Lobbying & Key Policy

The most significant core driver of service improvement and skills development lies within Scottish Care's capacity to work and lobby with the ongoing and upcoming policy agendas.

It is acknowledged that one of the main challenges facing Scottish Government, the NHS and local authorities now and in the future design of services is the increasingly ageing population.  The current policy drivers promote a pro-active response to this demographic shift and for a greater personalisation of care and support for older people closer to their own communities. 

There are a range of key policy strands which inform the changing landscape of care and support services. The growing emphasis on meeting both the health and social care needs of older people in particular, including those with long-term conditions, has significance for those who will work in or with social care and support services and the skills they will require to undertake new functions and tasks.

The Scottish Government set out its single overarching purpose and strategic objectives for health care within Better Health, Better Care: Action Plan (Scottish Government, 2007).  The Action Plan includes a range of measures to improve the quality of the NHS.  It gives effect to a commitment to local care whenever possible, embedded in communities and tailored to people's needs; and to a commitment to care that is quicker, safer and more efficient and effective than before.

The NHS Scotland Quality Strategy (Scottish Government, 2010) is a development of and builds on Better Health, Better Care and has three Healthcare Quality Ambitions, namely services which are person-centred, safe and clinically effective. 

The strategy of moving towards person-centred and community based services was given further momentum through Shifting the Balance of Care (Scottish Government, 2009) which addresses changes at different levels across health and social care systems. This incorporates the Integrated Resource Framework.  It means the development of clinical and care pathways that may involve shifting location, shifting responsibility; and identifying individuals earlier who might benefit from support that might sustain their independence and avoid adverse events or illness.  Much of these services will be in people's own homes and in care homes. 

The key policy driver Reshaping Care for Older People (Scottish Government, Joint Improvement Team, 2009) has resulted in Reshaping Care for Older People: A Programme for Change 2011 – 2012 (Scottish Government, 2011).  This provides a long term and strategic approach to delivering change to achieve the vision for future care for older people in Scotland.  It has a ten year horizon to deliver significant shifts in the balance of care from institutional to community settings.

Within its plan of action is a joint health and social services workforce work stream, addressing issues arising from the ageing demographic; the future availability and training of staff to work across the long-term care sector; new models of service delivery and the impact of the ageing population on the profile of the wider workforce.  This includes:

•  reviewing current and potential future workforce and skill requirements across health, social care, housing support, to respond to demographic pressures
• identifying options to promote shared access to training across the workforce.

In addition, critical is the creation of Scotland's National Dementia Strategy (Scottish Government, 2010), including 'Promoting Excellence', a knowledge and skills framework which is aimed at supporting people who have a diagnosis of dementia, their families and carers.  Its Action Plan incorporates all health and social care employees in its range, and has consequences for the skills and behaviours which will increasingly have to be met in care home, care at home and housing support services.

The emphasis within Living and Dying Well: A national action plan for palliative and end of life care in Scotland (Scottish Government, 2008) on reducing unnecessary admissions to hospital at end of life has implications for health and social care services in supporting a person's palliative care needs within the community, including care homes and within people's own homes.  

Continuing to support the social care policy direction is Changing Lives: Report of the 21st Century Social Work Review (Scottish Executive, 2006), setting out a vision for the future direction of social work services in Scotland.  It has some key messages including building capacity to deliver personalised services in social care settings, with the effect of having health services provided locally where possible.

The promotion of multi-disciplinary and cross-sector work is shown in the Community Care Outcomes Framework (Scottish Government, 2009), allowing partnerships (local authorities and their NHS partners) to understand their performance locally, at a strategic level, in improving outcomes for people who use community care services or support and their carers.  The framework underpins the NHS national performance framework (HEAT) and current Single Outcome Agreements for Scottish local authorities.

The Long-Term Conditions Toolkit (SEHD, 2007) and local Action Plans expect that every Community Health Partnership (CHP) develops an Action Plan that will ensure services and care are integrated, responsive and of a high quality.  

The Delivery Framework for Adult Rehabilitation (SEHD, 2007) is a joint process for health and social work. It gives strategic direction and support to all health and social care services and practitioners who deliver rehabilitation or enablement services to individuals and communities.  The vision underpinning the framework is the creation of a multi-disciplinary, multi-agency approach to rehabilitation services that are flexible and responsive in meeting the needs of individuals and communities in Scotland.  Care homes, care at home and housing support services will play a key part in promoting rehabilitation.

Self-directed Support: A National Strategy for Scotland (Scottish Government, 2010) has been developed to help take forward the personalisation of health and social care services in Scotland.  The strategy sets out a ten year framework for the development of self-directed support as the main way to deliver social care, supporting the personalisation of services in Scotland. The development of self-directed support generally may lead to the evolution of a wide range of new models of care delivery, with individuals having opportunities to individually or collectively commission support.

Underpinning personalisation and the principles of self-directed support is the move towards an outcomes approach to assessment, planning & review which aims to shift engagement with people who use services away from service-led approaches.  This involves everyone working together to achieve the best possible impact on the individual's life. The philosophy of this approach is one that emphasises the strengths, capacity and resilience of individuals, builds upon natural support systems and includes consideration of wider community based resources. The approach is consistent with policy priorities to engage people using services, personalisation and enablement and an assets approach to health. 

Scotland's policies for health and social care fundamentally shift the balance towards sustaining and improving health and preventing longer term conditions through an emphasis on self-help, reablement and support that is continuous, integrated and individualised. This sets a clear direction of travel towards a policy agenda which is community based.

In summary, there are key over-arching messages which frame the further development, and delivery, of the main policy direction, the reshaping care programme.  These include a shift in philosophy, attitudes and approaches; services becoming outcome focussed; an acceleration in the pace of sharing good practice; aligning partnership resources to achieve policy goals; and additional funding for care. The emerging framework sits above, and supports the delivery of, other strategies for particular groups or issues including the Dementia Strategy, Carers Strategy, and Self-directed Support Strategy.  Together these build a cohesive and comprehensive approach to meeting the care and support needs of older people.

The foregoing polices and processes will require members to adopt new and improved models of care and support practices and they will fundamentally affect the role, locus and employment of social care employees in the future. Tthis will impact most on independent service providers and their employees.