A national care service for Scotland

The RSE welcomes the opportunity to respond to the Scottish Government’s consultation on a ‘National Care Service for Scotland’. The response was facilitated through a working group that included RSE Fellows and members of the Young Academy of Scotland with significant and wide-ranging practitioner and research experience in the health and social care sector and academia.

The RSE broadly welcomes the proposals for a National Care Service (NCS), which are intended to change the way services and support are delivered in response to longstanding challenges. However, the response also highlights concerns that the consultation focuses on organisational restructuring rather than delivering a broader cultural shift that embraces innovation and prioritises services matched to individuals’ specific needs. The provision of locally controlled, individually responsive, and tailored care needs to be coupled with national standards and clearly defined career pathways and training for staff.

Professor John Gillies OBE FRSE outlines the RSE response to the Scottish Government’s consultation on ‘A National Care Service for Scotland’

Paper Summary

The RSE welcomes the opportunity to respond to the Scottish’s Government’s consultation on a National Care Service (NCS) for Scotland. Changes to the culture, planning and provision of social care are urgently needed, and there is much in the consultation that we welcome.

We are concerned, though, that the consultation paper focuses on organisational restructuring without addressing transformative cultural change which prioritises person-centric services matched to individual’s specific needs, broadens definitions of what constitutes care, and encourages feedback and learning through processes of continual improvement.

The NCS would benefit from a mixed governance model, which ensures national standards, terms and conditions, and training for staff whilst providing a locally controlled, individually responsive, and flexible service.

Proposals for the NCS should take account of the impact of socioeconomic deprivation, urban-rural geographic inequalities, and the needs of remote and island communities – the uneven impacts of which have been exacerbated by the COVID-19 pandemic – to design a more equitable service that values all people through the creation of a tailored care service which is attuned to local and individual requirements.

Greater clarity is required around the resourcing, budgetary, and contractual arrangements of the NCS, and proposals for reformed Integrated Joint Boards (IJBs), or Community Health and Social Care Boards (CHSCBs).

The consultation paper does not address the ethical and legal ramifications of patient confidentiality and privacy in the sharing, and use, of patient data. A balance should be struck between harnessing the value of ‘big data’ to revolutionise healthcare via data-driven solutions, and more holistic approaches which value data gathered through relationship-based care, including patients’ values, feelings, and local circumstances. This should be underpinned by genuine public engagement, an appreciation of the lived experiences of individuals, and the use of routinely available data to predict future trends.

We believe that addressing the above issues will be vital to ensure a thriving ecosystem of local care services, in accordance with the recommendations outlined within Derek Feeley’s Independent Review of Adult Social Care.

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