Deputy Chief Executive, Andrew Thomson, gives a breakdown of how the National Care Service came about, what it’s trying to achieve and how Carr Gomm is getting involved to ensure that the voices and aspirations of the people we support are at heart of changes in social care.
In the Programme for Government published in September 2020, the Scottish Government announced an independent review of adult social care to be chaired by Derek Feeley. The principal aim was to recommend improvements to adult social care in Scotland, primarily in terms of the outcomes achieved by and with people who use services, their carers and families, and the experience of people who work in adult social care.
Having listened carefully to the voices and the stories of many people and organisations, including Carr Gomm and our Involvement Group, Feeley concluded that there are three things we must change to secure better outcomes:
- We need to start by challenging some of the prevailing narrative about social care support. Whilst it has its fair share of challenges, it need not be unsustainable, or in crisis, or confined to the margins of society. Strong and effective social care support is foundational to the flourishing of everyone in Scotland. It is a good investment in our economy and in our citizens. To maximise the potential of social care support we must change our perspective of what social care support is. We need to shift the paradigm of social care support to one underpinned by a human rights-based approach.
- Feeley acknowledged that there are already many strengths in the system, and we need to build on these foundations: self-directed support, the independent living fund, and the integration of health and social care; he said we need to nurture and strengthen the workforce; and improve the support for unpaid carers.
- Finally, Feeley recommended a National Care Service to achieve consistency, to drive national standards, oversight, and improvements, and to ensure strategic integration with the NHS. He called for a transformation of the way that we plan, commission, and procure social care supports, based on trusting relationships rather than competition. And he called for the voice of lived experience to be amplified at every level of the redesign.
Feeley said a lot. And when we read his report, it was as if he had read our submissions and repeated them back to us. We were full of optimism for the future…
The National Care Service
Having welcomed Feeley’s report in January 2021, the Scottish Government introduced the National Care Service (Scotland) Bill in June 2022 and committed to establishing this new structure by the end of the parliamentary term, in 2026. This has been widely described as the most significant piece of public sector reform in Scotland since devolution.
Curiously, the proposals for a National Care Service are not as simple as implementing Feeley’s report! The proposals seem to rely on two key drivers: more control from the centre and greater enforcement of standards; there is insufficient focus on culture, relationships, and behaviour. The Bill focuses on governance and structures and pays insufficient attention to ensuring people will be at the centre of the new system. Whilst acknowledging the importance of the workforce, there is insufficient detail describing how workers or providers will be empowered, enabled, better supported, or better rewarded. And whilst Feeley stressed the importance of a fundamental shift from competitive commissioning to collaboration, the Bill seems to make no attempt to review existing procurement practice.
The Bill is described by the government as framework legislation, with the detail to be co-designed afterwards in partnership with people with lived experience and organisations like Carr Gomm.
There is a lot of opposition to the Bill, with critics saying it lacks detail, represents a “power grab” away from local democracy, and that the investment required would be better spent elsewhere.
The next stage of the Parliamentary process involves a Stage 1 debate, although this has been delayed (and delayed), and is now scheduled for autumn 2023, providing more time for discussion and compromise.
It feels as if many commentators have forgotten that Feeley recommended building on the strengths and foundations of the existing social care system, and of reframing the narrative. Positive and impactful work happens every day in Carr Gomm. We need to keep reminding people about that…
Carr Gomm’s Involvement
Having previously contributed to Feeley’s Independent Review of Adult Social Care and to the Scottish Government’s consultation on a National Care Service, Carr Gomm continues to be actively involved.
As a registered stakeholder, Carr Gomm remains informed about all developments and receives the regular National Care Service newsletter. We are part of the Government’s National Care Service Design programme, we have two seats at the Government’s Key Stakeholder Reference Group, and we have commented directly on the draft Bill.
It is crucial that we remain up-to-date with developments and understand the potential impacts, but more importantly that we continue to influence the civil servants and politicians as they decide what the National Care Service will look and feel like. We are ensuring that they understand the range and diversity of social care supports for different people. We are demonstrating what it means to support people in a person-centred way to live their lives safely and well, whilst making plans to achieve their hopes and dreams for tomorrow. We are using our voice to influence policy and stand up for the good change that we believe in.
 Former Scottish Government Director General for Health & Social Care, and Chief Executive of NHS Scotland