5 POLICY CONTEXT
Legal Framework
23. The National Health Service (Scotland) Act 1978 ("the 1978 Act") 26 requires Scottish Ministers to promote a comprehensive and integral health service to improve the physical and mental health of the people of Scotland and to provide or secure services for the prevention, diagnosis and treatment of illness. There is also a general duty to promote the improvement of physical and mental health. The discharge of these functions is essentially delegated to health boards. Their duties under the 1978 Act includes duties to provide medical, nursing and other services.
24. The Social Work (Scotland) Act 1968 ("the 1968 Act") 27 places a general duty on local authorities to promote social welfare (Section 12 of the 1968 Act) by making available advice, guidance and assistance. There are also specific duties to assess needs and decide whether those needs call for the provision of services, which essentially means services under part II of the 1968 Act. Local authorities have the lead responsibility for co-ordinating the assessment of all community care needs, on an inter agency basis.
25. Section 2 of the Chronically Sick and Disabled Persons Act 1970 28 is effective in Scotland through the Chronically Sick and Disabled Persons (Scotland) Act 1972 29. It applies to any chronically sick and disabled person, to whom section 12 of the 1968 Act applies, or if the person is under 18 years of age, to any disabled child to whom section 2 of the Children (Scotland) Act 1995 applies.
26. Sections 22 and 29 of the Children (Scotland) Act 1995 30 also place a duty on local authorities to provide services that promote and safeguard the welfare of children.
27. The Education (Additional Support for Learning) (Scotland) Act 2004 31 introduced a single structure for meeting the needs of children who require additional support to ensure they can make the most of their education.
28. Local authorities have a duty to assess the needs of any person for whom they may have a duty or power to provide community care services.
Co-operation between local authorities and health boards
29. Improving outcomes through joint working is an important policy goal. Sections 13 and 13a of the 1978 Act make provision for health boards to co-operate with one another and with other agencies, such as local authorities, to secure and advance the health of the people of Scotland. Similarly, Section 4 of the 1968 Act permits local authorities to work with health boards and other agencies to assist with the provision of community care services.
30. Part II of the Community Care and Health (Scotland) Act 2002 32 and the Community Care (Joint Working etc.) (Scotland) Regulations 2002 33 promote co-operation between local authorities and health boards to make joint community care and healthcare provisions, by enabling the delegation of functions, the transfer of resources and the pooling of budgets between local authorities and NHS Scotland.
Policy Context
31. The Scottish Government wants people to be able to remain in their own homes, living as independently as possible for as long as possible. Research has consistently shown that this outcome is what people themselves want. Government policy is therefore to support this.
32. The Scottish Government is also committed to improving outcomes through partnership working across all organisational boundaries. It encourages health and social care agencies to work together to provide joined up, community focussed services. It has developed a Community Care Outcomes Framework for joint working in community care
33. The Community Care Outcomes Framework offers local partnerships a robust means of managing outcomes in the local area, and the opportunity to benchmark with other partnerships using the Framework. This will promote continuous improvement by
- enabling local partnerships to understand at a strategic level their performance in terms of improving outcomes for people using community care services and their carers;
- sharing this information with other partnerships in Scotland and comparing their performance directly on the basis of consistent clear information.
34. Community care has delivered a shift in the balance of care over the last 15 years, with significant reductions in the number of older people and adults with learning disabilities and mental health problems living in hospital settings and a consequential increase in people living at home, or in a community setting. Over 90% of older people receiving care live in their own homes, and the vast majority of hospital patients are discharged in a timely and appropriate manner. Much of this has been achieved through partnership working between the NHS, local authorities, housing and the voluntary and private sectors.
35. Carers have new rights to an assessment and joint working has progressed through work in multi-disciplinary/agency teams. More generally, the Scottish Government is committed to modernising services to achieve better outcomes.
36. Community care services cover a wide range of health, social care and housing activities that collectively enable individuals to optimise their quality of life and help them to continue to live in their own homes and communities.
Shifting the balance of care
37. Shifting the balance of care to people's own homes and the community is a key part of community care policy. Better Health, Better Care4 promotes a similar shift in the NHS. Community care services are developing and responding positively to change around them. The long-term goals in community care are to support people at home for as long as possible, providing choice, supporting independence and rebalancing care to people's own homes.
38. Community care aims to enable everyone in the community to enjoy sustained health and well-being, especially those in disadvantaged communities. Nationally, we want to develop the best possible forum to achieve that. That means enabling better, faster and more local access to integrated health and care services that shift the balance to encouraging independence and choice, and working in partnership with others to achieve better outcomes.
39. Further information on the Better Health, Better Care Action Plan can be found at http://www.scotland.gov.uk/Topics/Health/Action-Plan
Rehabilitation Framework
40. The Delivery Framework for Adult Rehabilitation 5 is a joint document for health and social work and its purpose policy is to give 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 modern, effective, multi-disciplinary, multi-agency approach to rehabilitation services that are flexible and responsive in meeting the needs of individuals and communities in Scotland.
Changing Lives
41. Changing Lives, The Review of Social Work in Scotland6 set out a vision for social care services for the 21 st Century. The report outlines 13 recommendations based on the premise that 'more of the same won't work', highlighting the need for change to ensure services respond to future demographic changes, public expectations, workforce availability and financial allocations.
42. In response five key change programmes (service development; leadership and management; workforce; practice governance, and performance improvement) were taken forward. These programmes focussed on delivering a number of key pieces of work to help transform services so they:
- meet the legitimate aspirations of users
- increase peoples' capacity to take control of their lives
- are more focused on prevention
- are accessible and flexible
43. Further information about the Changing Lives report and the subsequent workstreams can be found at www.socialworkscotland.org.uk.
Free Personal and Nursing Care
44. Personal and nursing care is available without charge for everyone in Scotland aged 65 and over who needs it, whether at home, in hospital or in a care home. Free nursing care is available for people of any age who need it.
45. The Sutherland Report on free personal and nursing care made some recommendations which are currently under consideration.
46. Further details on the Free Personal and Nursing Care policy can be found in Circular CCD 5/2003 7 and at: http://www.scotland.gov.uk/Topics/Health/care/17655.
Self-Directed Support
47. Self-directed support in Scotland is part of the mainstream of social care delivery, targeted at empowering people to make their own choices about their support. Self directed support encompasses what has historically been called direct payments. It allows an individual more flexibility, choice and control over the support they receive, and can ultimately promote confidence and wellbeing for those with an assessed need. Research published in June 2008 gives evidence of the positive experiences of people who receive self-directed support: http://www.scotland.gov.uk/Publications/2008/05/30134008/2
48. Further details of the self-directed support scheme can be found in the Assessment of Need section and at http://www.scotland.gov.uk/Topics/Health/care/VAUnit/DirectPayments.
49. A full list of related policy and legislation can be found in Annexes C & D.