Social Care Minister Kevin Stewart has unveiled plans for a new National Care Service that would go beyond the recommendations of an independent review of adult social care and take on responsibility for all community health services, including general practice.

Other expanded areas include children’s services, social work and criminal justice provision.

The proposals were revealed today as the Scottish government published a three-month consultation on how to implement the findings of a review of adult social care carried out earlier this year.

Reforms are not likely to be on the statute book until summer 2023 at the earliest, the document states, although it says a National Care Service will be up-and-running by the end of the parliamentary term in 2026.

One ongoing area of disagreement, about the role of councils in social care, appears to have been resolved in favour of ministers.

The consultation document is clear that ministers will be accountable for social care as they are for the NHS.

Announcing the consultation today, Minister for Social Care Kevin Stewart said: “The review recommended the creation of a National Care Service, with Scottish ministers being accountable for adult social care support.

“I believe however that it is right for this consultation to look beyond simply the creation of a national service for adult social care.

“The ambition of this government is to go much further, and to create a comprehensive community health and social care service that supports people of all ages.”

A bigger remit

Although Derek Feeley’s review only looked at adult social care, today’s government consultation says extending the scope of a National Care Service – across ages and needs – should be considered.

This would see children and young people’s care, community justice, alcohol and drug services, and social work, as well as community health services, under the remit of the new body.

Responsibility for managing GPs’ contracts would move from the NHS to a National Care Service.

Farewell to Integration Joints Boards

Local service delivery by the National Care Service will happen through new community health and social care boards, replacing integration joint boards (IJBs) that were introduced five years ago.

Local councils will still have representation but their role will be dramatically reduced.

People filling in the consultation are asked whether they agree the new boards should be the ‘sole model’ for the delivery of social care and community health care, raising questions about areas such as Highland that has adopted its own approach to health and social care integration.

The slightly awkward position of IJBs – funded by councils and the health service, without any of their own staff – is set to be tidied up, with the Scottish government providing funding and each new community board employing its chief executive and other key staff directly.

Commissioning

Another responsibility of the National Care Service would be to draw up minimum requirements for commissioning of social care and support.

The consultation envisages the ‘mixed economy’ of care, with support purchased from mostly independent and third sector providers, continuing.

But this would be subject to standards setting rules on a core set of criteria that includes staff pay and conditions, outcomes for people using services and financial transparency on the part of care providers.

The National Care Service body would then be responsible for ensuring its network of community boards are following these rules.

Light on detail?

The consultation promises a step change in key areas of social care, including eligibility criteria and pay for care staff, though few details are offered up.

Also absent from the document are details on funding – aside from an SNP commitment to increase social care spending by 25% over the course of the parliament.

The document does not contain any specific proposals on what care workers should be paid. Instead, it says a new NCS would ‘take the lead’ in drawing up workforce standards, including on pay and conditions, with the possibility of a ‘fair work accreditation scheme’.

Sums paid to care providers to cover the free personal care and nursing costs of self-funding care home residents will be uprated.

It pledges an end to care eligibility criteria in ‘their current form’, so that support is available earlier, and a ‘Getting it Right for Everyone’ approach to support planning over the course of someone’s life.

Respondents are also asked what aspects of care home accommodation fees should be covered by the state, and what parts should be met by an individual.

More broadly, personal assistants are likely to be required to register with the Scottish government so that it is easier to provide support, according to the consultation document.

Unpaid carers

Just 3% of unpaid carers in Scotland receive support to take breaks from caring, the consultation suggests.

The Scottish government is backing a right to respite as recommended by the Feeley review, but says this must take account of different needs.

A right to a uniform package of support is “initially appealing”, the consultation states, but would likely be unaffordable and could not meet the needs of carers with the most intensive roles.

Other options include personalised support packages and individual thresholds to access higher levels of help.

The consultation asks respondents to pick what they would prefer from a list of options.

Data

It appears a National Care Service is seen by government as part of the answer to problems with data across not just social care but also health.

‘A nationally-consistent, integrated and accessible electronic social care and health record would be put in place that can be used and seen by all those who provide health and care support,’ the consultation states.

However it adds this would not be a ‘single, new system’ but an ‘additional national framework’. All primary and community health providers, and social care services, would be expected to report data to the Nation Care Service.

NHS care oversight to continue

Arrangements introduced during the pandemic that gave the health service greater oversight of care homes is set to continue – and could be expanded.

The ‘advisory’ role carried out by NHS nurse directors could be extended to cover care at home, as well as a responsibility to oversee the ‘safety and quality of care provided in social care’.

The regulators

Regulation would remain independent and separate from the National Care Service, as the Care Inspectorate looks likely to take on a greater role.  

The consultation lists a series of areas where current enforcement powers – such as improvement requirements and the cancellation of services in the most serious cases – could be strengthened.

It says changing legislation would mean the regulator could “speedily take action…[and] better protect residents of care homes and other social care users”.

An ‘early warning’ system run by England’s care watchdog should be replicated in Scotland, the consultation says, to flag up when a care provider is nearing financial difficulty and ‘minimise the risk of supplier failure’.

Providers could also be assessed on how well they respond to feedback and criticism.

NHS review on the cards

All this could prompt a bout of reforms to the health service.

‘When the outcomes of this consultation are clear, we will consider the implications and any necessary changes in structure, integration and alignment for and with the NHS,’ the document states.

In February former Health Secretary Jeane Freeman told MSPs the formula used to allocate funding to Scotland’s health boards would need to be reviewed in the run-up to the planned creation of a National Care Service.

Read more: Thinktank: Feeley plans not true National Care Service; Social work ‘blindspot’ in National Care Service plans; Integration ‘inconsistent and fragile’ five years on; Social care review: The reactions