Fear of creeping medicalisation within care has not been addressed in government proposals for a National Care Service say sector experts, as they voice fears that culture clashes between health and social care will prove insurmountable.

At a conference to discuss priorities for a national care service, representatives from third sector and leadership organisations told attendees that the oversimplified “lazy shorthand” of health and social care should be ditched.

Lorraine Gray, Chief Executive at the Scottish Social Services Council (SSSC), said: “Our experience is when we say health and social care, social care gets lost because health is so powerful.

“If we are really truly talking about parity, it’s so important that social care is an equal partner.”

The leader of the regulatory body of social service workers asked attendees of the Scottish Policy Conference’s event: “How do we ensure that the real value of social care doesn’t get lost at the same time as we work closely together?”

Scottish government proposals for a national care service published last summer envisages a “comprehensive community health and social care service” overseen by ministers, to place social care on an equal footing as the NHS.

An independent evaluation of 1,300 responses to a consultation on the plans found “strong support”, but some respondents raised concerns over a lack of detail and the absence of lived experience.

Ben Farrugia, Director of Social Work Scotland, the leadership body for social work and social care professions, claimed legitimate fears around healthcare privatisation had led to “no-go areas” of discussion, which presents a huge barrier to bridging the cultural divide between social care and social work on one side and health on the other:

“If you think about self-directed support, it’s a [culture of] real openness and appetite to do better in the social care space around self-directed support but there is a sense that we can’t really push that conversation into the health space for fear that that fuels the privatisation of the health care service.

“We have a culture being built on our social care side that is about empowerment and self-direction and ability to manage one’s own budget in some cases. But then we get to very similar needs on the continuum – instead we’re talking about waiting lists, talking about time: we’re not talking about giving people that money that we spend in the NHS to say, “I’m going to take that and spend it on a physiotherapist of my own choice”.

“I think if we’re not willing to get into those conversations, no matter how difficult, that barrier will remain and be almost insurmountable.”

Donald Macaskill from the providers’ organisation Scottish Care told attendees at yesterday’s Scottish Policy conference that the pandemic has ushered in a “creeping medicalisation” within social care that had suppressed the mutual integration of health and care:

“A National Care Service cannot be simply aiding an NHS – we do a different job, and we need to work better together, but we cannot do this when the two don’t understand each other.

“What I am concerned about is that we don’t lose the essence of social care, the ability of women and men to direct their own lives and that we do not create a national care service which is just a miniature national health service.”

The Scottish government did not include a definition of social care within its consultation on a national service, which Dr Macaskill said fails to illustrate the “distinctiveness” of the sector:

“[Social care is] the enabling of those who require support or care to achieve their full citizenship as intendent and autonomous individuals. It involves fostering individual contribution, allowing people to achieve their potential and nurturing their sense of belonging to their community so they can flourish.

“And that’s not a medical model. It is a holistic model of wellbeing which defines care as distinct and different from emergency, acute or secondary health intervention.”

The CEO of Food Train Scotland has previously highlighted that the legislation underpinning free personal and nursing care in Scotland was fundamentally at odds with the heart of social care and called for a “complete 180” to centre social and personal needs.

Speaking at an event on the Feeley review last September, Michelle Carruthers told attendees care should be understood as an exercise in relationships and community building rather than the current package of “daily living tasks, based on assessment and eligibility criteria”.

To ensure people who receive care are listened to, Sara Redmond from the Alliance told attendees there is a need to explicitly integrate equality and human rights across the whole system.

Writing as part of the organisation’s series earlier this year, equalities specialist Rohini Sharm Joshi OBE said the consultation’s commitment to “consider” the impact of proposals on equality groups was disheartening, and signalled the government’s reluctance to deal with inequalities head on.

Scotland’s Social Care Minister told a later session of yesterday’s Scottish Policy Conference that consultation on details of a national care service will be ongoing to allow the government to “consult and to communicate and collaborate” at every stage.

Social Work Scotland’s Mr Farrugia emphasised engagement with people with learning difficulties is crucial at this early stage of service design, but that this must not be “performative”.

Dr Macaskill suggested the consultation offered an opportunity for Scotland to become the first country to enshrine the right to social care as a fundamental human right – but this will require engagement of from those who do not actively use services.

“We are talking in echo chambers, and we need to have this conversation in wider communities, but we are not there yet.

“We must talk less about the structure of social care and more about the spirit.”

Framework legislation to set up a national care service is due to be published by the summer.

Read more: Minister: We’re not rushing NCS; Call for ‘revolution’ in social care commissioning; Minister: Public backs our National Care Service plans

 

 

 

 

 

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