SCOTLAND’S National Care Service will “collapse within the decade” if the Scottish Government’s plans are pushed through without change, the chief executive of Scottish Care has said.
Dr Donald Macaskill told the Sunday National that there was an opportunity to do “something radical and different” through the establishing of a National Care Service (NCS), but warned: “This is not it.”
The NCS bill, published in June before Holyrood’s summer recess, formed a key plank of the SNP’s manifesto in the 2021 Holyrood election. Social Care Minister Kevin Stewart called it “the most ambitious reform of public services in the devolution era”.
However, while the idea – which followed former NHS Scotland chief executive Derek Feeley’s lauded Independent Review of Adult Social Care – is popular, the NCS bill itself is not. Opposition parties, trade unions and the social care sector have all raised concerns, calling for it to be paused or withdrawn.
“It’s a fairly unique experience to have a major piece of legislation where the majority of stakeholders are critical of the substance of the bill,” Macaskill – who heads up the body representing the independent social care sector in Scotland – said.
“It will struggle to establish itself, it will cause more destability at a time in which the sector needs a degree of continuity, and I think if it [is not changed], it will collapse within the decade.”
The bill seeks to establish a range of regional and special care boards. Ministers would have the power to transfer functions from councils to these NCS boards, which would replace local government in being responsible for procuring care services.
A report from the Institute for Fiscal Studies, published in August, said that Scotland’s councils are looking to spend £4.3 billion on social work and care in 2022-2023 – around one-third of their total budgets.
Unions have said that the centralisation of a large chunk of councils’ budgets would have far-reaching impacts, hitting staffing across sectors outwith social care.
The Scottish secretary of the trade union Unison, Tracey Dalling, said: “We are asking the Scottish Government to withdraw the NCS bill.
“What is being proposed is not a valid or effective response to the care crisis, nor is it a route to high-quality social care. It is a massively centralising move and if the bill goes ahead as planned it would deal a fatal blow to local government.”
Macaskill agreed that the bill represents an over-centralisation of social care provision. While there are currently 32 local authorities in Scotland handling social care in their areas, the number of NCS boards is likely to be far fewer than this.
“Who’s on these boards?” the Scottish Care boss asked. “Who has voting rights? How do you enable them to remain local and contextual? Social care is about enabling people to be in a community, and you can’t do that from St Andrew’s House.”
The inference is that these boards would mimic the current Scottish NHS structure – which has 14 regional boards and seven special ones – although no details have been specified.
Macaskill suggested that the NCS’s name’s similarity to the NHS was more of a “political soundbite” than a functional reality.
“What we see in the bill is a cheap man’s NHS structure,” he said. “A watered-down version of an NHS structure, with the presumption of course that the NHS is working well.
“To be quite honest, we would not design the NHS the way it is today if we had a blank piece of paper. So why would you, even tangentially, mirror some of [its] structure?”
Both Macaskill and Unison have pointed to Wales as an example of how to keep things more locally focused. The Labour government in Cardiff, with the backing of Plaid Cymru, is looking to establish its own NCS.
In a statement issued in February, the Welsh Government also seemed to reference the NHS by saying it aimed to create a service “which is free at the point of need”.
It added: “Social care will remain a responsibility of local government and continue as a public service, embedded in our shared commitment to equalities and human rights and where the service user voice is clearly heard.”
However, Scottish Labour has echoed trade union Unison in accusing the Scottish Government’s NCS bill of being an “exercise in privatisation”, in contrast to the “public service” in Wales.
West Scotland MSP Katy Clark said: “As it stands, the Scottish Government’s proposals are not for a national care service but for a national care commissioning service.
“Tendering will not only continue – it will expand, with children’s services and areas of justice falling under the remit of the new centralised system.”
HOWEVER, Macaskill said that it was a “myth” that the state had ever run social care.
According to an Audit Scotland report from January 2022, there are around 210,000 people employed by the social care sector in Scotland. Of these, 20% are in the voluntary sector and 57% in the private sector.
Macaskill said: “The unions and Scottish Labour choose to forget that social care was never substantially delivered by the state.
“This myth that says ‘let’s return to the halcyon days where the state ran social care’, that’s baloney, the state never ran social care.
“What is important is the bill as it is does not make it clear what model of procurement is being used, what they mean by ‘ethical commissioning’, who is going to be allowed to tender and what conditions are going to be placed on a tendering exercise.”
Social Care Minister Kevin Stewart said: “The NCS is the most ambitious reform of public services in the devolution era. It will allow us to roll out the high standards of care we have right across Scotland, no matter where in the country you live. Working with people with direct experiences of services and who provide social care is crucial to this, so we have an organisation that best meets the needs of the people it serves.
“We published a financial memorandum alongside the bill that sets out potential costs of the NCS. All investment decisions will take into account the results of the public consultation and ongoing engagement with stakeholders.”
