The full extent of disagreement within the advisory panel behind the Independent Review of Adult Social Care has been revealed in emails newly released to healthandcare.scot following a freedom of information request.

The health spokesperson for local authority organisation COSLA at the time, Stuart Currie, suggested his “strong alternative view” on stripping councils of their leading role in social care be part of the report.

Report chair Derek Feeley rejected Councillor Currie’s overtures saying the “role of the panel is to advise rather than ‘sign off’” and that the responsibility for making recommendations through the report ‘lies squarely on his shoulders as Chair’.

An advisory panel of experts was set up to support Mr Feeley in making suggestions to the Scottish government on how to improve adult social care in Scotland and pave the way for a National Care Service (NCS).

A key recommendation of the report published in February 2021 was to end the role of local authorities as both commissioners and providers of adult social care services.

In emails between the two, Mr Currie said moving statutory responsible from councils could be seen as “blaming local government for the current situation” in adult social care.

Mr Currie wrote:

“[It would] Also be helpful to understand how you see “sign off” from panel members in relation to the recommendations where there is not agreement? I am not suggesting a minority report but reflecting where a strong alternative view is held and whether that should be part of the report.”

Mr Feeley replied:

“The terms of reference for the review place the responsibility making recommendation through the report squarely on my shoulders as Chair. Thus, the role of the panel, strictly speaking, is to advise rather than 'sign-off'. Of course, I hope we can get to something which we all agree can be submitted.”

The former East Lothian councillor also said the review’s recommendations would do little to reform the private care home business model, which he explained currently targets self-funders to maximise profits at the expense of those funded by councils.

COSLA has been vocal in its opposition to key parts of the Scottish government’s planned care reforms; rather than “waiting for expensive and costly structural change”, the organisation has instead called for urgent investment to improve the service for those who rely on it now.

The social care minister, Kevin Stewart, said analysis of 1300 consultation responses to the proposals set out by ministers following the Feeley review showed “strong support” for the government’s NCS.

 

Future of social care scrutiny?

The exchange of emails released to healthandcare.scot shows concerns were raised around Mr Feeley’s proposals on combining aspects of the roles of regulators.

The review recommends the Care Inspectorate and Healthcare Improvement Scotland (HIS) should be held jointly accountable for the planning and delivery of improvement programmes within the sector.

Caroline Gardner, the Auditor General for Scotland between 2012 and 2020, said she worried closer working of the two scrutiny bodies would not work in practice.

In an email sent to Derek Feeley on the 13th of January 2021, Ms Gardner said:

“I understand the pragmatism of keeping the Care Inspectorate and HIS as separate organisations, but I am sceptical of their ability/willingness to work together in the way proposed and I worry that will leave social care without the improvement expertise it badly needs.

“I don’t have a solution short of restructuring, which also has drawbacks.”

Mr Feeley responded that he shared her concerns but work “can’t risk being diverted by structural upheaval” and that it would be easier to integrate the organisations later than separate them.

 

And what about funding?

The Feeley review suggested its proposed reforms would cost around £660m to implement, however these estimates did not cover potentially significant costs to the government of any increase in pay for social care staff and enhanced support for hundreds of thousands of unpaid family carers.

At a meeting of the parliament’s Health and Social Care Committee last September, Mr Feeley said the numbers were “as realistic as we could get them in the time that we had available” but a “reasonable approximation”.

The Scottish government promised £800m by 2026/27 to implement Mr Feeley’s recommendations and an expanded remit of an NCS, but the Fraser of Allander Institute says the figure could end up being nearly double this.

In emails sent just weeks before the Feeley Review was published, another member of the review’s advisory panel, Malcolm Chisolm, former Scottish Executive Minister for Health and Community Care in 2001-2004, raised concerns of the report’s “all new” Funding Chapter.

Mr Chisolm also said “having so little for pay” and nothing for the Independent Living Fund (ILF) would likely receive negative feedback after publication.

The final review says an additional investment of £32m in the ILF, which maximises self-directed support for disabled adults with additional person-centred payments, would be needed if the fund was to reopen to new applicants.

 

Read more: Minister: Public backs our National Care Service plans; Care Service plans ‘attack on local democracy’; Watchdogs: Care can’t wait five years for action

 

 

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