Capacity, meeting demands and managing expectations are just some of the concerns vocalised by rural, remote and island areas in response to the proposals for a National Care Service.

Councillors whose area includes island communities say the government consultation – which closed this week - has failed to consider their areas’ unique needs in the proposed national overhaul of social care.

In its consultation response, Argyll & Bute Council said:

‘As a remote/rural council, we feel that there has been a lack of consideration of the particular and unique challenges that we face as an authority, compared to those within more urban areas, when developing the proposals.

‘We would urge the Scottish government to ensure that the impacts of this proposal are fully assessed in an Islands Impact Assessment and Fairer Scotland Duty Assessment.

‘For example, being able to provide equity of provision to all our residents and communities is a significant issue for an area like Argyll and Bute and there is a concern that some of the proposals will compound this issue.

‘It is anticipated that there will be an increase in demand for services, and the capacity required to aid individuals understand their choices, which creates challenges in terms of unmet needs and managing expectations.’

Currently local health and care is the responsibility of 30 Integration Joint Boards (IJBs) – partnerships between the local NHS board and council – as well as one ‘lead agency arrangement’ in Highland where the two split services.

An NCS would see this flexible arrangement come to an end, with all areas having to adopt a Community Health and Social Care Boards model (CHSCBs).

In its response, Highland Council said: ‘The consultation suggests that consistency is a key goal and there is criticism of different areas adopting different approaches, whereas the Highland Council’s view is that arrangements need to be flexible and adjust to local needs and contexts.

‘Even within the Highland Council area, the needs of someone living in Inverness will be very different to someone in Knoydart.

‘This is why services should be designed and delivered as close as possible to the people that use them ensuring resources are allocated in a locally responsive and therefore most effective way to meet the needs of service users.

‘There is insufficient recognition of these principles in the consultation and even less to the principle of subsidiarity.’

Emma Macdonald, Shetland North Councillor and chair of Shetland IJB, in a recent series of Facebook posts to her ward, said:

“I strongly believe that decisions should be made as close to the communities they impact as possible.

“Care here is very different to the many other areas of Scotland. We have excellent services and fantastic staff because we have invested in them.

“These proposals have the potential to change care in Shetland and take away local accountability and decision making.”

Shetland IJB say the area is fundamentally different to the rest of Scotland and thus requires a locally designed and implemented model of care.

The body contends Shetland has integrated health and care well and services are rated highly; the consultation offers little evidence on how an NCS would improve outcomes.

However, it says there are considerable dangers to greater centralisation.

‘There is risk that the formation of the NCS would mean that expected standards in Shetland would drop,’ it says in its response.

‘There are concerns that some form of Island proofing would be necessary with respect to funding and if social care was funded in the same centralised way as health i.e., via an NRAC [funding allocation] formula, then there would be a 12% gap in funding.’

The response continues: ‘There is significant risk of “System shock” by introducing the NCS proposals into a small system like Shetland, because of the infrastructure and resource requirements from a finite resource pool introducing resource stretch and uncertainty for the workforce.’

The IJB say it will undertake its own Island Impact Assessment to see what impact the proposed NCS would have on Shetland.

Lack of availability of service provision in some localities means rural and remote areas struggle to provide consistent care.

Argyll & Bute Council say the proposals, as they stand, would ‘amplify’ these issues.

At the moment, where some community and acute health and care services are not available, patients must use other council or NHS services.

Thus councillors are asking for patient pathways to be taken into account in these plans and that a ‘one size fits all approach is not appropriate’.

‘There needs to be a degree of flexibility to ensure that local context and service requirements are given due regard,’ adds in its submission.

‘Local knowledge, systems, services and workforces are best placed to identify the specific needs of people and communities within a local authority area.’

Read more: Analysis: The NCS headaches facing ministers; Details of National Care Service revealed; IJBs challenge plan for expanded NCS

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