The organisations responsible for local health and care have voiced a string of concerns about a Scottish government move to introduce a National Care Service (NCS), including one that warned ‘not all change results in improvement’.

A government consultation on how to implement the findings of an independent review of adult social care is currently underway.

The review recommended organisational reforms, including the setting up of a National Care Service, as well as improvements to eligibility and workforce pay.

Integration Joint Boards (IJBs) – which are set to be reformed under the proposed changes – have begun to publish responses ahead of the 2^nd November deadline.

A survey of the first submissions by healthandcare.scot reveals concerns about the expanded scope of the NCS, as well as the achievability of data pledges.

One IJB said the 137-page paper contained a lack of detail on ‘inputs and processes’, as another said the consultation document did not provide a “compelling case” for the scale of proposed structural change.

In IJBs where integration is already working well, there is fear that a fresh bout of reforms could unpick years of progress.

Children’s services

The government has proposed the inclusion of children’s social work and social care services in the NCS, to give parity with adult services and make them more ‘cohesive’.

This was a move beyond the recommendations of the Feeley review, which focused on adult social care.

But several IJBs say moving children’s services out of local authorities risks causing a disconnect with education and early years services.

In its consultation response, Aberdeenshire IJB says: ‘Whilst the ambition of cradle to grave ethos is recognised, there are concerns about how the inclusion of both adult and children’s services would work in practice.

‘There is also a real risk in terms of the disconnect from local authorities, community planning and children’s services planning arrangements but most significantly in terms of the strong connection we have with education and early years.

‘One of the critical concerns is the delivery of a model that reflects local need. Aberdeenshire’s Children’s Services Social Work has good reputation nationally and recognised for their commitment to improvement activity…There is a risk that this could be lost in a centralised service.

‘Not all change results in improvement.’

Of the 31 integration authorities, 19 currently have responsibility for children’s health and 10 for children and families’ social work.

Where children’s services are not delegated to the IJB, the local authority is responsible – often within the education department, such is the case in Aberdeenshire and East Lothian.

East Lothian said: ‘The model should be tested by starting with adults and following review, after an appropriate period, consider if the approach should be extended to children’s services. 

‘There is too much risk in including children at this stage.’

Community Health and Social Care Boards (CHSCBS)

The government has proposed IJBs – currently joint enterprises between local government and the NHS – become CHSCBs, which will be funded by the Scottish government and fully accountable to Scottish Ministers.

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

East Ayrshire IJB members see this as a ‘concerning disintegration’ of years of strong local arrangements.

Renfrewshire IJB said: ‘There is a real concern that the move from the IJB to a CHSCB could work against a lot of the ‘best practice’ aspects of local integration, which have developed over the last few years.

‘The risk is that some of the very good work that has been done by IJBs such as Renfrewshire, could be weakened by these proposals.’

Shetland IJB said: ‘With a commissioning model proposed for the NCS, there is a risk that CHSCBs will not be able to bring their strategic plans to fruition due to the dependency on partners for operational delivery and the lack of influence of the CHSCB CEO with respect to service delivery accountability.

‘This could also lead to a reversion from an integrated ethos back to silo working by partners.

‘Integration works well here and there is a risk of disruption to current progress.’

Data

The consultation includes plans for a ‘nationally-consistent, integrated and accessible electronic social care and health record’ to which all providers would input data.

But Aberdeenshire IJB doubts this approach is practical or achievable.

It says: ‘It is our view that the only way that this could be achieved would be with one system that is used nationally and does not allow for any local variation.

‘Even when the same system is used there can be significant variation in how data is
recorded and reported from that system depending on how it has been configured
locally.’

Smaller charities or personal assistants may also struggle to contribute to such a system, so data gaps would remain, the submission says.

East Lothian IJB says: ‘There are concerns about application of [common data standards and collection] across all sizes of organisations, as some, such as smaller local third sector organisations, may not have the technical or other capacities to deliver’

Shetland IJB members say they are supportive of the ‘ethos’ of better information sharing across health and social but are uncertain about the ability of an NCS to solve this with a single electronic record.

They add: ‘This would be a major culture shift regarding the use of systems and the use of personal data across different organisations.’

 

Read more: Details of National Care Service revealed; Social care reform: A tale of two governments

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