Developing the National Care Service – when is a covenant not a covenant?

Last week the Scottish Government announced that “a consultation document on a National Care Service is due to be published on 9^th August and the consultation will run until 18^th October”.  While Common Weal’s Care Reform Group, which was set up last year, is sceptical about the consultation, we are committed to engaging with the process as part of wider work to promote research, thinking and debate about what sort of National Care Service Scotland really needs. 

So far, to this end, we have published our Manifesto for a National Care Service, Struggling to Care or why the role of Social Workers needs to be reformed, and Care in your Community, a paper which looks at how  Community Hubs could bring social work, social care and other services closer to local communities in the new National Care Service.  We have also published the main critical response to date to the so-called Independent Adult Care Review conducted by Derek Feeley.   A suite of further policy papers will be published over the next few months ranging from a critique of the Scottish Government Independent Care Review for Children, the Promise, to the health and safety of the social care workforce and the meaning of care.

The need for a critical response to the consultation is illustrated by the main item in last week’s news release, the Scottish Government’s creation of a social covenant steering group.  Establishing the Group was described “as a first step towards the creation of a National Care Service” and “a key recommendation” of the Adult Social Care Review.  It is no such thing.  While Feeley did recommend that a new social covenant was needed, as a means of realising a human rights based approach to social care, he stated this should involve “mutual commitment by citizens, representative bodies, providers, civic Scotland, and national government to set aside self-interest and each work together for the common good”.  He did not say HOW this should be done.

Whatever you think of this covenant idea, the new steering group is in no position to deliver it.  This is because it consists almost entirely of citizens with current experience of care services but excludes other groups mentioned by Feeley, such as Providers or representatives from bodies like Trade Unions. You need all parties present to negotiate a covenant.

This is not to argue that “the real life experts” on the group, people with direct experience of care services, should not play a role in agreeing the “underlying and unifying principles to help guide decision-making” which is part of their remit.  Indeed, Common Weal’s hope would be that the Steering Group adopt some, if not all, of the principles we have already developed.  These include that the new National Care Service should be cradle to the grave, not for profit and free at the point of use like the NHS.  Many of these principles, however, conflict with the recommendations of the Adult Care Review, recommendations which the Scottish Government has already said it has accepted.  That appears to leave little room for the Steering Group to agree a different set of principles or for the wider public to influence the outcome of the consultation process.

There is an important difference too between real life experts, people who can articulate how the care system has affected them or their relatives, and experts in the care system itself.  These include professional social workers and the people with specialist knowledge who can describe how care provision has become increasingly financialised and how profits end up in tax havens or who can articulate what resources are really needed if we are to care for people properly.  Our view is that in developing a new National Care Service the Scottish Government needs to take account not just of individual’s experiences but to analyse and understand the reasons for the current failings in the social care system, culminating in the meltdown during the Covid pandemic.  Despite there being considerable social care expertise in Scotland, there is just one such social care expert on the group and they are from Sweden.  Why?

While the Scottish Government’s apparent intention is that that the Steering Group will produce policy soundbites that provide cover for delivering the Feeley recommendations this may not happen.  The Steering Group may include three members of Derek Feeley’s Advisory Group but they don’t agree on everything, including the role of local authorities.  The Steering Group also includes some independent-minded critics of the Scottish Government, like Cathie Russell from the Care Home Relatives Group who has been campaigning for the rights of care home residents and their relatives during the Covid crisis.  The conclusions of the Steering Group therefore are not a foregone conclusion and it could yet provide some opportunities for promoting the type of debate about the shape and direction of the National Care Service that we would like to see.

Whether or not this happens, it is extremely important after all of what service users, carers and the workforce have been through over the last fifteen months, that as wide range of individuals and groups respond to the consultation as possible and argue for a properly resourced care service worthy of the name.  Besides producing further policy papers to support that aim, Common Weal’s intention is to produce a briefing on the consultation when it appears and to organise and participate in events which promote the sort of wider debate about the future of care that we think is needed.  Watch this space!  If you would like to get involved contact us at hello@common.scot.

Nick Kempe, Convener, Common Weal Care Reform Group