community planning and housing.
However, as Donald Macaskill has explained it also provides opportunities
“The creation of a National Care Service whilst it may diminish local authority engagement offers many the opportunity to engage more and be empowered by a new system, including those who receive supports and those who provide them’ “ (CE Scottish Care)
What is welcomed is the clear statement that social care requires further investment to fund the range of recommendations which include
- expand access to support including for lower-level preventive community support;
- implement the recommendations of the Fair Work Convention;
remove charging for non-residential social care support; - increase the sums paid for Free Personal and Nursing Care for self-funders using care homes to the levels included in the National Care Home Contract; f re-open the Independent Living Fund, with the threshold sum for entry to the new scheme reviewed and adjusted;
- review financial support made available to unpaid carers and increase investment in respite.
The financial implications of these proposals are set out with an estimated 0.6 billion per annum required to fund the recommendations above.
It will be very interesting to hear the current Scottish Government response to the Review along with other political parties given the pending elections in Scotland in May.
We could watch this space, but change needs to be now, and Community Led Support already provides the solution.