Designing Care with All of Us

Common Weal

This week, our Common Weal Care Reform Group published their latest policy paper in the series of their truly groundbreaking work on the campaign for a National Care Service. Ready to Fail is a critique of the Scottish Government’s own approach to “co-design” of the service that we’ve published out of extreme concern that despite the NCS Bill being paused after a successful campaign by us and the STUC there are signs that the Government is not enacting the reforms it promised to make during that pause and, in fact, they are carrying on regardless with the plan started before that pause. This plan will result in large private consulting agencies like KPMG designing a care service that takes power out of local hands and places them directly and solely in the hands of the Minister for Care – whomever they might be.

It is easy for a politician to say something like ‘we’ll co-design this project with people’ but it’s harder to do in practice, to ensure that all voices are given appropriate weight and that they are actually heard not just when they confirm preconceived assumptions but when they challenge them too. As we say in the paper, for co-design to work, it needs to be properly resourced and for co-design processes to start at the local rather than the national level. But, more radically, if we are to have co-design of services in Scotland, power needs to be devolved to those involved at the front-line within nationally agreed frameworks (e.g., around pay and conditions). Real co-design fundamentally requires much greater democracy and would provide an opportunity to re-invigorate local government in Scotland with much further devolution of power within local areas.

As far as we can see during this pause period there has been little in the way of expansion of co-design processes. Engagement with the public has been sparse. For example, while a handful of public in-person and virtual events have been planned over the summer the one covering Glasgow this week took place in just a single day in Govan. Edinburgh won’t get one at all and while similar events are planned in other towns and cities in the coming weeks, if you miss your local one or can’t travel to it your options for helping to co-design the NCS are limited.

Attempts to engage with the government have been made by us and by many others in the care sector and while it would be untrue to say that we have been excluded entirely the process has not been easy and we have reports of folk being shunted from one of dozens of “working groups” to another with little clarity on how all of the work will be pulled together and even less evidence that input is making it as far as government press releases and ministerial statements. For folk like us in think tanks, we’re used to this kind of thing but for carers, care groups and the cared for, it has proven to be an intensely frustrating experience and the Scottish Government risks burning through a lot of political capital and goodwill in a time when this process should be building it.

So what is the solution? Well, it shouldn’t be nearly as top-down as it has been. The NCS as currently designed is about as centralised a framework as it’s possible to get without outright asking Westminster to reserve powers over care. We’ve outlined both in our primary blueprint and in papers such as Care In Your Community that care is best served when it is designed and delivered locally. This isn’t about nebulous fears of a “post-code lottery” – such things occur when the care you need is only available somewhere else – but about designing your local services such that you DO get the care you need even if it’s not needed elsewhere. The latter is impossible if a single Minister is making decisions about care across a whole region or country (we’d even argue that Scotland’s Local Authorities themselves are often too big to provide such localised care).

We are particularly concerned that the co-design process has itself been designed to produce a list of anecdotes and case studies from those who receive care, where what it needs is a systematic and evidence-based approach that brings in not just those who receive care but those who deliver it. This, I must stress, is not about locking out the voices of those who need care (which, after all will likely include all of us at some point) but to ensure that their voice is made as substantial as possible and not just relegated to a footnote in the final report or a nice headline in the press release.

Our paper has offered twelve recommendations for how the Scottish Government, Local Authorities and other stakeholders can reform the co-design process and ensure that it actually designs a National Care Service that is built by All of Us and doesn’t merely deliver a centralised KPMG model that not enough people were able to object to.

Co-design is not consultation – it’s not the Government checking with us to see if we agree with their plans – it’s taking that opportunity that we were told opened to us in the wake of the pandemic to create lasting, meaningful change and to build a new kind of public works that would sit in the public consciousness with the same pride that we have in the National Health Service.

Please read our paper, tell us what you think of it, and if you agree with us please let your local representatives know that this is what you think of when you say you want a National Care Service worthy of the name.