How can other countries’ social care systems influence Scotland’s National Care Service?
Scotland is not alone in the world as it seeks to develop a new National Care Service (NCS). Many countries are seeking new ways that can better respond to the challenges of increasing demands and reduced budgets. Multiple mounting pressures on established health and care systems have impelled the need – and opportunity – for systematic change. For example, Japan, which has had a world-leading universal healthcare system for over fifty years and enjoyed a higher life expectancy than most countries, is now experiencing pressures that have brought the system close to breaking point. Even countries like Sweden – where statutory health and care services have long been recognized as exemplars of best practice – are looking for new ways to create more affordable services whilst, at the same time, managing citizens overly high expectations of baseline norms. These pessimistic forecasts impel us, if nothing else, to radically reconsider how to create new and hopefully compassionate systems that can be sustainable for our new times.
In Scotland, we are fortunate that human rights and compassion were a central theme in Derek Feeley’s Independent Review of Adult Social Care (2021) which made urgent recommendations for transformational reform of the social care sector. In the review, Feeley underlined the need to not only recognise but actively realise the principles of “human rights, equality and participation for people using social care support” and co-design, involvement and consultation continue to be part of the dialogue towards the creation of the new service. Whatever final form the National Care Service takes, the realisation of a rights-based, person-centred approach that maximally involves people in their own care must be at the core.
Beyond this, as well as consulting with national stakeholders, the Scottish Government have been exploring other health and care systems to learn from and help shape what the new NCS might look like. They compared international social care models in high-income countries from Australia and New Zealand to Alaska, the European Union, the United States and Japan. Each of the systems diverge from the other in important ways – whether that’s through funding models or degrees of integration between health and care or through the way services are delivered – and each system evolved within its own particular cultural and demographic environment so are not replicable. But although each system may be unique and different, sharing the same aim, they offer valuable opportunities for learning.
For example, Australia’s radical and pioneering National Disability Insurance Scheme might help inform continued developments in Scotland’s own model of Self-Directed Support . And their use of holograms in remote community care settings might, likewise, provide invaluable insights and possible solutions to the challenges of equal access to health and care in rural Scotland.
In Scotland, there may also be the will and undoubtedly the skill to replicate in some form Japan’s much vaunted use of robots to bring comfort and companionship in settings where care is needed; although research is increasingly finding these can, at best, only ever be used to complement rather than replace real human contact. Meanwhile innovative ideas for intergenerational living spaces are being developed in many countries and must surely be considered in any future planning strategy, while the potential uses – and possible abuses – of artificial intelligence can only be fully harnessed through shared global learning.
As well as learning from what’s new and innovative, it’s also important to learn from the past. For example, Northern Ireland already has a well-established, closely integrated health and care system, yet despite this, as was starkly demonstrated in Darren McGarvey’s recent BBC TV documentary, The State We’re In, Northern Ireland still faces challenges directly related to the relationship between the two. So even when implementing strategies that might seem intuitively obvious, such as closer integration between health and care, investing in international dialogue might stop us reinventing punctured wheels and instead encourage us to work together on our shared global challenges.
Rebecca Robinson, International Collaborations Project Manager
For more on our International Collaborations project, visit the IC webpage.
