Community / IJB’s concern over national care service proposal amid ‘one size doesn’t fit all’ warning

SHETLAND’s health and care partnership is to write to the Scottish Government expressing concern over proposals for a national care service.

The integration joint board (IJB) – which brings together the NHS and council – met on Thursday to finalise its contribution to a government consultation on the plans, which was drawn together following engagement events and seminars.

Its response highlighted that the existing local model of care in Shetland has produced “successful outcomes” for people and quality of service.

The board also warned of a significant risk of “system shock” by introducing a national care service into a small area like Shetland, “because of the infrastructure and resource requirements from a finite resource pool introducing resource stretch and uncertainty for the workforce”.

There are also concerns that it could disrupt successful integration of services in Shetland.

IJB chair councillor Emma Macdonald.

The idea of a national care service was raised in a recent independent review of adult social care in Scotland, and it was included in the SNP’s manifesto in the May election.


But it has provoked significant concern locally over the effect it could have on care services in Shetland, which are largely operated by the council, and not by private companies.

Alongside increased council spending, Shetland Charitable Trust also provides annual funding for the ‘rural care model’, which in 2021/22 amounted to nearly £2 million.

That grant provides core funding to add value to the community care provided in Shetland, as the level of service is over and above that which would normally be provided by a local authority.

The IJB’s consultation response added: “Integration is working in Shetland demonstrating good partnership working at both the strategic and operational levels.

“If the resource that will be required to fund a new national care service (NCS) went into IJBs then this would provide significant local service improvements and provide sustainable new models of working.”

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The response also highlighted that due to a higher cost of living, care workers are paid more in Shetland and residential placements are more expensive than on the mainland.

The council spends £1,174 per person per week on residential care for older folk, while the figure for Scotland is £401. This means Shetland has the highest spend in the country.

The consultation response said there is a risk that a “national procurement process does not reflect the cost of care provision nor the cost of sustaining the workforce”.

During Thursday’s IJB meeting chair councillor Emma Macdonald, who praised the work which went into the consultation response, said “one size doesn’t fit all when it comes to care”.

She said integration was working well in Shetland. “I do have some serious concerns that […] it will seriously diminish what has been achieved”.


Board member Jane Haswell also warned that “we can’t lose sight of the importance of local knowledge and relationships”.

Meanwhile councillor John Fraser successfully called for the word “off island” to be changed in the consultation response when speaking about placements on the Scottish mainland – as it was ambiguous for those living on Shetland’s islands.

The deadline for responding to the consultation is 2 November, and individuals have been encouraged to have their say too.

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