National Care Service (Scotland) Bill (Detailed)

We believe that several key considerations still need to be addressed in the detail of the National Care Service (Scotland) Bill to ensure it can fulfil its purpose - “to improve the quality and consistency of social work and social care services in Scotland”.

The Bill fails to acknowledge the role of over 200,000 volunteers directly supporting health, wellbeing and disability organisations, as well as the many thousands of other volunteers supporting older adults, physical activity and community connection (comparative analysis of SHS 2018 and 2020 data’, 2021, Volunteer Scotland). Volunteers are a key part of the Social Care workforce but are not mentioned in the Bill at all. It is vital that volunteers are explicitly referenced in the Bill when detailing arrangements for workforce planning and development.

Similarly, the Bill does not adequately recognise the voluntary sector as a key partner in the delivery of social care. The Scottish Government’s commitment to a joined up, collaborative approach to the National Care Service is commendable, and we are reassured to see that the contribution of the voluntary sector is acknowledged in proposed plans for Community Health and Social Care Boards. However, it is unclear in the Bill how the voluntary sector will be meaningfully engaged and consulted at a local and national level about care plans.

The third sector is incredibly diverse with over 40,000 voluntary organisations estimated to exist, including 24,832 registered charities (‘Sector Stats’, 2022, SCVO). Meaningful collaboration with the voluntary sector is challenging, particularly given it is estimated that half of voluntary organisations are community groups who will likely be largely or wholly operated by volunteers. As a result of significant restrictions on time and resource, many voluntary organisations find it difficult to engage with collaborative decision-making processes at both a local and a national level.

As a result, the Bill needs to explicitly state that the voluntary sector will be meaningfully included in decision-making structures, and identify solutions for some of the challenges with engaging this sector. We would propose that the Third Sector Interface network has a key role in representing the interests of the local voluntary sector on Care Boards, and would require significant additional resource to ensure they can consult widely and provide adequate representation.

We have some concern about centralising decision-making to the extent detailed in the National Care Service (Scotland) Bill when much of the social care sector locally has developed organically to meet local demand. We are also wary of increasing the bureaucratic burden on small voluntary sector care providers, often run by volunteers, with more detailed reporting structures. It is important to ensure that the requirements of smaller voluntary organisations that support social care are proportionate to their size and capacity.

In Section 24, ‘Training’, we believe it is important to acknowledge the training requirements of volunteers in the provision of social care services, as well as those of paid staff. Volunteers have different training needs to paid employees, in terms of capacity, timing and types of roles they will be expected to fill, and these will need to be acknowledged at the design and delivery stages.

We are reassured that many aspects of the proposed National Care Service are yet to be outlined in future secondary legislation as this will allow for more meaningful consultation and co-creation on some key areas. These include further clarity around the composition of care boards, plans for achieving financially sustainable services and priorities for shifting the focus to early intervention and prevention. However, it is vital to ensure that the wider voluntary sector is meaningfully consulted at all stages. As detailed previously, meaningful consultation with the voluntary sector is challenging and will require dedicated resource.

It is hoped that the Bill will make funding for services related to social care in the voluntary sector, many of which are reliant on volunteers, more sustainable. Organisations in the voluntary and community sectors have a key role in supporting much of the community-based and early intervention work in social care but are operating in an increasingly challenging financial environment.

In the Scottish Government’s recent research exploring the impact of Covid-19 on volunteering, 48% of volunteer involving organisations identified dedicated funding for their volunteer programmes as a priority for their medium or long term recovery ‘Scottish Third Sector Perspectives On Volunteering During Covid-19: Survey Report’, 2021, Scottish Government and Volunteer Scotland). Similarly, OSCR’s survey exploring the impact of Covid-19 on Scottish Charities exposed a particularly acute issue related to fatigue and burnout experienced by trustees, who are volunteers, particularly in smaller organisations with no paid staff (‘November COVID-19 survey: Volunteers and Trustees Supplementary’, 2020, OSCR).

Cost of living increases are also affecting the balance sheet of many voluntary and community organisations. Demand for services is increasing, as are operating costs, yet the money available is decreasing. Those whose core funding comes from the public sector are often subject to either fixed funding, which is declining in real terms due to high inflation, or reduced funding. This is compounded by the fact that many people will likely have less disposable income to donate to charities in the months ahead. The Charities Aid Foundation recently found that 12% of individuals are planning to cut back on charity donations (‘Cost-of-living squeeze hits donations to charity sector’, 2022, Charities Aid Foundation)

As a result of this, it’s vital that the financial challenges facing the voluntary sector are addressed in the long-term funding of social care, social work and community healthcare

We are largely supportive of the National Care Service Principles detailed in the Bill, but feel further consideration is required as to how they will be achieved in practice.

The principle to ‘increase equality and enable people and communities to thrive’ is admirable, but the inequality of access to both services and opportunities for participation present a significant challenge. We know that those living in the areas of greatest deprivation have significantly worse mental and physical health outcomes, and that those who have the highest demand for health and care services are likely to generate the highest benefits from volunteering (‘Volunteering, Health and Wellbeing’, 2018, Volunteer Scotland). However, volunteering participation rates in Scotland’s most deprived communities are significantly lower than the average participation rate of 26% - 20% in 2018 and 14% in 2020 (Comparative analysis of SHS 2018 and 2020 data’, 2021, Volunteer Scotland). As such, significant investment is required in inclusive volunteering strategies for people and communities to thrive.

The principles to ensure that the National Care Service is an exemplar of Fair Work practices, and to ensure that the care workforce is recognised and valued, are equally welcome but also require explicit recognition of volunteers as part of the workforce.

Volunteers can have a valuable role to play in the provision of health and social care services, but it is vital that this is not a replacement for duties previously performed by paid staff. In response to a question regarding waiting lists for social care in parliament on the 4th May 2022, the Minister for Mental Wellbeing and Social Care stated that ‘Through contact with partnerships, I am aware that there is a range of local initiatives across the country to support recipients of care, using volunteers, redeployed staff and third sector partners.’ Whilst we welcome the recognition of volunteers in the provision of social care, referring to them as part of a solution in the context of staff shortages could unintentionally condone the displacement of paid staff by volunteers.

In the commitment to Fair Work, and to ensuring that the care workforce is recognised and valued, we would like to see explicit recognition that volunteers will not be used to carry out duties normally performed by paid staff or to disguise the effects of staff shortages. Volunteer Scotland and the Scottish Trade Union Council developed the Volunteer Charter identifying the key principles for ‘assuring legitimacy and preventing exploitation of workers and volunteers’ (2019, Volunteer Scotland and STUC). In particular, the 5th principle states that ‘volunteers should not carry out duties formerly carried out by paid workers nor should they be used to disguise the effects of non-filled vacancies or cuts in services.’

The commitment to prevention and early intervention are an important step in the right direction. The role of the voluntary sector and volunteers is key to achieving this, and also reflects the principle to provide financially sustainable care. The voluntary sector provides excellent value for money, both in terms of reducing the care burden through services focussed on prevention and in providing significant return on investment in the delivery of care services. As such, procurement processes tailored to the needs of the voluntary sector are vital, as is a commitment to multi-year funding. This is detailed further in our answer to the question related to Ethical Commissioning and Procurement.

We welcome the commitment to ethical commissioning and procurement, but we believe that the Bill and associated memoranda do not go far enough in ensuring that the specific needs of the voluntary sector, and the volunteers it engages, are addressed.

Volunteer-led services are often seen as a cheaper option by funders. This undervalues the contribution of volunteers and misrepresents the level of investment required for sustainable volunteer management. Whilst volunteers are unpaid, they are not free. The effective and inclusive engagement of volunteers requires dedicated resource, usually in the form of paid coordinators and budget to cover recruitment, training, ongoing support and recognition costs, as well as volunteer travel expenses, for it to thrive.

An evaluation carried out by the York Health Economics Consortium (YHEC) of Children’s Hospices Across Scotland (CHAS) showed that they had invested £306,000 in their volunteering programme in 2018/19 (2021, Hanlon, J. and Hex, N.) This might seem to be a considerable sum of money, however it was also calculated that the return on this investment was £737,000 - over 140%. CHAS have a care model that has fully embedded volunteering. Indeed, their Volunteering Strategy states that ‘volunteering is critical to the success of CHAS’ (‘Our Volunteering Strategy’, 2020, CHAS). This demonstrates the significant value that volunteers can add to care services, so long as it receives an appropriate level of investment.

As a result, we feel that the detail around ethical procurement in the Policy Memorandum should explicitly reference the requirement to invest in sustainable volunteer management. This could include a commitment for funded services that involve volunteers to a relevant quality standard such as Investing in Volunteers or Volunteer Friendly. It could also include agreement to abide by the Volunteer Charter, which provides clear and unambiguous principles for assuring volunteer legitimacy and preventing exploitation.

A commitment to multi-year funding for voluntary sector providers would also support the sustainable engagement of volunteers in the delivery of services, ensuring adequate time for recruitment, training and relationship-building.