A consultation on what Nicola Sturgeon has called the biggest reforms since the founding of the NHS closes today.

An attempt by ministers to expand the remit of the National Care Service means the call for views might not be as straightforward as they had hoped.

While many are broadly supportive of the plans for a National Care Service there’s also a sense the consultation process has rushed too quickly to questions about structures while lacking detail in other important areas.

This has extended to the consultation itself - which one IJB member described as an "exhausting document".

For its part, the government has insisted it is in ‘listening mode’.

healthandcare.scot takes a look at some of the tough questions that the consultation could throw up.

General practice

GPs have been blindsided by a proposal to move their contracts to the new care service.

This was envisaged as a ‘tidying’ up of existing arrangements by Derek Feeley, the author of an independent review of adult social care that lies behind the NCS.

But both the BMA and RCGP have come out against the changes.

The Scottish government insists GPs will remain an integral part of the NHS.

The scope of the National Care Service

The Feeley review was praised for its engagement and consultation but only looked in detail at adult social care services.

When he unveiled the consultation, Social Care Minister Kevin Stewart said: “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.”

This would include children’s services, social work and community justice.

As the Equality & Human Rights Commission put it: ‘The government took what in our view was the right approach and set up an independent review. This provided the government with evidence…and made a strong case for redesigning the system.

‘We are not aware that the equivalent evidence gathering, engagement with service users and analysis has been carried out in order to determine how best to improve Justice Social Work, Alcohol and Drug Services and Children’s Services in Scotland.’

While the government has argued for children’s and adult services being under one agency, there is the danger this creates fresh divides between children’s care and education services, as several Integration Joint Boards (IJBs) have pointed out.

The shape of new community health and care boards

Community health and social care boards are set to replace IJBs, which bring together the NHS and local authorities.

Derek Feeley envisaged CHSCBs being directly funded by government and taking on more of a central role in commissioning services.

However, the number and range of staff who will move to CHSCBs and how this will impact services is still unclear.

The consultation says this will include chief officers and strategic planning staff as a minimum.

Some respondents have argued for all social care and community health staff to be directly employed by the new boards.

Quarriers, a charity that provides care and support to around 5,000 people, suggests the system will otherwise end up ‘gridlocked’ by competing power structures.

But such a move would throw up further problems over the position of GPs, who are in the middle of implementing a new contract, and links between community and acute health services.

Decision-making

The Feeley review was clear that every board member should have a vote, after it voiced concerns that existing arrangements had not led to unpaid carers, disabled people and third sector groups being able to influence decisions.

But the consultation document leaves this question open.

In its response to the consultation, the Health & Social Care Alliance says CHSCBs should have 'full voting rights for representatives who access services and unpaid carers, and their attendance (properly reimbursed) should be a pre-requisite for quorate meetings and decision-making.'

Regulation

One under-reported aspect of the care service is how the role of existing regulators such as the Care Inspectorate and the Scottish Social Services Council could change.

The latter has ‘significant concerns’ about proposals to move responsibility for setting standards for workforce qualifications and training to a National Care Service, rather than remaining independent of government.

It has suggested this would make Scotland an outlier in the UK and could lead to ‘unforeseen consequences’ for workers who move to different areas.

 

Read more: Details of National Care Service revealed; Social care reform: A tale of two governments; IJBs challenge plan for expanded NCS

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