A National Care Service

The Scottish government proposes to create a National Care Service by reforming existing IJBs and creating a new National Care Service Board. Accountability for social care, social work and community health services will be shared between the Scottish Government, local government and NHS boards. The intention is that they will work together to provide new national level oversight and to drive improvements to the quality and consistency of services. 

The National Care Service Bill has not had a straightforward journey through parliament. While the Bill passed its stage 1 debate in February, MSPs and a range of organisations, including RCN Scotland, had raised serious concerns about the lack of detail in the Bill. In response, the Scottish government agreed to allow for more parliamentary scrutiny and shared further detail about its proposals in June.    

We have submitted further written evidence on these proposals and on 24 September, RCN Scotland Director Colin Poolman, gave evidence to the parliament’s Health, Social Care and Sport Committee for the second time on the Bill. 

RCN Scotland shares the Scottish government’s desire to improve the quality and consistency of social care and community health services, and we agree that reform is needed. However, we remain doubtful that the Bill will achieve this objective or address the serious challenges facing the sector. We believe the Bill is being taken forward without a clear understanding of how to fix the current problems and we are concerned that the focus on the NCS will do nothing to address the current crisis in service capacity or tackle workforce shortages and recruitment and retention challenges.   

Given that the Scottish government is committed to pressing ahead with plans for an NCS, we will continue to engage with Scottish government and MSPs to addresses the priorities for nursing in social care and community health services. 

It is the intention that community health services and social care services will be brought into the National Care Service overseen by a National Care Service Board. Nursing staff currently working for the NHS and for social care providers will continue to have the same employer, however governance arrangements and arrangements for the setting of standards and strategic planning may change. There may also be an opportunity to strengthen workers’ rights and staff representation, particularly in social care. 

The Scottish government also intends to introduce a single model of integration which will result in the removal of the Lead Agency Model used in Highland. We have written to the Minister, NHS Higland and Highland Council to seek clarity on the implications for the nursing workforce in Highland. 

RCN Scotland did not support the Bill because it remained unclear how the legislation would address the current crisis facing social care and community health. Now the Bill has passed Stage 1, we will work with stakeholders to influence the legislation on behalf of our members in all settings. 

The Bill is a framework bill that lays the foundations for a National Care Service, which means that much of the detail about how it would operate in practice is not set out in the Bill. RCN Scotland has repeatedly called for greater clarity particularly around issues to do with governance, nursing representation, workforce planning and the improvement of terms and conditions.  

RCN Scotland believes that focus is needed now on retaining the workforce and adequately funding nursing in social care and community health. Individuals who require social care and community health services, and those who work in these sectors, cannot afford to wait until the creation of an NCS for the serious issues around workforce shortages and access to services to be addressed in a sustainable way.

You can watch RCN Scotland Director Colin Poolman speaking to the Health, Social Care and Sport Committee.

• 16 Nov 2023 - RCN Scotland calls for the Scottish government to act now on social care
• 27 Sep 2023 - RCN members meet Minister to discuss national care service proposals
• 07 Jul 2023 - Members working in social care and community health settings urged to participate in National Care Service forums
• 03 Apr 2023 - RCN expresses serious concerns about National Care Service Bill in letter to new minister
• 03 Mar 2023 - RCN Scotland comment on reports National Care Service Bill to be delayed
• 24 Feb 2023 - RCN Scotland calls for National Care Service Bill to be paused
• 20 Dec 2022 - Now is the time to focus on tackling Scotland’s health and social care crisis, not restructuring services for a National Care Service

Although we have said that now is not the right time to proceed with creating a National Care Service, RCN Scotland will continue to influence the legislation and the government’s plans for shaping a National Care Service.

To keep up to date with our work in this area and make your voice heard, email: policyscotland@rcn.org.uk

The need for significant reform to the way in which adult social care is provided has been a topic of discussion for a number of years. The COVID-19 pandemic brought these issues into sharp focus. In May 2019, the Cabinet Secretary for Health and Social Care announced an independent review to look at the long-term future of adult social care in Scotland, including consideration of the creation of a national care service – the Feeley review.

RCN Scotland provided written evidence to the Feeley review and, following this, hosted a series of consultation events last year to inform our response to the Scottish Government’s consultation on the creation of a national care service. Members came together from across the RCN Scotland membership - including members working in acute services, social care, community services, scrutiny, and education.