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Consulting on a National Care Service & A #Covid Inquiry

“Let’s be clear – this is not a “thinly veiled” attack on Local Government – there is no subtlety to it and, sadly for local communities, the ‘onion peel’ of Local Government services by this Government shows no sign of letting up.”

Alison Evison COSLA

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.

In her statement to the Scottish Parliament on 24th of August 2021 the First Minister Nicola Sturgeon said:

“The Scottish Government has always been committed to the establishment of a statutory public inquiry into the handling of the pandemic.

“I can confirm that, today, we have started the process of getting the inquiry up and running. It will be established by the end of this year as promised and will take a persons-centred, human rights based approach.

“We have just published draft aims and principles for the inquiry which, following consultation between now and the end of September, with interested parties, including bereaved families, are intended to become the formal Terms of Reference.

“A copy of the draft and details of how to contribute views can be found on the Scottish Government website.”

Click on this link to access the information about the draft aims of the Covid Inquiry: A COVID-19 Inquiry for Scotland

The public are now encouraged to share their ideas and comments on the suggested approach via email by 30 September.

Public feedback on the aims and principles paper should be sent to COVID-19publicinquirysetupteam@gov.scot

Nicola Sturgeon continued in her statement to say:

“The Lord Advocate has also begun discussions with the Lord President about appointing a judge to lead the inquiry. It is fully our intention that this will be a judge-led inquiry.

“The inquiry will look at all matters related to the handling of the pandemic that were within our devolved competence. This will include, of course, the situation in care homes.

“However, we will also liaise closely with the UK Government – and with other devolved governments – on the likely terms of a UK wide inquiry. Where possible it will be important to avoid duplication and overlap to reduce the burden on those giving evidence.

“However, the need for co-operation with other governments is not a reason to delay the establishment of our own inquiry.

“I believe that a full public inquiry has a very important role to play, both in scrutinising the decisions we took – and indeed continue to take – in the course of the pandemic, and also in identifying and learning lessons for the future.

“I therefore believe that it is appropriate to establish that inquiry as soon as possible. The process that we have begun today is an important step towards.”

Covid Cases in Care Homes in Scotland

  • as at 15 September, 130 (12%) adult care homes had a current case of suspected COVID-19
  • in the week 6-12 September there were 206 new confirmed positive COVID‑19 cases among care home residents and 201 among care home staff
  • as of 12 September 2021, there have been 10,976 confirmed cases of COVID-19 amongst residents and 7,020 amongst staff of care homes for all ages since 9 March 2020

Deaths in Scotland Due to Covid

As of 12th September 2021, 10,688 deaths involving Covid-19 have been registered – National Records of Scotland (NRS).

32% of Covid-related deaths were in care homes.

In this graph showing location of death, light blue is for care homes.

Graph from NRS

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

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.”

Liam McArthur, LibDem MSP for the Orkney Constituency is opposed to the development of a National Care Service. He said:

“Scotland’s social care sector certainly needs reform as we look to recovery from the pandemic and meet the needs of an ageing population.

“Unfortunately, all too often the ‘go to’ response for SNP Ministers when it comes to reform is to centralise.  Rarely, if ever, is that the answer to the needs of local communities, particularly those in rural and island areas.

“Scotland’s local authorities are right to condemn this as an “attack on localism” which undermines the value of local services and local decision-making.

“The Scottish Government is proposing to go even further that the recommendations of the Feeley Review.  Rather than a power grab, Ministers should be setting national standards, entitlements for users and a step change in pay and conditions, reflecting the value of the work carried out by those in the sector.”

Opposition from Local Authorities

The body that represents all of Scotland’s local authorities (COSLA) has also voiced its opposition to the plans, saying that it “cuts straight through the heart of the way Scotland is governed.”

COSLA President Councillor Alison Evison said that it,” cuts through the heart of governance in Scotland.”

She continued:

“It is an attack on localism and on the rights of local people to make decisions  democratically for their Place.  It once again brings a centralising approach to how decisions which should be taken locally are made.”

COSLA mostly welcomed the independent review of adult social care but criticised the Scottish Government’s plan for not being evidence based and of the many years it will take to implement.

Alison Evison said:

“It is deeply concerning that the consultation is also a considerable departure from the recommendations of the independent review set up to look at Adult Social Care.

“The lack of prior engagement with Local Government is not new – the partnership between the Scottish Government and Local Government which we have been seeking to build, continues to elude us in practice and it is the communities we serve who are losing out.

“Let’s be clear – this is not a “thinly veiled” attack on Local Government – there is no subtlety to it and, sadly for local communities, the ‘onion peel’ of Local Government services by this Government shows no sign of letting up.

“On behalf of the communities we serve, COSLA and Local Government will engage constructively with the Consultation process.  People may be surprised by the extent of services covered by this Consultation and I would urge as many as possible to respond to it, as this could really be the end for anything other than central control in Scotland.

“We all want better services for our communities, nobody more so than Local Government and that is what Local and National Government should be working on collectively for our communities.”

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. Families in Scotland who suffered the loss of a loved one in a Care Home to Covid, recently 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

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.

These two consultations are intrinsically linked. They will shape the way we care for ourselves and others in Scotland. Please take time to respond to them. The Orkney News will continue to follow this story as it develops.

Click on this link to access the information about the draft aims of the Covid Inquiry: A COVID-19 Inquiry for Scotland

Click on this link for A National Care Service and how you can take part in the consultation.

Fiona Grahame

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