National Care Service (NCS) Bill: Stage 2 Briefing
Overview
The NCS Bill is intended to transform the delivery of community health and social services. The Scottish Association of Social Work (SASW) has been lobbying the Scottish Government to ensure that the Bill supports social work, ensures its specialisms are robustly connected, and that the profession is rooted in communities and focussed on relationships.
The NCS is to be created through a ‘framework’ bill. That is, enabling legislation that provides a legal outline with further details to be delivered later through secondary legislation (regulations).
However, unlike primary legislation, regulations are usually not significantly scrutinised by parliament and may be enacted by a minister without much oversight. The Scottish Government seeks to continue co-design work once the Bill has passed and use these regulations to enact changes. This risks undermining the effectiveness and legitimacy of the Bill as well as its ability to deliver better social work and social care to Scotland’s citizens.
In advance of the publication of the Stage 2 proposed amendments, SASW agreed some key tests[i] with our members and national committee to determine if we could support the Bill in the form proposed. Those issues are explored throughout this paper.
In late June, the Scottish Government published their suggested amendments to the Bill at Stage 2[ii]. Proposals for a single national care service with local boards reporting directly to it have been scrapped. Following the Verity House Agreement in Summer 2023, the Government agreed to abandon plans to transfer duties, powers, staff and assets from local authorities and is instead proposing a system of reformed integration boards with a singular oversight board to deliver the NCS.
NCS Amendments proposed by Scottish Government
A National Care Service Board (NCSB)
This is proposed as a non-departmental public body (NDPB) which would mean it was accountable to ministers and the Scottish Parliament, as well as having duties to improve accountability towards stakeholders and the general public. This would mean that the Minister will set the strategy for the Board and the NCSB will then deliver it. The Board will oversee local care boards (reformed integration authorities), the provisioning of services and would aim to secure continuous improvement in the wellbeing of the people of Scotland.
The Board will develop a support and improvement framework for NCS services. This will be the mechanism by which the NCS Board will take a view on the performance of community health, social work and social care services and deliver improvement.
There are already many inspection and scrutiny regimes that deliver performance information. The Bill indicates there will be no duplication of the existing duties of improvement bodies. However, any additional layer of performance management may add new layers of bureaucracy.
Across the Bill, there is no reference to the NCS Board considering the levels or distribution of funding to NCS Services. Direct funding from Government to local care boards is under discussion but will not be resolved as part of the Bill, it seems.
A national board with powers to scrutinise local performance might result in greater transparency of community health, social care and social work funding, the use of public money and the gap between the resource available and the resource needed.
Will this lead to a better relationship between national and local government focussed on delivering great public services? Is this a step in the right direction for you to get what you need to work with people who need support?
A National Social Work Agency (NSWA) and the role of The Chief Social Work Advisor (CSWA)
These will be created in statute as an executive agency within the Scottish Government with responsibility for:
- Social work education and training
- Workforce planning
- Policy rationale and improvement activities based on evidence-based insight
- Implementation support with social work employers to ensure Scotland achieves its policy intentions
- Training and professional development.
We lobbied for a NSWA to bring a national approach and support to a national profession and clarity in legislation of the role of the CSWA. It is important that this is on the face of the Bill, recognising the role of social work in Scotland, presenting the opportunity to influence Scottish Government policy and spending on social work. The Bill, of course, cannot commit to increasing resources but we need every available avenue to support social work’s voice in government.
There is nothing in the Bill about the structure of the NSWA, how it might work in partnership with others to implement new initiatives more successfully nor is the status or level in Government of the CSWA mentioned. We will seek assurance that the CSWA will hold an equivalent seniority as other professional leaders such as the Chief Medical Officer and Chief Nursing Officer.
Children’s and Justice Services
Currently local authorities and health boards must delegate some services and have the option to delegate others. All adult services must be delegated, and some local authorities have delegated justice and/or children’s services. Within the Bill, children’s and justice services will become part of the NCS if they are already delegated but will not become part of the NCS if they are not.
Ministers have expressed the view that all justice and children’s services should be incorporated into the NCS but have determined that this should be explored once the Bill has been passed and secondary legislation can be enacted.
The Scottish Government’s concerns about the lack of focus on prevention and early support, inconsistency of people’s access to support due to different levels of eligibility criteria, and the lack of mobility of agreed care plans and support packages were addressed in The Independent Review of Social Care (IRASC[iii])
Eligibility criteria, or access to care, is not addressed within the NCS Bill. The Scottish Government is working with carers and disabled people’s organisations alongside SASW and Social Work Scotland to create advice for Scottish Ministers on how to enact the IRASC recommendation that eligibility criteria be removed or reformed. We await with interest the outcome of those discussions and the Minister’s decision.
SASW has lobbied for all social work services to be within the same governance structure. Leaving this decision until the Bill has passed will mean that the NCS Board cannot have oversight of services not delegated to the local care boards. A service that varies in composition across council areas cannot be experienced as a national service, so this maintains the current confusion of governance arrangements across the country. The post legislative negotiations with Councils about the scheme of delegation are unlikely to be resolved quickly, meaning that the aspiration for a national service may not fulfilled.
Reform of Integration Authorities (IAs) and representation on local care boards
Integration Authorities will be reformed into local care boards with a single model of integration. The lead agency model used by Highland where the local authority has responsibility for all children’s and justice services and the NHS delivering all health and social services for adults will not be an option.
A single form of integration across Scotland is one step towards a simpler form of care and support that can be understood across Scotland. However, without a single scheme of delegation (as above) the variability of services across geographic areas continues.
Local boards are to be revised to include representation of people with lived experience, unpaid carers and people delivering frontline services. This is framed as individuals representing their experience rather than the wider experience of all carers, workers or supported people. SASW welcomes this important change to governance systems. Representation is vital.
In terms of lived experience, carers and worker representatives, which groups of people will be chosen to be represented? How will, three individuals represent the wide range of experiences of people using and working in services? We will continue to press for proper democratic processes to elect to these positions with post holders being accountable to their constituency.
Whilst we have participated in the Expert Legislative Advisory Group (ELAG) on a weekly basis to explore the Governments proposed amendments we have considerable concerns about how the information generated from those sessions has been used to justify rather than scrutinise the Government amendments presented to the group.
Conclusion/Questions for you
It has been over three years since the Independent Review of Social Care was published. The Bill initially published by Scottish Government has been significantly changed as a result of the political relationship between national and local government. This Bill appears to offer little change to our current systems other than the addition of a National Care Board.
- Is this a necessary first step towards a simpler system that sets a direction for local and national government?
- Is the opportunity for transparent accountability of funding and spending at national level enough to offset any increased bureaucracy?
- Is it appropriate and reasonable for a government to ask us to accept the framework Bill and for us to trust that this will create the environment and support structures we need?
During summer 2024 SASW will be running some engagement sessions, a questionnaire and a short life working group to help us present evidence to the Parliamentary Health, Social Care and Sport Committee. Please join us in any of these ways that suit you best. Contact scotland@basw.co.uk
[i]National Care Service (NCS) Bill : SASW's position statements on the Bill | BASW
[ii]National Care Service (Scotland) Bill - draft Stage 2 amendments | Scottish Parliament Website
[iii] Adult social care: independent review - gov.scot (www.gov.scot)
