Nick Kempe for the CW Social Care Group – 28th October 2021
Common Weal has carefully considered and completed the 96 questions in the Scottish Government’s National Care Service (NCS) consultation which closes on Tuesday 2nd November. If you read our response, you will see that we do not believe the consultation is fit for purpose. We would still, however, encourage people to respond.
The main positives in the consultation is the section on the scope of the NCS (Questions 23 – 53) which included some questions about extending the recommendations of the Independent Review of Adult Social Care to all care groups. This has the potential to create a National Care Service from the cradle to the grave. We understand there are now serious concerns from Children’s Services about being included in a health dominated NCS. The solution to this is not to continue the splits in social work and social care but rather to abandon the proposed plans for further “integration” of health and social care and allow the NHS and NCS to develop as separate, but complementary organisations.
Apart from extending the scope of the NCS, the consultation avoids asking any questions about why the current system has failed so badly, what should be learned from the pandemic or what would be needed to create a NCS worthy of the name. There is no attempt to explore why the NCS shouldn’t be like the NHS, where services are for all and free at the point of need and not for profit, where staff are properly paid and trained and where allocating the necessary resources is, despite all the challenges, a national priority. Instead, the underlying assumption behind the questions appears to be that the current system should continue but can be dressed up with a number of ad hoc reforms as somehow being a new NCS. The Scottish Government is in danger of missing the opportunity to found a NCS based on principles which have widespread popular support and worthy of the name.
Worse, through its proposals to integrate health and care, two very systems, it threatens to undermine the very principles on which the NHS was founded: if the proposed Community Health and Social Care Boards are tasked with commissioning private services for care, it will surely be a small step to them being allowed to commission private health services, as is happening down in England. The proposal in the consultation (Question 30) to devolve management of GP contracts to the new CHSCBs should be viewed as a step in that direction and is hard to reconcile with the proposal (Question 57) to standardise social worker contracts nationally.
Our further major concern is that the Scottish Government appears unable to see beyond service user consumer choice dressed up as human rights. There is absolutely nothing in the entire consultation about models of service – whether current models of care home care for example need to change as a result of the pandemic – but instead a mistaken belief that giving service users choice will somehow solve the deficiencies of the private care market. It hasn’t and and tinkering around the edges of the procurement system (Questions 67-70) won’t change that. Instead, we need a totally difference approach based on collective as well as individual needs, in which services are designed with and embedded in local communities. In our view only local authorities, suitably democratised, can deliver that.
The consultation questions themselves are in our view generally not fit for purpose and poorly designed. Rather than being open ended, most offer respondents binary choices based on assumptions with which most respondents will have a significant number of reservations. In our case, we have decided therefore not to answer most questions, unless we can give an unequivocal yes or no (as opposed to a “yes but” or a “no but”). We suspect that many respondents will set aside their reservations on the basis that if they don’t tick a box their response won’t be counted. Because of these flaws we don’t think the Scottish Government will be able to put much weight on any of the responses.
To compound these difficulties, a significant number of questions allow no space for comment or articulate what they think. In those cases, we have added comments in the nearest available comments box.
These failings are not primarily the fault of Scottish Government staff. The Covid pandemic exposed the lack of capacity and expertise in the care system. The consequences of that lack of capacity and joined up thinking in the Scottish Government is also illustrated by the failure to incorporate the consultation on Anne’s Law in the NCS consultation. Unfortunately, instead of utilising expertise from Scotland (service user and carer organisations, trade unions, professional organisations representing social workers, academics and researchers) the Scottish Government appears to have decided to outsource design of the NCS to Price Waterhouse Cooper and we understand a further tender is in the pipeline.
Although there is now very little time to respond to the consultation, we hope that publication of our response may assist others to register their concerns here: https://consult.gov.scot/health-and-social-care/a-national-care-service-for-scotland/consultation/ . There is no need to answer more than a fraction of the questions. All we would advise is that respondents are very careful before ticking any of the boxes!