How To Show Scotland Still Cares

Craig DalzellA lot is happening in politics circles right now from the budgets (UK and Scottish) through to Common Weal’s own tenth birthday (did you see our celebration email earlier this week? If not, you can read it here).As someone who’s own political journey basically started because of what would become Common Weal (you can read about my first ever encounter with Robin McAlpine here) it’s been an incredible journey that I remain proud to be a part of especially through my contribution to the policy library which, as our celebration email mentioned, now stands at 112 policy papers plus dozens more briefing notes and consultation responses. That’s an average of one paper per month (excluding the Christmas break...mostly…) for a solid decade. We couldn’t have done it without you.It’s the latest of those 112 policy papers that I want to spend a bit of time talking about in our newsletter this week. It came out last Friday – just a bit too late for my writing deadline then – and is essentially a last ditch effort to salvage some good out of the seemingly doomed National Care Service Bill.A few weeks ago, Common Weal joined other organisations such as Cosla, the STUC and several trade unions in pulling our support for the National Care Service Bill as it currently stands. The process of “co-design” (by which, the Government appears to mean “listen to what we say and then we’ll be confused when you don’t like it”) hasn’t worked and we’ve been left trying to amend a Bill that is beyond repair. To be absolutely clear, we still support a National Care Service and remain solid in our call for the Government to deliver one that is worthy of that name. It’s just that the Bill we have in front of us will not do that and it’s not likely it could ever be amended to be able to.But this leaves us in a predicament. The care sector in Scotland badly needs reform and badly needs improvements. The lack of those improvements is causing, right now, an uncountable amount of unmet care needs and therefore needless suffering of far too many – not to mention the problems faced by care staff due to lack of pay, lack of agency and lack of training. And that’s before we get to the issues of rampant profiteering in the private sector (which the current Bill would do absolutely nothing to prevent or even reduce).And there is yet good in the NCS Bill to, if not fix everything, to at least make some improvements in key areas. This is why we produced Tackling The Care Crisis Now, which is an attempt to decouple those good parts of the Bill and separate them from the flawed and now-doomed framework of the NCS. This would allow those parts to be implemented as quickly as possible until (not instead of) a proper NCS framework bill can be designed and brought back to Parliament.The prototype for this kind of decoupling is already Government policy. Anne’s Law (which was featured in a recent newsletter article written by the widow of Anne Duke for whom the law is named) is designed to give a legal right of visitation for care home residents to prevent the horrific scenes from during the pandemic of people dying alone and abandoned. The Government has accepted that this right could be granted via separate legislation and needn’t wait until the National Care Service is up and running and so is now consulting on bringing that legislation now.We have identified several other policies such as the National Social Work Agency, standardisation of care records, a national complaints service, enshrining the principles of care as government policy, regulations over procurement of care services from outwith the public sector and many others.We have also identified areas for change that could come as we work through this process as we recognise that not every stakeholder in the Scottish care landscape agrees with everything that could be decoupled from the Bill – to give an example from Common Weal’s point of view: If the section on procurement is enacted as written then it would explicitly allow for the private sector to be commissioned to provide for-profit care services (in precisely the same way that we and others are fighting to prevent private companies from doing in the National Health Service). We’ve suggested that the legislation is tightened to explicitly encourage or even mandate that such outsourced care services are provided on a public-owned or at the very least not-for-profit bases. Similarly, the Care Home Relatives Group who initiated Anne’s Law are not happy with the precisely wording of the Bill as it stands and so even the prototype example that inspired our project is also an example of a policy that could be decoupled but should be reformed as well.Finally, we have identified three pathways to getting all of this done. The simplest and most democratically transparent way would be to invoke bespoke processes for each policy. In many cases, this wouldn’t involve actual legislation (the Government could simply write up new procurement guidelines for not-for-profit care, or could write a Care Charter to make the principles of delivering care Government policy, even if informally) but in many cases it would involve primary or secondary legislation and therein is the downside. The next Scottish election is only about 18 months away now (well, the next scheduled election is 18 months away. The chances of an unscheduled election as a result of a failure to pass a budget in December is no longer zero) and procedure dictates that any legislation not passed by the closing of Parliament will automatically fall and need to be reintroduced from scratch. With an already heavy legislative workload on Parliament there may simply not be enough time to pass everything.A second option therefore is to pull all of the decoupled policies from the NCS Bill and present them in a “Care Reform Bill” which could pass using the same Parliamentary time as would have been used by the now-dropped NCS Bill. This would still be a challenge to introduce new legislation and get it passed in time but it would still offer a maximum of democratic scrutiny and especially allow for stakeholders to campaign to amend specific sections.The third option is much less saving a sinking ship more of a salvage operation on the wreck but would involving taking the “bad bits” of the Bill out and leaving behind only the good. The framework and structure of the NCS could be amended out and the Bill turned into (and ideally renamed as) a Care Reform Bill. This would mean skipping the Stage 1 process and saving a substantial chunk of precious time compared to option two of a dedicated Care Reform Bill. The downsides of this approach include the obvious compromise on democratic scrutiny but also the possibility that the Bill simply may not be amendable in this way. Amendments must be “within scope”, which is a basic safety mechanism to prevent a Bill being entirely deleted and replaced with something completely unrelated or amended to add poison pills and pork barrel projects (which can happen in the US system). Even without deliberate sabotage, it’s possible that the Parliament could accidentally leave behind a critical clause that, for instance, gives the Care Minister dictatorial control to change things later. Nevertheless, this is the option that the Scottish Greens effectively adopted at their conference at the weekend (after quite a fraught process including members throwing out the entire conference agenda on the first day to prevent the leadership strong-arming their preferred version of that motion through and vetoing a competing membership motion that would have been closer to our option two) though they’ve made it clear that if the reforms they call for are not possible or are not passed, then they’ll vote down the Bill and default to option two.Once again, we still support a National Care Service and want to see one launched as quickly as it can be properly designed and we’re clear that these improvements we suggest are not a substitute for one. Even if every one of them is amended into an acceptable form and passed, we still need that Care Service. But we also can’t wait for that Care Service to start tackling the care crisis and there is a lot that we can and must do now to start making a positive change for those who both need and deliver vital care services across the country.