My vision for the future of Independent Health and Social Care in Scotland

The Independent Health and Social Care (IHSC) sector provides a staggering number of services within Scotland. Having spent more than half of my career working in a myriad of settings within this sector, I’ve experienced first-hand the challenges that colleagues face on a daily basis.

Nursing staff in the IHSC sector are highly skilled professionals with an in-depth knowledge of long-term conditions and managing complex morbidities and frailty. Despite managing a variety of complex conditions, there are no doctors employed within these and few, if any, clinical colleagues able to assist them with complex decision making. Despite this, they are often viewed as “less able” than their colleagues in the NHS.

Factors such as Covid and Brexit have worsened pre-existing problems with staffing. Providers are struggling to attract and retain the staff they need, resulting in clinicians and support staff being spread too thinly, with high turnover rates and an over-reliance on agency staff. Despite best efforts, this lack of continuity can often lead to standards of care being compromised.

The cumulative effect of these challenges has resulted in many members of the nursing family struggling with their physical and mental health. We are seeing these safety-critical staff experiencing long term sickness, feeling undervalued, burned out, retiring early and in some cases leaving the profession altogether. This is happening in workplaces across the IHSC sector, including care homes, care-at-home services and independent hospitals.

On top of these current challenges, we’re likely to face even more difficulties in the future. People are living longer and having less children, resulting in the proportion of people needing care growing, while the proportion of working age adults shrinks. National Records of Scotland predicts that by mid-2043, 22.9% of the population will be of pensionable age, compared to 19.0% in mid-2018. This will inevitably increase the struggle that providers face in finding people of working age to staff services.

Fortunately, there are signs that things may be improving. In 2019, the Scottish Government published the Health and Care (Staffing) Scotland Bill, which places a legal requirement on NHS boards and care services to ensure that appropriate numbers of suitably trained staff are in place at all times. Following delays caused by the pandemic, the Government has now set out a 21-month timetable to implement the Act.

There is also hope that a better care system may emerge from the COVID-19 crisis. The Government’s Independent Review of Adult Social Care in Scotland, published in 2021, outlines a vision for a National Care Service. The aim of this new delivery system will be to drive national improvements where they are required, to ensure strategic integration with the National Health Service, to set national standards, terms and conditions and to bring national oversight and accountability to a vital part of Scotland's social fabric. This vision of social care reform will shift the responsibility for care services from local authorities to Scottish ministers by 2026.

There is still much to be decided about what the National Care Service will look like, but it is clear that the voices of people with lived experience of social care need to be at the centre. The Independent Review highlighted the particular importance of recording what support people asked for but did not receive. This will be key to understanding what “better” looks like and evaluating if we have made a positive impact. Now is the time to improve our data collection and analysis to ensure it is as meaningful and consistent as possible.

My own personal vision for the future is of a National Care Service that works alongside our National Health Service to help people stay well and be supported in the way they want to be, where they want to be, while respecting their rights. I want to see self-management being encouraged with a view to independent living. I want us to learn when we get it wrong and celebrate when we get it right. I want to see the voices of the IHSC workforce being listened to and their expertise being acknowledged and respected.