In August 2021, the Scottish Government set out plans to create a new ‘National Care Service’ following recommendations published in the Independent Review of Adult Social Care (otherwise known as the Feeley Review) in February of the same year. The Feeley Review established that there needed to be ‘revision and redesign’ to improve outcomes for those using the care system. The Review recommended the implementation of a person-centred, human rights-based approach, the responsibility of the delivery of social care support be delegated to Scottish Ministers and that local Integration Joint Boards (IJBs) should become a ‘delivery arm’ to a new NCS.
The scope of the National Care would bring other services outwith the current system of care, such as Children’s Services, Justice Social Work and Alcohol and Drug Services under one umbrella. The Scottish Government opened a consultation on these proposals, which Scottish Families responded to in partnership with Scottish Recovery Consortium (SRC) on November 2, 2021. Our response focused on proposals to include alcohol and drug services within a National Care Service, and was shaped by a co-hosted consultation event, where colleagues from the Scottish Government presented an overview of the National Care Service and its reasoning, then opened the floor to family members and those with lived experience to share their views.
How We Responded
Both Scottish Families and SRC welcomed the idea of a cross-sectional approach, which plans to offer integrated treatment to people accessing social care in Scotland. We know that people who are affected by substance use need support across different care services, such as housing and mental health, as well as alcohol and drug services. However, both organisations had some key concerns.
Firstly, there were concerns about the scale and the timeframe of the consultation. The consultation document was lengthy and proposed serious changes which took time to digest. It was difficult to form a meaningful response in the time given by the Scottish Government.
The Scottish Government is proposing significant structural change, and there are concerns surrounding how services will be managed upon the completion of an NCS, and throughout the transition from the current system. We understand that structural change is needed in some respect but believe cultural change and addressing stigma within services should be a priority.
The Scottish Government has made a point of better valuing the workforce across social care, which we wholeheartedly agree with. We know that frontline staff are often undervalued and can be understaffed. Although unpaid carers were acknowledged in the consultation, little was said about how a National Care Service would support them in caring for a loved one.
Proposals to Include Alcohol and Drug Services
The most relevant part of the consultation for both Scottish Families and SRC was the proposal to include alcohol and drug services with a National Care Service. The Scottish Government asked a series of questions relating to the current delivery of Alcohol and Drug Services through Alcohol and Drug Partnerships (ADPs), the national commissioning of residential rehabilitation services, and what future planning of services should look like.
In short, we feel that outcomes can vary depending on the ADP area. During our consultation event, family members and those with lived experience highlighted that a ‘postcode lottery’ exists, as where you live can often determine the options available and the quality of treatment you receive. If ADPs received adequate improvements and funding, it is possible that services would be better planned and managed. There is the risk that if Alcohol and Drug Services became part of the National Care Service, the local partnership working that ADPs do with voluntary organisations could be lost. Although it must be acknowledged that there are significant drawbacks of ADPs, such as poor outcomes for people who engage with services, access routes to services in the first place, and a lack of input from people with lived experience. There has also been a lack of commitment from ADPs to implement the human-rights, person-centred approach that was published in the Scottish Government Strategy ‘Rights, Respect and Recovery’ in 2018.
However, it is impossible to answer if alcohol and drugs services would be better off within a National Care Service. There are still many unanswered questions regarding this proposal, as to the future of ADPs and how services would be planned and managed. Although greater integration with other services would be welcomed, it is unclear how alcohol and drugs services would fit into the proposed larger Community Health and Social Care Boards.
In relation to proposals around the national commissioning of residential rehab, we also had a mixed response. Those that attended our consultation events spoke of how longer-term rehab stays need to be more widely available and support plans need to be in place for when people return home. If national commissioning would make rehabilitation facilities more accessible, and reduce financial pressure that families experience from private rehabs, this would be welcomed. Concerns were also raised about the lack of local rehabilitation facilities, with most people having to travel far from their families to access treatment. If residential rehab was to be commissioned nationally, it needs to be accessible and funded for anyone who wishes to go.
Lastly, we were asked about what services should be commissioned that may currently be missing. We heard from those at our consultation event that there is a lack of support for people who have alcohol-related brain damage, for example, and their families and that it’s extremely difficult to get support outwith 9am and 5pm. We were also told that greater integration of mental health and Alcohol and Drug Services is much needed. The potential for a 24-hour crisis line is something that families have highlighted for a long time, and we would support the commissioning of such a service. We know that services can be disjointed, under-advertised and often don’t offer the aftercare that people need. Problems with existing services, staff attitudes and stigma need to be addressed, whether alcohol and drug services become a part of the National Care Service.
What Happens Next?
Scottish Families and SRC submitted our joint response to the Scottish Government on 2/11/21. We are keen to be involved with what happens next in the consultation process, along with our other partnered organisations. At the time of writing, we are currently awaiting a response from the Scottish Government as to the outcome of the consultation. For now, you can view our full response below.