With the creation of the National Care Service, the Scottish government is embarking on what ministers themselves are calling ‘the most ambitious reform of public services since the creation of the NHS’.

At the same time, retention of staff in both social care and the NHS has emerged as a major challenge in building both the numbers and skills mix needed for the health and care workforces.

healthandcare.scot publisher John Macgill was recently invited to talk about communicating a shared vision at a time of change and reorganisation at the Scottish Policy Conferences workforce seminar. This is what he said.

The SNP's manifesto ahead of the 2021 Holyrood elections made a series of commitments to change both social care and the NHS. Those promises are now Scottish government policy: to establish a national care service by 2026 and, at the same time to review the “number, structure and regulation of health boards – and other related delivery services”.

So, we are promised change – change for the better perhaps, but change all the same. The change will be co-designed, consultative and rooted in the lived experience of people using and delivering services.

Despite that, I would argue that we haven’t been doing change – and particularly communicating change – as well as we could have.

Cast your mind back to 1 April 2016 and Scotland’s 31 integration authorities coming on stream to bring together NHS and local authorities to partnerships that delivered both primary and community health services and social care.

One particular problem associated with that change was that many people working in both local authority care and social work services, and in primary and community NHS services, were simply unaware on day one of the new integration authorities and – for a while thereafter – that anything had changed.

There was a failure to communicate both what was happening and why.

Now, as we embark on the process to create a National Care Service (NCS), government needs to learn the lesson of integration and invest in a major communications programme – starting well in advance of people seeing the NCS changes beginning to happen – explaining where everyone fits in to the vision.

Ministers say they want to achieve a vision of a care service that enables people of all ages to access timely, consistent, equitable and fair high quality health and social care support – which all sounds perfectly reasonable.

But saying that is not enough.

If the health and social care workforces are to buy into the new NCS, government needs to be explaining now why change is taking place, specifically: what is it that is not so good for people receiving treatment or care now that proposed changes will put right?

What can the NCS deliver that could not have been achieved by implementing previous good legislation effectively and investing more in existing services? How will outcomes actually be made to improve? Why exactly; what exactly.

Communicating with staff to begin to create a vision of care they can embrace is not something that can be left until all the details are ironed out.

With the publication of the National Care Service Bill, we now know that those integration organisations will have a lifetime of around 10 years, to be replaced by new ‘care boards’ as the local delivery organisations for the NCS.

It would be difficult not to regard this as a bit of a vote of no-confidence in health and social care integration.

Just 18 months after the integration authorities went live, Audit Scotland in its update on progress of health and social care integration flagged its concerns that 57% of the partnerships had seen changes in their senior management team, including a high rate of change of chief officers.

Today, those chief officers – leaders with many years’ experience – have no certainty that they will have a job when the new NCS comes into being.

While they might be in pole position to move across to the new care boards, the national care service bill – because it is enabling, umbrella legislation rather than being stuffed with detail – does not tell us how many care boards there will be.

It is a fair bet that, given that ministers are keen to mirror the NHS rather than local government (and to exert direct control without the help of local government) there will not be 31 care boards matching council boundaries but rather between 11 and 14 matching the boundaries of the mainland NHS boards.

Faced with uncertainty, will all those chief officers stick it out until 2026?

The chief officers are no different from the people they lead, trying to get on with their jobs amidst the uncertainty caused by a change in government policy.

For any workforce, perhaps particularly for a workforce that gives everything but often feels undervalued, change can be demotivating. If so much is to change, is that some sort of verdict that what is being done at the moment isn’t working, some sort of failure?

Change can be a distraction. Just ask those representatives of NHS primary care staff who spent time, successfully, persuading ministers not to roll things like general practice into the new NCS.

Change can be a blocker to getting things done. How many decisions are being put off until after 2026? How certain can any business plan be for an independent supplier if they’re not sure where they fit in the new setup?

And proposals to impose change can cause worry and anxiety. What will the shift in emphasis from local councils delivering social care to Scottish government-led care boards mean for those people currently delivering care employed by councils?

We only need to look at the UK’s shrunken post-pandemic workforce to see that people sometimes choose to step back rather than continue in jobs that they don't feel valued.

For ‘change’ we can equally use the word ‘uncertainty’.

If ministers are to ensure that their policy to create an NCS doesn’t work against their need to retain staff, they have to meet uncertainty head on.

With hundreds of details of the NCS to be worked out, ministers should share decisions as they go along, as soon as any decision has been made.

Because change is more scary if you don’t know how it will affect you.

 

Read more: NCS Lived Experience Panel Launched; Fear it is "too little too late" for social care; A rebuttal to the National Care Service discontents; NCS Bill published; Embedding voices of experience into NCS plans

 

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