Are you going to have your say on care?
The Scottish Government's consultation on a National Care Service
The official consultation on creating a National Care Service, launched on Monday and lasting until 18th October, is 122 pages long and contains 95 questions. Like most consultations, the questions that are not asked and the options that are not given are as significant as those that are. This makes it difficult for the lay person, whether those with a direct interest in the current system – the people who need care, carers and the social care workforce – or members of the general public, to see the wood for the trees and to work out the implications of the questions and how to answer.
The consultation is nevertheless worth an initial look and, if you are minded to respond to the consultation, you don’t need to do it all in one go. You can save your answers and come back and amend them later before you submit your response. There are also a number of public engagement events (listed at the bottom of the article) which anyone concerned about the creation of a National Care Service can attend. We would encourage supporters of Common Weal to register, attend and ask any questions you have.
The Common Weal Care Reform Group – along no doubt with every other group concerned about the future of care – intends to engage with the process (earlier this week we had a helpful half hour meeting with civil servants about our ideas for a National Care Service). Over the next few weeks we will continue to publish papers on a blueprint for a National Care Service, publish briefings on the consultation and point people to the questions in the consultation that we believe are particularly important and share our thoughts on how they should be answered. Meantime, it is worth drawing attention to some of the key issues.
The consultation document is unfortunately not clear about what the Scottish Government has already decided and what it has not. Besides committing to create a National Care Service, the SNP’s election manifesto made a number of specific commitments in respect to social care. One was to abolish charges for care services for people living at home. That may explain why such charges are not mentioned in the consultation and why there is a question on charges for residential care. However, the manifesto also committed to “Introduce a new, fair National Wage for Care staff and introduce national pay bargaining for the sector” whereas Question 88 of the consultation asks respondents to rank the importance of better pay and collective bargaining in a list of 13 proposals regarding workforce pay and conditions. So, is the Scottish Government committed to national collective bargaining or not?
Conversely, there are things that were not in the SNP manifesto, that have clearly been decided: for example, Section 1c on giving carers a break, does not ask people’s views on the creation of a new legal right and whether this is sensible - there is no parallel proposal to create a legal right for people who need care to receive services - only how the right should be “designed”. The wording of the questions, which ranges from “Do you agree” to “Should”, and whether or not choices/options are given for the answers, gives some indication of where the Scottish Government has already made up its mind and where it is looking for answers.
But care is very political and even a government hell bent on one option can be forced to change course. Cosla’s immediate and welcome response to the proposals as a fundamental attack on local democracy is one example, while both the Tories and the Liberal Democrats have also already spoken out against the increased centralisation that would result. It is not difficult, therefore, to envisage a parliamentary majority emerging against some of the current proposals. This could result in a very different type of National Care Service to the one currently being proposed, one more in accordance with what Common Weal has advocated in our Manifesto for a National Care Service.
That it may be possible to persuade the Scottish Government by force of argument in some cases is demonstrated by its about-turn on separating adult from children’s social care services. This never made sense, it’s not just that children with care needs often grow up to be adults with care needs, it’s also that the majority of the children who come under the Child Protection system live in households where addiction and mental and physical health problems feature and addiction problems are a major reason why people get caught up in the Criminal Justice system. The single most welcome aspect of the consultation is that the Scottish Government has apparently heard our call for a “cradle to grave” National Care Service and, unlike the recent Feeley Review, is proposing to include children and criminal justice services and keep Social Work together in a reformed role.
This in turn, however, highlights one of the fundamental contradictions in the Scottish Government’s current thinking. Having committed to not-for profit services for children in the Promise, their response to the Independent Care Review for Children, the consultation document is based on the assumption that the private sector should continue in the National Care Service. Moreover, the proposals on commissioning are likely to increase its role. So again, which is it? The underlying problems is the Scottish Government still lacks a vision about what care really means and, based on this, a coherent set of principles for a National Care Service which might help resolve these issues. There is nothing in the consultation asking about this.
The biggest issue of all, on which all else hinges, is resources. Reference is made to the SNP manifesto commitment to increase social care expenditure by 25% over the course of this parliament, but the consultation fails to explain that this won’t be sufficient to restore the cuts that have taken place over the last 10 years or the abolition of care charges. That leaves nothing to pay for the many positive sounding proposals covered by the consultation, from improving the pay and conditions of the workforce to the creation of new preventive services. Instead of asking people if we need to invest more in care and, if so, how we should do this, the consultation states that:
“public resources are still limited. As we consider the feedback from this consultation, all proposals will be assessed for value for money, to make sure the maximum impact is achieved from that investment. But in doing so we will look at the overall benefits of improving people’s experience of care and the outcomes they achieve, as well as the direct costs or savings of providing that care.”
To create a National Care Service worthy of the name the Scottish Government first needs to recognise that the single most important reason the current system is broken is because of lack of finance and they need to stop flogging the dead horse.
Nick Kempe, Common Weal Social Care Working Group