Social care reform must not gather dust on a shelf, says Shona Robison

Shona Robison - Image credit: Independent Living in Scotland

“I think we already have a lot of the key pillars in place. It’s about driving the pace of that,” health secretary Shona Robison told Holyrood, following calls for major change in the way social care is delivered in Scotland.

Sixteen organisations representing people with disabilities, carers and the care sector this week published their shared ambition for the future of social care support in Scotland, calling for a fundamental rethink of the way social care is managed to promote human rights for disabled people.

As well as calling for an independent commission on funding social care, they want to see a national framework for social care support set in law, with common eligibility criteria and outcomes across the whole country.

It comes amid concerns that health and social care integration alone won’t deliver the change disabled people want.

Robison already has a programme of work scheduled with local government organisation COSLA to look at social care, but there are specific demands in the shared statement that may not be included in that.

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Will the Scottish Government be following up on some of the specific calls to action?

“What we’ve just arranged is a follow-up meeting with the key people involved in the launch today,” Robison tells Holyrood.

“We want this not to be a document that gathers dust on a shelf, but something that actually effects change, so we will follow up with a sit-down with the key stakeholders and we’ll look at some of the issues that were raised today.

“Parallel to that is the work with COSLA, which many of the stakeholders here are involved in as well, which is looking at the national care home contract, care at home, some of the big issues that are around.”

The COSLA work programme is an important piece of work and would be the home for the type of issues a commission would look at, Robison says.

“A commission takes a long time and I want the pace of change to step up,” she explains.

“And I think we already have a lot of the key pillars in place. It’s about driving the pace of that.

“So part of that is work ongoing with COSLA, but also I want to meet directly to address some of the issues that were raised today.”

One of the key themes that came across from the several speakers, as well as from the shared statement itself, is the need for disabled people to have more control over their own lives and support, for care not be something that is done ‘to’ or ‘for’ them.

Although health and social care integration is underway, that doesn’t necessarily lead to more individual choice is decisions.

Indeed, Inclusion Scotland chief executive Sally Witcher expressed concern that integration could in fact lead to social care simply becoming ‘healthcare in the community’.

While Robison insisted that a healthcare takeover of social care was not the intention of integration, what can the Scottish Government do to ensure disabled people are given more choice and control over their own lives?

“Well, it [more choice and control] doesn’t necessarily come from integration, but I think integration makes it more possible. But part of that is about the culture,” says Robison.

“If you look at the culture and transformation and creativity underpinning self-directed support and ILF [the Independent Living Fund], for example, that is all about people having control over their services they receive, being in the driving seat of that.

“Those are the principals underpinning it, particularly self-directed support.

“What we need to do is to develop and drive, that integration needs to have those same principals at its heart.”

There are good examples and best practice where that’s happening, Robison says, but it needs to happen everywhere, and part of that is getting the right people around the table.

“Locally again, some of these places have got good practice about having third sector and service users, carers around the table making decisions, but it’s not the same everywhere and that cultural change of really people being in the driving seat. [There’s] sometimes risk and service providers are quite risk averse.

 “Actually, life is about risk. It’s about a proportionate and managed level of risk and people being able to spend their daily lives doing what they want to do rather than fitting in necessarily to what’s on offer from services.

“So, that’s going to take time, but I think integration makes that more possible. But it won’t automatically happen. It’ll have to be driven.”