National Care Service (Scotland) Bill (Stage 2) - Your views on draft amendments

Unclear of the added value, or added efficiency it will bring/result in.

A new NCS Board may be of a level of potential support in improving and ensuring standards across non-health services.
Although it is extremely difficult to foresee how this can be introduced, or established, with cost efficiency and in a manner that brings clarity and streamlining

Unclear rationale for, and anticipated benefits of, replacing already established IJB structures with something new.
A refresh, even re-naming of existing local structures with a new NCS Board overarchingly would seem more efficient

The proposed inclusion of community HEALTH services.

The possible inclusion of community child health services e.g. Health Visiting, Family Nurse Partnership, School Nursing, Care Experienced Young People Medical/Nursing, (Community Midwifery) and Childhood Immunisation services into an NCS raises significant concern and risks. My understanding is that this concern is felt across a range of NHS leaders, in varying roles, across a number of Health Boards. This includes within the National Child Health Commissioner Group.

It is understood, and supported, that Local Authority (LA) children's services e.g. Children & Families Social Work and Education services will move into NCSLBs/an NCS

It is not my view, or that of other strategic child health leaders that NHS community child health services and LA children's services require to be within the same national structure to be more effective. Human relationships, and other factors, are more key and crucial to that improved effectiveness.

From the 5 years of experience and learning from the current (approx) 50:50 national split of (community) child health services and LA children's services being 'out of' or 'within' a HCSP, there is NO reported evidence of improvements for the workforces or for children/families of these services sitting within a joint HSCP/IJB structure.

Ref: Children's Services Reform Research study (Dec 2023) - commissioned by Scottish Gov.

There is a view held, borne out in NHS Tayside since 2018, that the incorporation of community child health services as part of an NHS Board's whole 'Women/Children & Families' operational services structure has significant advantages to both children/families and the respective workforces. This cannot, nor should not, be overlooked. Patient/family journeys are enhanced, crucial relationship building across services are enabled and 'transitions' (known as 'discharges' pre 2018 locally) across services are improved.

The proposal to separate the connected and interdependent suite of children's health services causes concern amongst leaders, and raises risks to children/families. Not to mention added confusion/lack of clarity/reduced understanding for the population served.

The proposal to separate these connected and interdependent NHS children's services, based on the rudimentary criteria of where they are, primarily, delivered i.e. in a hospital or in a community would benefit from being understood/considered/discussed further. It is not the location of the service which a child receives that is crucial to safe, effective & quality care delivery. It can, however, be the knowledge, skill, job satisfaction level and feelings of belonging/value of the staff which a child encounters. There is a real risk that some of the latter would be adversely affected by (re) introducing a separation of this unique and distinct proportion of the health service workforce i.e. children's services staff

The rationale and case for the inclusion of community child health services has not been made clear, articulated effectively and could appear to be being made without due regard to the complexities nor any true understanding of the detail of the current status position.

More generally, there is difficulty in seeing how a new NCS structure, as proposed, will allow efficiencies and support simplicity. It is also difficult to visualise how it will contribute to the economic benefits required. Additional complexity, is somewhat anticipated at this stage.