A Scottish National Care Service must factor in the needs of the terminally ill - Amy Dalrymple

The Scottish Government’s National Care Service (NCS) proposals provide a focus for a much-needed debate about social care in Scotland – what it is and what it should be, who runs and who funds it, to the tune of how much, who provides it, who gets it, and how.

Social care is an integral part of the palliative support terminally ill people receive. People living with a terminal illness are increasingly dependent on social care, particularly approaching the end of life, alongside primary health and palliative care services.

But the NCS proposals don’t only concern social care. The Government’s 2021 consultation is clear that ‘community health services’ will be included, but it is not clear on what these are, or could be.

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In the draft Bill published in June this year, there is a power for Scottish Ministers to “designate as a National Care Service function any function of a Health Board or a Special Health Board”.

Amy Dalrymple, Associate Director of Policy & Public Affairs Scotland, Marie CurieAmy Dalrymple, Associate Director of Policy & Public Affairs Scotland, Marie Curie
Amy Dalrymple, Associate Director of Policy & Public Affairs Scotland, Marie Curie

But nowhere in the Bill or the Policy Memorandum is it defined which health services should be included in the National Care Service.

If the Scottish Government intends that only certain health services will be part of the NCS, it needs to define this – or be transparent that this remains to be determined.

The way that health and care services combine determines a person’s experience of terminal illness and end of life; it is crucial that we know how social care and health services will work together.

So many of the people who will use both the social care and health services that the NCS may provide will be terminally ill; these services will be palliative. Palliative care can be provided in different places, including in a person’s home, in hospital, in a care home or in a hospice. It can be delivered by general health and social care professionals, or carers, as part of the day-to-day care they provide for terminally ill people. A person may also receive support from specialist palliative care professionals, involved in managing more complex care needs, who will often work in partnership with other professionals to provide co-ordinated, personalised care.

Perhaps this vagueness about health services within the NCS presents an opportunity. Marie Curie has longstanding support for more integrated planning and delivery of health and social care in Scotland and we welcome the apparent intention to deliver this. There is unrealised potential for palliative care services to innovate and grow to better meet the needs of local populations.

But as it stands, the National Care Service Bill leaves gaping uncertainties about how health and social care services will be integrated and delivered in practice, which could significantly impact health outcomes of dying people, their families and carers.

Scottish Government must be intentional and open about health services becoming part of the NCS. It needs to include health services in its co-design process with people who use services to shape what the NCS will be – and that must include people with serious and terminal illness.

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It needs to work with frontline staff and the third sector organisations like Marie Curie who have expertise gained by committed research and hard experience about what is needed at both individual and system level, locally and nationally to ensure terminally ill people, their families and carers get the support they need.

Amy Dalrymple, Associate Director of Policy & Public Affairs Scotland, Marie Curie

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