By Councillor Paul Kelly, COSLA Spokesperson for Health and Social Care
It has been more than 18 months since the report of the Independent Review of Adult Social Care, chaired by Derek Feeley, was published. Feeley set out a series of bold and ambitious recommendations for transformational reform within the social care sector. The review was commissioned by the Scottish Government following the coronavirus pandemic which brought many of the known challenges faced by the health and social care workforce to the forefront. The review aimed to gain a deeper understanding of the needs, rights, and preferences of people using social care services and give a voice to those within the workforce.
The Feeley review was significant as it echoed many of the principles outlined in the ground-breaking Christie Commission Report (2011), which is still regarded as the best practice guide for delivering public services. Both reports share a number of key themes rooted in: people, prevention, investment and collaboration.
COSLA endorsed many of the principles set out in the report particularly in relation to: empowering people, valuing the workforce and embedding a human rights approach to social care. It is important to point out that Local Government have long been advocating for many of the recommendations outlined within the report particularly in relation to embedding the voice of lived experience within the system and moving towards a preventative approach.
In response to the review, which called for urgent action to be taken, the Scottish Government and COSLA published a joint statement of intent in March 2021 aiming to drive forward improvements without the need for legislative or structural change. Considerable progress has been made against many of these commitments.
The Scottish Government has since laid the National Care Service (Scotland) Bill in Parliament with a focus on bureaucratic structural change. The Bill goes much further than the recommendations set out in the Feeley review in that it includes the potential for children's and justice services to be included in the National Care Service.
Feeley stated that there was an “expectation from the public” following the pandemic that Ministers should be accountable for social care and social work services. This shift in accountability and governance has been heavily criticised by Local Government and other stakeholders due to a lack of evidence supporting the idea that this will lead to improved service provision.
The review was clear that the newly created Care Boards must include diverse representation from the workforce, service providers and lived experience; however, the Bill lacks clarity on how this will be achieved, instead focussing on the centralisation of power as Ministers will determine who sits on these Care Boards. We are concerned that the removal of local democratic accountability will mean that decisions will be taken in response to the wishes of Ministers in Edinburgh rather than the local electorate and service users. We do not believe this is what was envisioned by Feeley.
Funding is of course a significant issue particularly in a system that has seen years of underinvestment. The Feeley review provided a starting figure for its recommendations of £660 million (in 2018-19 prices). In comparison, COSLA has estimated the total to be closer to £1.5 billion – far in excess of the "more than £840 million" additional investment in social care stated by the Scottish Government in the Resource Spending Review.
The National Care Service is expected to cost £250 million to establish and £500 million each year to run. When estimating the cost of delivering social care services in future, the plans for the proposed National Care Service fail to incorporate several existing policy commitments including those contained in the joint statement of intent. The current financial envelope is therefore clearly insufficient to both implement the changes and keep pace with the current increasing demand and does not take into consideration the potential addition of children services and justice social work which would increase this figure significantly. Money spent on the set up and running costs of a bureaucracy would be much better spent on services now to make sure we reduce the high levels of unmet need in our communities.
Another area which falls short of what Feeley recommended is in relation to profit within the care sector. The review proposed that these profits would be better spent to raise standards of care and terms and conditions for staff, however, the Bill has offered no solutions to move from transactional commissioning to collaborative commissioning. There has also been no attempt to review existing procurement law, and, critically, there has been no emphasis on the culture change that is required to achieve this.
Carers have been asked to do more for their relatives as a result of the pandemic and as the social care system comes under increasing pressure. Whilst the Bill includes the Feeley recommendation of a right to breaks for unpaid carers, it underestimates the cost implication of this and has failed to consider increasing the range and volume of different types of breaks to better meet carers' needs. This is problematic as improving support to carers is a key element in prevention strategies.
The Feeley review instilled a sense of hope and optimism to a social care and social work sector which has desperately been calling for reform and investment. COSLA responded to Feeley positively and joined with the Scottish Government to set out a range of actions to take forward many of the recommendations in the review. Progress has been made, but more needs to be done. It was never going to be easy and that has become more challenging with a Cost of Living crisis that has stretched the public finances to breaking point and placed providers in all sectors under enormous pressures. We do, however, remain committed to change and reform that is meaningful.
The National Care Service Bill does not reflect the recommendations set out in Feeley. This has resulted in a number of stakeholders voicing their disappointment at the Bill's proposals as no clear rationale or justification has been offered for the divergent approach. Many agree that national leadership on certain matters such as workforce planning, training, and terms and conditions could benefit the sector, however, the current approach to co-design has left many feeling excluded and unheard which is far from the supportive, collaborative culture advocated by Feeley.
Feeley reinforced the importance of building on current structures and that is exactly what Local Government is proposing. Improvements will progress faster by building on existing good practice (such as the joint statement of intent and self-directed support), through enhanced funding - which is now proposed to be directed towards bureaucratic reform - and focusing on a cultural shift from crisis to early intervention and prevention. With effective strategic planning and prioritisation this can be achieved, avoiding unnecessary and costly structural change.
The Bill fails to recognise that social care is not just about services but about supporting people to live independently, and this can be done more effectively through strong partnership working embedded in local communities. Local authorities should not simply be dismissed by effectively removing them from decision making on how care is provided. They have expert local knowledge of their communities and the support of integrated council services such as education, community mental health and welfare services. Local Government believes an alternative approach can be achieved through meaningful collaboration rooted in co-operation, empowerment and trust.