Council to send clear message on Scottish Government National Care Service consultation

Orkney councillors have agreed a response to the National Care Service consultation, including the need to work closely with the Scottish Government to ensure the best social care outcomes for Orkney residents.

Elected members approved two responses to the consultation at a Special General Meeting of the Council on Monday (1 November) – the first involved the provision of answers to an extensive survey, and the second, a letter to Kevin Stewart MSP Minister for Mental Wellbeing and Social Care. Both were shaped by feedback and input from a range of key anchor organisations involved in the delivery of health and social care services across Orkneys, their staff, service users and elected members.

Orkney Health and Care Chief Officer/Executive Director, Stephen Brown, and officers who collated the formal responses within the tight consultation timeframe were commended for their work by councillors.

Key messaging on behalf of Orkney to the consultation includes:

• Welcoming the aspiration to improve care across Scotland.
• The need for early intervention of support to those who require it.
• Recognition that social care across Scotland has been underfunded and that this needs to be addressed.
• Assurances that any new legislation is subject to an Islands Impact Assessment.
• Expressing concern over the potential for loss of local accountability if responsibility for care transfers from local elected members to Scottish Ministers.
• Local partnerships, working in tandem with the people are Orkney, are best placed to improve the health and wellbeing of local communities.

The consultation follows on from the Independent Review of Adult Social Care, which was commissioned to recommend improvements to adult social care in Scotland, primarily in terms of the outcomes achieved by and with people who use services, their carers and families, and the experience of people who work in adult social care.

Significantly, the Scottish Government’s consultation has extended the scope of the Review to other service areas including children and families, community justice, alcohol and drug services and social work. Should responsibilities for these services be removed from local government, it would represent the most significant change to local government since local government reorganisation in 1996.

Under the Islands (Scotland) Act 2018, an Islands Communities Impact Assessment is required before legislation which has the potential to affect island communities is drafted – with Scottish Ministers also bound to publish their reasons if a request for an assessment is declined.

The request for an additional letter in response to the consultation survey came from the Council’s Leader James Stockan and Chair of Orkney Health and Care and Vice-chair of the Integration Joint Board, Councillor Rachael King, last month.

Councillor Stockan said: “We must continue to stand up for what we feel is important to us and use the Act which was hard fought and won by island communities, through the Our Islands Our Future campaign, and bring it to bear on what must be the single most important issue – the wellbeing of our communities. We must get the best results for Orkney. We cannot change Government policy, but we need to be involved in the process of developing that policy.”

The Scottish Government consultation ‘A National Care Service for Scotland’ is available on the Scottish Government website (www.gov.scot).

The full letter response:

A National Care Service for Scotland – Consultation

As a group of key anchor organisations charged with the delivery of health and social care services across Orkney, we write in connection with the ongoing consultation for a National Care Service.

We welcome the Scottish Government’s commitment to improving the quality delivery of social care and the opportunity to contribute to the consultation from our own organisational perspectives but, in addition, wanted to collectively highlight some key considerations.

• We welcome the Scottish Government’s commitment to addressing the challenges across our health and social care system. We note the recognition, within the consultation document and the preceding Independent Review of Adult Social Care and of the underfunding of social care over many years. We would welcome this being recognised fully within the financial schedules of any new legislation.
• The focus of the discussions moving forward, and the resultant legislation, needs to be driven by the health and social care needs of our communities and shouldn’t begin by structural consideration.
• We believe that the interests of our communities in Orkney will be best served by the Scottish Government undertaking an islands equality impact assessment in advance of any proposed legislation being laid before parliament and we welcome the Scottish Government’s commitment to do so.
• Whilst we agree on the need to join up our health and social care provision fully and effectively, the creation of a National Care Service, as proposed, runs the potential risk of adding layers to an already cluttered landscape. For a small system, delivering to a small population, it is important that we de-clutter that landscape wherever possible and reduce layers of bureaucracy.
• We welcome the potential value add that a national body, assuming responsibility for improvement and national standards in care, could bring and we support the aspiration to ensure the adoption of Fair Working Practices for all organisations.
• We firmly believe in the principles of local decision-making and services being designed and delivered in collaboration with local communities. As a small, remote, and rural islands community, with specific and unique needs, this aspiration can best be met by involving the entirety of our community planning partners at a local level. It is imperative that the proposed Community Health and Social Care Boards protect local accountability by the inclusion of, inter alia, elected members, appointed NHS Executive local representatives and appropriate third sector partners.
• We welcome the Scottish Government’s aspiration to address the workforce challenges, particularly in relation to pay and conditions for many of our social care staff. Although this can be effectively delivered via a national approach, Orkney is experiencing local challenges that are unique to remote and rural island settings. Creating a sustainable local workforce, particularly with a rising dependency ratio, is a challenge that can only be addressed effectively through locally led solutions.
• Although we recognise the advantages of nationally procuring some specialist services, for example, a residential drug rehabilitation resource, the Orkney provider landscape is unique to our islands. Many of the larger providers operating across Scotland do not have, nor indeed wish to have a presence here. As such, where services are procured, they are generally with smaller, locally based third sector providers. We are keen to ensure that the solid foundations we have with the local third sector continue to flourish. This will require the Integration Joint Board/Community Health and Social Care Board to maintain its ability to procure services locally wherever possible.
• Finally, we recognise that the legislation is intended to address nationwide issues across a range of areas. Whilst we fully recognise some of those issues, our local systems and economy of care is markedly different from many other areas in Scotland. We feel it important, therefore, that regardless of the outcome of the current consultation and the proposals likely to feature in the draft legislation, a degree of flexibility requires to be built in to ensure that a small remote and rural island community system such as Orkney has a degree of flexibility to adapt our local arrangements to best meet the needs of our local communities. We recognise that serving the needs of such a small population in a remote, islands setting, gives us a unique perspective on some of the proposals contained within the consultation document. We will take the opportunity to respond to the consultation in further detail through our respective organisations but wished to articulate some of the key common themes emerging for us all. We trust this above is helpful and we look forward to engaging further as proposals are honed and developed.

Yours sincerely, John W Mundell OBE interim Chief Executive Orkney Islands Council; Michael Dickson interim Chief Executive NHS Orkney; Stephen Brown Chief Officer Orkney Health and Care; Leader Orkney Islands Council James Stockan;  Meghan McEwen Chair of NHS Orkney; Issy Grieve Chair of the Integration Joint Board; Gail Anderson Chief Executive Voluntary Action Orkney; Councillor Rachael King Chair, Orkney Health and Care Committee.