The Covid pandemic has brought into stark view how we care for others in our communities, particularly the elderly and those in adult care homes in Scotland.

The Scottish Government has launched a consultation into setting up a National Care Service. This has been prompted by the appalling number of covid related deaths in our Care Homes. A date for a public inquiry into the deaths in care homes and why people were being transferred out of hospital without being tested has yet to be announced.

32% of all Covid related registered deaths in Scotland have been in Care Homes.

Would a National Care Service have made a difference to these appalling statistics ?

Why have a consultation before a public inquiry which can delve into the reasons why there was such a high death toll in our care homes in Scotland ( and throughout the UK.) ?

A National Care Service for Scotland

In 2016 the Scottish Government set up Integrated Health and Social Care Boards. 31 Boards were set up designed to bring together the services provided by the NHS and the Care Sector.

Integration is the most significant change to health and social care services in Scotland since the creation of the NHS in 1948. Integration aims to improve care and support for people who use services, their carers and their families. It does this by putting a greater emphasis on joining up services and focussing on anticipatory and preventative care. 

Health and Social Care Integration

A review of the Integration of Health and Social Care in 2019 conceded that the pace of change had been too slow. The whole idea behind the integration was that the needs of the individual would be placed at the centre of any service delivery. An Audit Scotland report published in 2018 concluded that the ‘remaining challenges were significant.’

Caroline Gardner, Auditor General, said:

‘All partners, at a national and local level, need to work together to ensure the successful delivery of integrated health and social care services in Scotland. This will allow people to receive the care they need at the right time and in the right setting, with a focus on community-based, preventative care.’

In 2018 Integration Authorities were collectively responsible for almost £9 billion of health and social care spending.

Graham Sharp, Chair, Accounts Commission said:

“There are examples of integrated health and social care services making a positive difference to people’s lives, but these tend to be local and small scale. The potential for a profound and long-term shift in the way health and social care services are delivered is clear, but there is still a long way to go. A collective effort from the Scottish Government, COSLA, NHS Boards, councils and the Integration Authorities is needed for health and social integration to make a more meaningful difference to the people of Scotland.”

In 2020, another review was announced, to report in January 2021, on progress made from that 2018 audit report and 2019 review.

Jeane Freeman, Health Minister in the Scottish Government at that time said:

“This independent review will examine how adult social care can be most effectively reformed to deliver a national approach to care and support services – and this will include consideration of a national care service.

“It will also build upon our existing commitments to improving provision – long standing issues in adult social care have been thrown into sharp relief during the pandemic, and they demand our attention.

“We owe it to those who use and work in adult social care services to acknowledge these challenges, to learn from them, and to consider carefully how we can most effective plan for the future.”

Published in February 2021 the Review of adult social care in Scotland stated:

 we hope with support for improvement from across Scottish civic and democratic society, to deliver a system of social care that takes as its central aim the realisation of every citizen’s right to participate fully in society, whatever their needs for support. And that system needs to work in full partnership with other aspects of our public services, not least the NHS but not only the NHS either: housing, and justice, education and economic development are all central too.

Adult Social Care Review

The review calls on a new approach to social care provision in Scotland with a National Care Service. The review recommended that local government lose its power over social care provision and a National Care Service be created with responsibility being with a Scottish Government Minister. The Integration Boards would be reformed and would manage GP contracts.

The Scottish Government’s Plan for a National Care Service

The National Care Service being proposed by the Scottish Government goes further than the recommendations from the 2021 review. It seeks to create a comprehensive community health and social care service that supports people of all ages.

The Scottish Government state that :

The proposed reforms around social care represent one of the most significant pieces of public service reform to be proposed by the Scottish Government, and have the potential to be the biggest public sector reform in Scotland for decades.

A National Care Plan

Which is very similar to what was claimed the Integration of Health and Social Care would be back in 2016 (see beginning of article)

You can read more about that here: A National Care Service and how you can take part in the consultation.

Emma Roddick, SNP MSP for Highlands and Islands welcomed the consultation and urged people to take part. She said:

“Health and social care in Scotland is an area I am passionate about. As someone who has experienced the current system, I am happy to see reform towards a person-centred approach and better support for care workers.

“It is vital that people in the Highlands and Islands with experience of care give their views. We live in a unique environment, often with little choice in or control over the services we can access. By responding to this consultation, we can ensure that our residents experience the same standard of care as those in the rest of the country.”

A series of online events is taking place to explain the ‘cultural’ shift the consultation wishes to produce. You can find out about them here.

The consultation closes on 18th of October 2021.

Kevin Stewart, Minister for Social Care said:

“We have already made significant improvements, with reforms such as the integration of health and social care, and implementation of the Real Living Wage Policy for Adult Social Care workers and this year the Scottish Government pledged £64.5m to fully fund the pay increase. But we can go further. What we are now proposing is the biggest public sector reform for decades, since the creation of the National Health Service.

“The Review recommended the creation of a National Care Service, with Scottish Ministers being accountable for adult social care support. I believe however that it is right for this consultation to look beyond simply the creation of a national service for adult social care. The ambition of this government is to go much further, and to create a comprehensive community health and social care service that supports people of all ages. We are also committed to a ensuring there is strong local accountability in the system.

“Absolutely vital to this is ensuring that our invaluable social care workforce feel happy, respected and fulfilled in their role.

“We are at the beginning of a journey to improve social care in Scotland. We will only get this right with your support. I want to hear from as many people and organisations as possible over the next couple of months, so we can build a better system together.”

A Public Inquiry Into Care Home Deaths ?

In November 2020 the Scottish Parliament voted to hold a public inquiry into covid related Care Home deaths. Nicola Sturgeon stated in Parliament on 5th of November 2020 that:

“As all members know, establishing a statutory public inquiry requires certain steps and it cannot simply be done overnight. However, our commitment to doing that as quickly as possible, while ensuring that those on the front line in any capacity can continue to focus on getting the country through the second wave of Covid, is absolute.”

Boris Johnson announced that in England a public inquiry into Care Home deaths will take place in Spring of 2022. Meanwhile families in Scotland who suffered the loss of a loved one in a Care Home to Covid, have called on the Scottish Government to hold a public inquiry.

The Care Inspectorate also produced a report on Covid related deaths in Care Homes

From the onset of recording (16 March 2020) up to the end of the financial year (31 March 2021) the Care Inspectorate received 3,774 notifications of deaths of care home residents that were related to Covid-19. All but 13 of these were in care homes for older people

Of those care homes for older people provided by the private sector, 60.8% reported at least one such death, compared with 57.1% of care homes provided by the voluntary sector and 50.8% by the public sector

Care Inspectorate Report

Will there be a public inquiry in Scotland into Care Home Deaths as voted on by the Scottish Parliament last year?

 22 organisations across civil society, including Age Scotland sent a joint letter to the First Minister in March this year, calling for an inquiry to begin urgently, seeking clarity over whether human rights of various groups were breached as the country responded to COVID-19.

With a vote in the Scottish Parliament, pleas from bereaved relatives and correspondence from 22 organisations, why is it possible to hold a consultation on a National Care Service for Scotland and not a public inquiry into covid deaths in care homes and why that happened?

Reporter: Fiona Grahame