Fulfilling the promise: the potential of a National Care Service

My colleagues Dr Tara French and Imogen Caird have launched the fruit of over a year’s work which they had undertaken with another colleague Becca Young. ‘Coileanadh’ is the output of phase two of the Scottish Care ‘Collective Care Future’ programme. It presents a vision of care and support in Scotland created in collaboration with Andthen, a design strategy studio. The visual landscape embodies the contributions of a diverse range of expertise and experiences from providers, staff, people supported, families and wider partners in care and support in Scotland. The findings include eight concepts and three priority areas of focus relating to the overarching philosophy and culture, the policy and partnership enablers, and the way in which change can be enacted in social care practice.  The work also includes 39 practical steps for action across these themes.

I will let you have a read of the change landscape envisaged by the work, but I just want to focus on a couple of the themes raised.

This last week has seen the formal commitment in Parliament by the new Cabinet Secretary for Health and Social Care, Humza Yousaf, to the creation of a National Care Service. It is a bold vision – albeit one at the moment with little detail, but it represents a real opportunity to create a better way of providing and receiving support and care in Scotland. The authors of Coileanadh believe the actions identified in their work are both complementary and distinct to the recommendations of the Independent Review of Adult Social Care which first formulated the idea of the National Care Service. Coileanadh explores the synergies and areas of opportunity that can help to overcome the implementation gap and articulate the key requirements of a National Care Service, what it refers to as a National Care Framework. In doing so, they aim to offer a more holistic perspective on the creation of a National Care Framework and the resulting implications for how work in this context could be taken forward.

I have already reflected in this blog on a number of occasions on some elements of the National Care Service not least the positive image of a social care covenant, but today I want to take a couple of Coileanadh themes to underline why I think it is important that the distinctiveness of social care is continuously affirmed and why we need to adopt a life-course approach.

The distinctive integrity of social care.

Coileanadh starts with a call to ‘put the foot down’ in order to harness the moment and wider climate that currently exists to make significant change. There is a wide acceptance, accentuated by the experiences of the pandemic, that the model of social care support we have in Scotland is not working. Recognising the problem as the Feeley Report did so eloquently is a critical first step in addressing the challenge. It is, as many have said, not that we have the wrong legislation or the wrong vision, it is because we have failed to implement what we promised. Overcoming the barriers to implementation will be the major challenge of any new models or systems seeking to change the current landscape.

A critical part of creating a national care service is as Coileanadh argues the need to ‘develop a commonly accepted ‘hallmark’ of non-negotiable ‘conditions’ so that everyone is held to account for upholding these and working to ensure that these are supported. This would give assurance and confidence to all people involved, both in terms of quality and recognition.

Part of that is adopting a social care mindset which creates and establishes a more supportive approach to understanding people’s experiences, needs and preferences. This cannot be a functionalist and transactional model but one which is relational in essence, and which starts from a wellbeing perspective that emphasises individuality. We have to get beyond the accounting of value by commissioned timeslots, where care and its outcomes are measured by the length of a visit, with all the negative impacts such casual care arithmetic has upon supported person and worker alike.

A social care mind-set involves shifting the balance of power that clinical models are believed to hold in relation to decision-making and recognising the unique contribution of social care. In all the talk of a national service there is a risk that we try to ape and mirror the NHS. Social care is not health care. It demands and involves a different vision and perspective, one rooted in autonomy and control, personal independence and choice. The National Care Service cannot simply be the National Health Service for social care. Social care has value and importance in its own right not just as an adjunct to acute health care. As Coileandah states: ‘At the moment value is largely from a system-oriented perspective e.g., relieving pressure on hospitals, prioritising settings of support such as the drive for people to remain in their own home and a focus on ‘beds’, ‘placements’ and ‘packages’ as forms of measurement.’

Any model of social care has to be rooted and focussed on the needs of the person and not rescuing the fractures of the system. There is an opportunity in the consultation in the next few months to articulate and substantiate the vision of a distinctive social care mindset. One that moves us from talking about people being ‘treated’ to ‘supported’ and not saying ‘putting’ someone in a care home or ‘maintaining’ someone at home.

A life-course approach

Part of that re-envisioning of both the debate and the foundations of a new way of doing things is the necessity to adopt a ‘life-course approach.’ As Coileanadh argues we need to ensure that any model of social care is not rooted in a discriminatory and broken approach to personal life and wellbeing, not least in terms of age. Instilling a life course approach means normalising the ageing experience in order to view this as a natural journey.

Empowering people to have choice as they age and preparing society with information and awareness of support available should be critical elements of any national commitment. Coileanadh puts it well:

‘A focus on opportunities within the education system and enabling earlier conversations about the value of age and the celebration of wisdom, experiences and richness that comes with the journey of life would foster open and transparent conversations when reflecting on the life course and personal growth. Instilling a value for ‘levelling up’ will support the profile of older people and social care to the extent that people feel privileged to make choices, have options, and encourage people to work in a sector that is rewarding and with opportunity. All stages of life should be viewed with equal importance, e.g., later stages as important as birth, and people should be equipped with the knowledge to prepare for and navigate each stage and life event positively.’

Coileanadh is the Gaelic word which means to fulfil and accomplish. The conversations have been held, the words heard, the desires expressed. Now is the time to make the change happen. Now is the time to put aside vested interest and partisan position, and to adopt the holistic shared common purpose of creating something new and better. This is a task not just undertaken for those who use care support, who work and manage, who provide and regulate, who commission and finance today– but for everyone who follows. There really is an opportunity to fulfil the promise.

It is time to push the boat out, to seek a better horizon than the limitations of our sight, to dream bigger than our imagination, and to do better than our skills permit. And in the brilliant words of Edwin Morgan the unknown is always the best even in older age:

At Eighty

Push the boat out, compañeros,

push the boat out, whatever the sea.

Who says we cannot guide ourselves

through the boiling reefs, black as they are,

the enemy of us all makes sure of it!

Mariners, keep good watch always

for that last passage of blue water

we have heard of and long to reach

(no matter if we cannot, no matter!)

in our eighty-year-old timbers

leaky and patched as they are but sweet

well seasoned with the scent of woods

long perished, serviceable still

in unarrested pungency

of salt and blistering sunlight. Out,

push it all out into the unknown!

Unknown is best, it beckons best,

like distant ships in mist, or bells

clanging ruthless from stormy buoys.

From https://www.scottishpoetrylibrary.org.uk/poem/eighty-0/

Donald Macaskill

 

 

 

 

 

 

Donald Macaskill