How to Not Care

Nicola Biggerstaff - 9 September 2022

Last week our Care Reform Group here at Common Weal released their official response to the Scottish Government’s National Care Service (Scotland) Bill. Our critique provides an overview of our concerns with this bill as well emphasising again our recommendations found in our Caring for All blueprint. As an overwhelming rejection of our own National Care Service (NCS) plan here at Common Weal, the current government plans as they are present threats to local government powers, privacy, and overall quality of care. The government must, with urgency, be open to our suggestions which will enable a local, personalised service for those who need it most.

In our critique, we highlight the following key points:

―  We strongly note our concern about the undemocratic nature of the NCS Bill process. Many of the key details of the NCS will be determined via secondary legislation which reduces Parliamentary scrutiny and limits the ability for civic bodies and care representatives to make meaningful input at this stage.

―  We believe the Bill is an “enabling bill” which will hand expansive powers over care to Scottish Ministers even to the point of giving them the option of direct control over a sector that, until now, has been the remit of Local Authorities.

―  We think the Bill frames the provision of care around new “Care Boards”. We do not yet know how these boards will be set up but if they follow the geographic boundaries of current analogous Health Boards then this will make care provision significantly less local and more remote from Scottish communities than it is and would represent a “power grab” from Local Authorities.

―  By even further removing care from communities, we believe this Bill stands in direct contraction to the Scottish Government’s principle of “community empowerment”. We fundamentally disagree with the transfer of power from democratic institutions to institutions governed by undemocratic appointments.

―  Therefore, we believe that if Care Boards are set up, their geographic extent must be not less local than their host Local Authority and should ideally be built as locally as possible – centred around Common Weal’s Community Hub model if possible.

―  None of our eight principles we advocated for as fundamental to care have been mentioned in this Bill, or even a firm commitment to care being publicly owned and free at the point of need.

―  There are few references to protections of the workforce in the Bill. Notably, while not ruled out, the principle of national collective bargaining is not protected within the Bill. The availability of training for staff is to be delivered only at the discretion of Scottish Ministers, rather than being enshrined as a basic workers’ right.

―  The provision of health and safety of workers in the Bill is also almost entirely absent from the Bill, and we consider it disappointing that the lessons learned from the pandemic around the need to protect staff have been so quickly forgotten.

―  The role of social work is omitted entirely from the Bill. This is a major omission and a lost opportunity for reform of social work in Scotland.

―  NCS Care Boards are to be explicitly including within the scope of Freedom of Information and this is welcome, but we note that private providers of care are explicitly excluded from the same FOI legislation, even when they provide care outsourced from the public sector and using public money. Private services delivered via public procurement or other public money should be covered by the same scope of FOI as they would if the same service was being delivered “in house” by a Local Authority, Care Board or Scottish Minister.

―  There remain significant questions around the transfer of staff, services, and assets from Local Authorities to the NCS, how this will be handled and whether or not Local Authorities will receive fair compensation from the loss of power, responsibility and revenue streams generated through the provision of care.

These points form the basis of our argument that the Bill as proposed will not provide a service which meets the increasing needs caused by the aftermath of the pandemic as well as our aging population. In short, we believe the Bill presents an opportunity for the government to undermine the democratic process by removing the powers of local authorities to deliver on social care. Secondly, it exposes glaring omissions in data protection laws, highlighting that the current Bill as presented will set a dangerous precedent in which prosecution for failure to share patient data could become reality.

We are, however, glad to see organisations, including many trade union organisations, concur with our concerns, developing an increasing coalition of agreement on our key points. In particular, we welcome the Scottish Association of Social Worker’s endorsement of our own proposals to incorporate into law the legal duty to provide care in order to ensure current resource and capacity issues are satisfactorily addressed. We also welcome both COSLA’s call for services to be ‘locally delivered and democratically accountable’ as well as Unite’s call for care infrastructure to be ‘the responsibility of democratically elected and accountable Local Authorities’. These, in combination with Social Work Scotland’s concerns with the contradiction between the Bill and the Social Work (Scotland) Act 1968 cementing the provision of care within local authorities, and the STUC’s call for a service free at the point of need without risk of privatisation, there is a clear consensus from the public sector for a care service which is publicly owned and the locally delivered to ensure accountability to current and future service users. The current legislation must be amended to enshrine this into law and provide the most robust guarantees for both care workers and care receivers.

The Programme for Governance announced at Holyrood this week framed the Bill as ‘one of the most significant pieces of public service reform to be proposed by the Scottish Government’ and ‘the most significant development in health and social care since the creation of the National Health Service’. While the concept has the potential to be one of the most progressive policies in Europe, allowing us to catch up with the more socially progressive policies more commonly seen in the Nordics, the framework we have been presented with here in Scotland falls far short of the infrastructure necessary create a robust enough service which addresses the issues previously mentioned.

Here at Common Weal, we will continue to urge Parliament to reconsider our proposals for a National Care Service, highlighted in Caring for All, to provide a localised, high-quality care service which benefits everyone at all life stages.