Adult social care and support in Scotland

Author: Anne Jepson

PDF Published: Thursday 03 Dec 2020 (SB20-78)

Expand
Overview
Report

Hide

Hide

Overview
Report
- Executive Summary
- Introduction
- Definitions of social care support
- Changing demography
- History of social care
- Social care is not organised like health care...yet
  - A brief aside: Social Care and Social Security Benefits
- Legislation and policy context
  - Social Work (Scotland) Act 1968
  - Part IV of the NHS Community Care Act 1990
  - The National Assistance (Assessment of Resources) Regulations 1992
  - The Regulation of Care (Scotland) Act 2001
  - The Community Care and Health (Scotland) Act 2002
    
    Free personal and nursing care in a care home
    
    Recouping payments made for personal and nursing care
    
    'Frank's Law'
  - Part V of the Public Service Reform (Scotland) Act 2010
  - Social Care (Self-directed Support)(Scotland) Act 2013
    
    The implementation journey of Self-directed Support
  - Public Bodies (Joint Working)(Scotland) Act 2014
  - Carers (Scotland)Act 2016
  - Other relevant legislation
- Accessing social care and support
  - Types of care and support
    
    Residential care (care homes)
    
    Changing provision of residential care
    
    Care at home
    
    Housing support
- How is social care organised?
  - How social care is funded
    
    Calls for reform of social care funding
    
    The challenge of costing outcomes
  - How social care is commissioned and procured
  - How social care is regulated
  - Staffing in social care
    
    Recruitment and retention
    
    Fair work and framework commissioning
    
    Workforce Planning
    
    Training
    
    Personal Assistants
  - Unpaid carers
- Scottish Government and COSLA Reform of social care
- Issues for social care (for twenty years and counting)
  - ...and proposed remedies in Scotland
    
    Reshaping care for older people
    
    Shifting the balance of care from hospital to the community
  - Scottish Parliamentary scrutiny and activity
    
    Committee scrutiny and third sector research: Social care and COVID-19
Sources

Note the reduction in children(i.e. birth rate) and working age adults and the near 4 percentage point rise in people of pensionable age.

Image: Figure 1: Estimated future proportions of working and non-working age populations

The charts above show us how many people, in different age groups and with different conditions, are receiving care and support.

Image: Figure 2: Age breakdown of people receiving social care support by condition

Most people getting support decide that they want the social work department to arrange it.

Image: Figure 3 How do people choose to use Self-Directed Support?

This diagram shows the 'journey' for a person who needs care and support. The journey starts (at the top of the diagram) with a social worker and the person deciding together what care and support is needed. This is a simplified version, and doesn't include all elements or considerations.

Image: Figure 4: Social care support pathway for adults

This chart shows that local authorities pay for most people to stay in care homes but that nearly a third of people pay for a care home place with their own money.

Image: Figure 5: How care home places are funded

These graphs shows the weekly cost of staying in a care home with and without nursing care. It also shows that the cost is higher for the people who have to pay for the care home themselves.

Image: Figure 6 Average gross weekly care home charges (cash)

This chart shows us that the number of care homes has gone down, except for those that are privately owned.

Image: Figure 7: Number of care homes over time

This chart shows the different groups who stay in care homes and how the number of care homes has changed over time.

Image: Figure 8: Change in numbers of care homes for all groups 2007-19

This chart shows that those most of those who receive care are over 75. This group also get the most help (more than 10 hours a week). But around 5000 people younger than 64 also get more than 10 hours help a week.

Image: Figure 9: numbers of people and hours of care and support provided in different age groups

This chart shows that most people who work in social care help people in their own homes. Each small circle equals 100 workers and the different colours tell us whether they work for a charity, a business or the local council.

Image: Figure 10: Staff employed in different aspects of social care in 2019

NHS Scotland. (n.d.) A Route Map to the 2020 Vision for Health and Social Care. Retrieved from https://www.nhshighland.scot.nhs.uk/Publications/Documents/Route%20Map%20to%20the%202020%20Vision%20for%20Health%20and%20Social%20Care.pdf [accessed 24 September 2020]

Scottish Government. (2018, October 4). Medium Term Financial Framework for Health and Social Care. Retrieved from https://www.gov.scot/publications/scottish-government-medium-term-health-social-care-financial-framework/pages/3/ [accessed September 2020]

Audit Scotland. (2020). e hub-transforming health and social care in Scotland. Retrieved from https://www.audit-scotland.gov.uk/reports/e-hubs/transforming-health-and-social-care-in-scotland

Coalition of Care and Support Providers Scotland. (2020). Hot Topics - Integration of health and social care. Retrieved from http://www.ccpscotland.org/hot-topics/integration-health-social-care/

Scottish Government. (2020). Social Care. Retrieved from https://www.gov.scot/policies/social-care/#:~:text=Social%20care%20means%20all%20forms,continue%20in%20their%20caring%20role.

The King's Fund. (2019, November). Key Facts and Figures about Adult Social Care. Retrieved from https://www.kingsfund.org.uk/audio-video/key-facts-figures-adult-social-care [accessed 27 January 2020]

National Framework for Continuing Healthcare. (2013, April). Retrieved from https://apexhealth.net/wp-content/uploads/2016/04/National-Framework-for-NHS-CHC-NHS-FNC-Nov-2012.pdf [accessed 27 January 2020]

UK Parliament. (1929). Schedule 1, Local Government (Scotland) Act 1929. Retrieved from http://www.legislation.gov.uk/ukpga/Geo5/19-20/25/schedule/FIRST/enacted [accessed 29 January 2020]

UK Parliament. (1948). The National Assistance Act 1948. Retrieved from http://www.legislation.gov.uk/ukpga/Geo6/11-12/29/contents [accessed 29 January 2020]

UK Parliament. (1968). Social Work (Scotland) Act 1968. Retrieved from http://www.legislation.gov.uk/ukpga/1968/49/contents [accessed 29 January 2020]

Scottish Parliament. (2014). Public Bodies (Joint Working) (Scotland) Act 2014. Retrieved from http://www.legislation.gov.uk/asp/2014/9/contents/enacted [accessed 22 January 2020]

Audit Scotland. (n.d.) Integration of Health and Social Care - ehub. Retrieved from https://www.audit-scotland.gov.uk/reports/e-hubs/transforming-health-and-social-care-in-scotland

Scottish Government Ministerial Strategic Group. (2019, February). Progress review: health and social care integration. Retrieved from https://www.gov.scot/publications/ministerial-strategic-group-health-community-care-review-progress-integration-health-social-care-final-report/pages/1/

Care Inspectorate. (2020). Quarterly statistical summary report (Q3 2019). Retrieved from https://www.careinspectorate.com/index.php/publications-statistics/133-public/statistics/quarterly-statistical-summary-report-qtr-3-2019-20 [accessed 15 June 2020]

CCPS. (2018). Market Facilitation Guide. Retrieved from http://www.ccpscotland.org/wp-content/uploads/2018/11/ccps-marketfacilitation-guide.pdf

Kidner, C. (2019). Scottish social security benefits. Retrieved from https://bprcdn.parliament.scot/published/2019/10/31/Scottish-social-security-benefits/SB%2019-68.pdf

Scottish Government NHS Scotland. (2020). Care Information Scotland: Public Information on social care in Scotland . Retrieved from https://careinfoscotland.scot/

UK Parliament. (n.d.) National Health Service and Community Care Act 1990 Part IV. Retrieved from https://www.legislation.gov.uk/ukpga/1990/19/part/IV

UK Parliament. (n.d.) National Assistance (Assessment of Resources) Regulations 1992. Retrieved from https://www.legislation.gov.uk/uksi/1992/2977/contents/made

COSLA. (2020). Charging guidance for non-residential care. Retrieved from https://www.cosla.gov.uk/about-cosla/our-teams/health-and-social-care/social-care-charging-information

UK Parliament. (n.d.) Regulation of Care (Scotland) Act 2001. Retrieved from https://www.legislation.gov.uk/asp/2001/8/contents

UK Parliament. (2010). Public Service Reform (Scotland) Act. Retrieved from http://www.legislation.gov.uk/asp/2010/8/contents [accessed 2020 June 21]

UK Parliament. (n.d.) Community Care and Health (Scotland) Act 2002. Retrieved from https://www.legislation.gov.uk/asp/2002/5/part/1/crossheading/charging-and-not-charging-for-social-care

Royal Commission on Long Term Care, London, . (1999). With respect to old age Long term care - rights and responsibilities (summary by the Health Foundation). Retrieved from https://navigator.health.org.uk/theme/respect-old-age-long-term-care-rights-and-responsibilities

Scottish Government. (2020, April). Charging guidance for residential accommodation. Retrieved from https://www.sehd.scot.nhs.uk/publications/CC2020_01.pdf

Scottish Government. (2015). NATIONAL STANDARD ELIGIBILITY CRITERIA AND WAITING TIMES FOR THE PERSONAL AND NURSING CARE OF OLDER PEOPLE - GUIDANCE. Retrieved from https://www.gov.scot/binaries/content/documents/govscot/publications/advice-and-guidance/2015/01/personal-and-nursing-care-of-older-people--national-standard-criteria-and-waiting-times-guidance/documents/personal-and-nursing-care-of-older-people---national-standard-criteria-and-waiting-times-guidance/personal-and-nursing-care-of-older-people---national-standard-criteria-and-waiting-times-guidance/govscot%3Adocument/National%2BStandard%2BCriteria%2Band%2BWaiting%2BTimes%2Bfor%2Bthe%2BPersonal%2Band%2BNursing%2BCare%2Bof%2BOlder%2BPeople%2BGuidance%2B.pdf

Scottish Parliament. (2013). PE01480: Alzheimer's and dementia awareness. Retrieved from http://external.parliament.scot/GettingInvolved/Petitions/alzheimers

Scottish Government. (2018). Circular No. CCD3/2018. Retrieved from https://www.sehd.scot.nhs.uk/publications/cc2018_03.pdf

NHS NSS Information Services Division (ISD). (2019, June). Insights into Social Care in Scotland (Experimental Statistics Publication). Retrieved from https://www.isdscotland.org/Health-Topics/Health-and-Social-Community-Care/Publications/2019-06-11/2019-06-11-Social-Care-Report.pdf? [accessed 15 June 2020]

UK Parliament. (n.d.) Social Care (Self-direct Support) (Scotland) Act 2013. Retrieved from https://www.legislation.gov.uk/asp/2013/1/contents/enacted

Scottish Government. (n.d.) Self-directed Support Strategy 2010-2020 Implementation Plan 2019-21. Retrieved from https://www.gov.scot/publications/self-directed-support-strategy-2010-2020-implementation-plan-2019-21/pages/2/

Scottish Government. (2014). Statutory Guidance to accompany the Social Care (Self-directed Support) Scotland Act 2013. Retrieved from https://www.sdsscotland.org.uk/wp-content/uploads/2018/11/Statutory-Guidance.pdf

Payne, J. (2012). SPICe Briefing: Social Care (Self-directed Support) Bill. Retrieved from https://www.parliament.scot/ResearchBriefingsAndFactsheets/S4/SB_12-32.pdf

Scottish Government. (2020, January). Directions from integration authorities to health boards and local authorities: statutory guidance. Retrieved from https://www.gov.scot/publications/statutory-guidance-directions-integration-authorities-health-boards-local-authorities/

COSLA, S.G. (n.d.) NATIONAL STANDARD ELIGIBILITY CRITERIA AND WAITING TIMES FOR THE PERSONAL AND NURSING CARE OF OLDER PEOPLE - GUIDANCE. Retrieved from https://www.gov.scot/binaries/content/documents/govscot/publications/advice-and-guidance/2015/01/personal-and-nursing-care-of-older-people--national-standard-criteria-and-waiting-times-guidance/documents/personal-and-nursing-care-of-older-people---national-standard-criteria-and-waiting-times-guidance/personal-and-nursing-care-of-older-people---national-standard-criteria-and-waiting-times-guidance/govscot%3Adocument/National%2BStandard%2BCriteria%2Band%2BWaiting%2BTimes%2Bfor%2Bthe%2BPersonal%2Band%2BNursing%2BCare%2Bof%2BOlder%2BPeople%2BGuidance%2B.pdf [accessed 30 January 2020]

Scottish Government. (2018, March). Statutory Guidance. Carers (Scotland) Act 2016. Retrieved from https://www.gov.scot/publications/carers-scotland-act-2016-statutory-guidance/pages/0/

Scottish Parliament SPICe. (2019). Transitions of young people with service and care needs between child and adult services in Scotland. Retrieved from https://digitalpublications.parliament.scot/ResearchBriefings/Report/2019/3/29/Transitions-of-young-people-with-service-and-care-needs-between-child-and-adult-services-in-Scotland#Executive-Summary

Government, S. (2015). Health and Wellbeing Outcomes framework. Retrieved from https://hub.careinspectorate.com/media/1282/national-health-and-wellbeing-outcomes-a-framework-for-improving.pdf [accessed 2 March 2020]

Government, S. (n.d.) Health and Care Standards. Retrieved from http://www.newcarestandards.scot/ [accessed 2 March 2020]

COSLA. (2020). NATIONAL STRATEGY & GUIDANCE Charges Applying to Social Care Support for people at home. Retrieved from https://www.cosla.gov.uk/__data/assets/pdf_file/0016/17521/2020-21-COSLA-Charging-Policy-for-Social-Care-Support.pdf

NHS Scotland Information Services Division. (2018). Care Home Census for Adults in Scotland. Retrieved from https://www.isdscotland.org/Health-Topics/Health-and-Social-Community-Care/Publications/2018-09-11/2018-09-11-CHCensus-Report.pdf

Competition and Markets Authority UK. (2017). Care Homes Market Study. Retrieved from https://www.gov.uk/cma-cases/care-homes-market-study

Scottish Government. (2017). Social Tenants in Scotland . Retrieved from https://www.gov.scot/publications/social-tenants-scotland-2017/pages/5/

Audit Scotland. (2012). Commissioning Social Care. Retrieved from https://www.audit-scotland.gov.uk/docs/health/2012/nr_120301_social_care.pdf [accessed 31 January 2020]

Scottish Government. (2018). Medium term health and social care financial framework. Retrieved from https://www.gov.scot/publications/scottish-government-medium-term-health-social-care-financial-framework/

Scottish Government. (2016). Social Work and Social Care: a statistical summary. Retrieved from https://www.gov.scot/binaries/content/documents/govscot/publications/corporate-report/2016/02/social-work-and-social-care-statistics-for-scotland-a-summary/documents/social-work-social-care-statistics-scotland-summary-pdf/social-work-social-care-statistics-scotland-summary-pdf/govscot%3Adocument/Social%2BWork%2Band%2BSocial%2BCare%2BStatistics%2Bfor%2BScotland%2B-%2BA%2BSummary.pdf

The King's Fund. (2019). (Video) Short History of social care funding reform in England 1997-2019. Retrieved from https://www.kingsfund.org.uk/audio-video/short-history-social-care-funding

The King's Fund. (2018, May). A Fork in the Road: next steps for social care funding reform. Retrieved from https://www.kingsfund.org.uk/sites/default/files/2018-05/A-fork-in-the-road-next-steps-for-social-care-funding-reform-May-2018.pdf

Burnside, R. (2018). Guide to the new budget process. Retrieved from https://digitalpublications.parliament.scot/ResearchBriefings/Report/2018/5/10/Guide-to-the-new-Scottish-budget-process

Audit Scotland. (2019, June). Planning for Outcomes. Retrieved from https://www.audit-scotland.gov.uk/uploads/docs/report/2019/briefing_190603_planning_outcomes.pdf

Scottish Government. (2015, December). Strategic Commissioning Plans: guidance. Retrieved from https://www.gov.scot/publications/strategic-commissioning-plans-guidance/pages/9/

Localities Guidance to accompany Public Bodies (Joint Working)(Scotland) Act 2014. (2015). Retrieved from https://www.gov.scot/publications/localities-guidance/

Scottish Government. (2016). Statutory Guidance , Procurement Reform (Scotland)Act 2014. Retrieved from https://www.gov.scot/publications/guidance-under-procurement-reform-scotland-act-2014/pages/1/

CCPS/ University of Strathclyde, Glasgow. (2019, May). Handing Back Contracts: Exploring the rising trend in third sector provider withdrawal from the social care market. Retrieved from http://www.ccpscotland.org/wp-content/uploads/2019/05/Handing_Back_report_CCPS.pdf [accessed 24 June 2020]

SSSC. (2019, November 22). Scottish Social Service Sector: Report on 2018 Workforce Data.. Retrieved from https://data.sssc.uk.com/data-publications/22-workforce-data-report/216-scottish-social-service-sector-report-on-2018-workforce-data [accessed 12 February 2020]

Fairwork Convention. (2019). Fairwork in Scotland's Social Care Sector. Retrieved from https://www.fairworkconvention.scot/wp-content/uploads/2018/11/Fair-Work-in-Scotland%E2%80%99s-Social-Care-Sector-2019.pdf

Scottish Government and COSLA. (2019). Implications of labour markets for the social care workforce: report. Retrieved from https://www.gov.scot/publications/implications-national-local-labour-markets-social-care-workforce-report-scottish-government-cosla/

Scottish Government. (2015). Scotland's Carers. Report. Retrieved from https://www.gov.scot/publications/scotlands-carers/

Carers UK. (2019). Will I Care? The likelihood of being a carer in adult life. Retrieved from http://www.carersuk.org/images/News__campaigns/CarersRightsDay_Nov19_FINAL.pdf

UK Parliament. (2020). Coronavirus Act 2020. Retrieved from https://www.legislation.gov.uk/ukpga/2020/7/contents/enacted

Last Updated: 13/12 1:24pm

An error occured while loading, please try again in a few minutes.