Putting The Care Cart Before The Horse
Nick KempeOn 3rd November Scott Wortley and James Mitchell, Professor of Public Policy at Edinburgh University, wrote a powerful piece for the Sunday Times explaining how the Scottish Government had introduced and then submitted extensive amendments to the National Care Service Bill without having set out a clear policy position of what it wanted to achieve and how. Their basic argument was that policy should come before legislation and that the structures and processes of the Scottish Parliament, which had been set up to deliver this, had been subverted by the Scottish Government’s approach to the NCS Bill.What Professor Mitchell did not know was that Common Weal, having tried for over two and a half years tried to get the Scottish Government to publish the policy work it had commissioned from KPMG, had at last been successful. This followed our appeal to the Information Commissioner which had forced the Scottish Government to reveal it had awarded the contract to KPMG despite being advised “The FRC came out with a ruling to say the entire firm was dishonest. QC advice is that this is grave professional misconduct and so grounds for exclusion”. Andrew Learmonth described our efforts to get the information released in the Herald on Sunday on 17th November.At the end his article Mr Learmonth quoted a Scottish Government spokesperson as saying “This is an inaccurate description of the work that was carried out. KPMG provided advisory support on key functions during the early stages of the NCS programme.” That claim is contradicted by the Scottish Government’s initial release of the information in September. Asked for the final product of the work KPMG had done to prepared a Business Case for the National Care Service, the Scottish Government sent a link to the Programme Business Case sent by Maree Todd to the Finance and Public Administration Committee of the Scottish Parliament in December 2023. That was a year and a half after the NCS Bill had been introduced to the Scottish Parliament, not preliminary at all and a good example of Professor Mitchell’s contention about policy following legislation.There was no mention in Maree Todd’s letter or in the document itself, which sets out the Scottish Government’s Strategic, Economic, Finance and Business cases for a National Care Service, that it was the work of KPMG. Whether it really represents the final product of KPMG’s is another matter which the Scottish Government has refused to clarify. The FOI response shows that KPMG received the final instalment of the £636k they were paid for their work in January 2023. This suggests that either the document had been sitting on the Minister’s desk for 11 months or that Scottish Government officials had developed whatever KPMG had done further, as is suggested by Maree Todd’s description of it as “the latest iteration of the Programme Business Case”.The Scottish Government’s eventual response to our request for the work KPMG had undertaken on the Current Operating Model (COM) and Target Operating Model (TOM) for the NCS is even more revealing in policy terms.The Scottish Government’s contract with KPMG had scheduled a presentation on “deliverables”, i.e. the Programme Business Case, the Current Operating Model and the Target Operating Model, for 22nd September 2022. In other words, the description of what need to change in the current care system (COM) and the policy justification for a new target operating model (TOM) were planned for AFTER the NCS Bill was first introduced to the Scottish Parliament on 20th June 2022. Two years later the Scottish Government were still trying to keep secret what they thought needed to change – which the Scottish Government redacted from their initial response this September but provided after we had asked for a review in October.On the work KPMG had undertaken on the TOM, the Scottish Government sent a link to letter which had been sent by the responsible Minister, Maree Todd to the Health, Social Care and Sport Committee in February 2024. Appended to it was a TOM summary consisting of nine powerpoint slides which were therefore first published 13 months after KPMG is supposed to have completed the work.Those slides revealed that “a full TOM document is in development”. While COM and TOM are horrible jargon, how a National Care Service would operate at the front line and be experienced by those with care needs, their unpaid carers and the care workforce is the crucial issue. Common Weal set out our own TOM, although we did not call it that, in Caring for All which we published two and a half years ago. The Scottish Government has still to do so.Instead of describing how the National Care Service would operate on the ground, the TOM summary is all about how it would be managed. Four of the six slides which have any real content, are about the National Care Service Board and proposals to reform Integrated Joint Boards while another slide being about management tools such as data and information systems. The relationships, that are central to how people experience care, don’t get a mention.These serious flaws which, as Craig Dalzell described last week, have caused stakeholders to withdraw their support for the National Care Service Bill and forced the Scottish Government to pause it a second time, come down to a policy failure and, underlying that, a failure in politics. While talking about the importance of co-design, the Scottish Government outsourced policy development to private sector management consultants and the consequences have been disastrous. Two slideshows instead of a coherent policy proposal which should have provided a starting point for public debate BEFORE legislation was drafted.It is little wonder the Scottish Government has been so reluctant to release the information about KPMG’s work. When it comes to the real need for a National Care Service, the Scottish Government have all the appearance of a headless chicken. The Care Reform Group have submitted further FOI requests for the “full TOM” for the NCS and the TOM for the proposed National Social Work Agency, as referred to in the TOM summary slideshow, not in the hope of resuscitating the current bill but of exposing further the policy failure that underlies it.