Scottish Care warmly welcomes the publication of the Independent Review of Adult Social Care in Scotland.
Right from the start in tone, language and structure this Review speaks with a voice of realism and authenticity to the challenges facing the social care sector in Scotland. It is the result of extensive engagement and consultation and we are grateful for the time taken to hear the voices of those working and providing care home and homecare services in the independent care sector. We also note that many of the points we raised in our own submission ‘What if and Why not’ find their place in the Review’s report.
In particular we want to affirm the central message of the Review – that the time is now right for major change in the way in which we deliver social care in Scotland. Our What if and Why not submission emphasised this message and the principles required to achieve change, which are positively reflected in the Review. We fully acknowledge the need to create a paradigm shift moving from a largely deficit approach to care and support to one which fosters capacity, enables investment, focuses on prevention and promotes independence. We are pleased to note the degree to which human rights are front and central both to the delivery of care and support and the structures which enable support to happen.
As a sector we want to affirm that care homes have a critical role in the future of adult social care, and we would want to build on the learning from innovative models of residential care currently being developed in Scotland and internationally. It is our conviction that the fulfilment of personal independence for many individuals can be achieved in shared and group living just as much as it can be in the community. Indeed, this is reflected in the Review. What is critical is the maximising of individual choice and we must take a broad and inclusive approach to enabling that choice, including care homes as a positive option, beyond the challenges of the current pandemic circumstances.
The Review rightly argues for a dramatic revolution in the way in which we commission and procure social care services. We need to strip out competition and replace it with collaborative, responsible and ethical approaches which include those who are the primary purchasers of care – citizens themselves. In a homecare context, the details of this will be important and we hope to see a radical shift adopted as a result of the Review away from punitive and restrictive approaches. We hope that commissioning and procurement reform will ensure that we also see an end to the discriminatory treatment of those who live in care homes where to date few have been able to benefit from the individual autonomy around budgets given to those who receive care in the community.
We wholeheartedly agree with the Review that social care must be seen as a major contributor to the Scottish economy and that the language around cost, benefit and the role and purpose of social care needs to change. This will require a truly transformative rather than purely improvement-based approach, across broad sectors of society, if real change and sustainability is to be achieved.
There are some areas where we believe more work needs to be done. This is perhaps especially evident in the finance section. The vision articulated within the Review is a brave and a bright one. It will demand considerable fiscal investment whether it is in the developing of new models of support and care which are more citizen-led, investment in new supports around the education and professionalism of the care workforce, or in the raising of Fair Work standards. All this will require considerable resource and we hope that this will be achieved. We believe more work needs to be undertaken to truly reflect the cost of this new vision of care.
In addition we would like more work to be undertaken on the issue of paying for residential care. We continue to believe that it is both iniquitous and discriminatory that depending on the health condition you have, dementia or cancer, the expense for the care you require to live and be part of your community is unfairly levelled at those who require to move from their own home into a residential or nursing home. We would like to believe that a National Care Service could develop more innovative, inclusive and equal fiscal fairness around accommodation costs.
We recognise that there is considerable work to do to take the words of this Review and make them live and as an organisation, Scottish Care and our wider membership is committed to playing a constructive and creative part in the creation of a National Care Service for Scotland. We believe this representation of significant systemic change presents an important and exciting opportunity to make the changes required around governance, accountability, resourcing and partnership. We all need to put our collective energy and will for change towards making this a success. What will be important is that the creation of such a service does not become an exercise in additional bureaucracy and processes but truly provides a vehicle for collaboration, transformation and bridging the many implementation gaps identified in the Review.
The Review is a very positive step towards achieving the national, cross-sectoral and cross-party consensus required to achieve the changes required for a positive social care future. Where further detail and drive is most required is on the ‘how’, since effective implementation at pace and scale will be the key to ensuring this Review achieves the ambition so broadly shared across Scotland. We are pleased to see Derek Feeley’s words echo those in our What if and Why not report in his questioning of rationale and timing – if not now, when? With the independent sector clearly critical at all levels of the Review’s recommendations, we hope that the work Scottish Care continues to undertake – not least through our Care Futures programme – will provide some of the tools, expertise and energy required to ensure this Review doesn’t face its own implementation gap. The independent sector is clear in its commitment to being a partner on the important journey ahead.
Dr Donald Macaskill commented:
“It is very rare that the outcome of a Review has been anticipated with such a high level of expectation and demand. It has not disappointed.
“The Review offers the vision of an authentic, rights-based, inclusive and diverse social care future for Scotland. It rightly acknowledges that there is much that we should be proud of in Scotland in what we have and in what we are doing. However, as I have often reflected, words alone and legislation left on the shelf will not do. Its recognition that we need to engage in robust implementation of what we have as well as re-shaping new and creative approaches, is both refreshing and vital. We need to make sure that what we say on paper really changes the lives of those who need care and support.
“I welcome the flesh which it puts on the bones of the idea of a National Care Service. Having been concerned about the way in which such a phrase was being used as a soundbite without substance, I am delighted to see the articulation of a realistic and dynamic model, process and structure. But more importantly I am pleased to see that central to all the Review’s findings is the urgent necessity to focus on the needs of the individual who is being supported to ensure their ability to be a full citizen of their community and of Scotland.
“The emphasis on fair commissioning and fair work; the focus on a human rights foundation for the individual; the transformation of regulation to re-orientate it towards improvement and quality; the creation of distinct structures of accountability and direct political governance is all to be welcomed. These are the elements for the creation of a more dynamic, open and yet inclusive and diverse infrastructure of care.
“There will be a lot of debate and discussion over the next few months as we move towards an election. I hope that the debate and policy articulation will seek to build upon the vision we find in this Review through equally constructive and inclusive contribution. The time for partisan point-scoring should be left behind: the hour for collaborative, mutual, responsible contribution is now. This Report paints a picture of what care and support in Scotland could be. It will not be without challenge but it is surely worth the working.”
