Caring for all

Is Scotland going to get a real National Care Service?

Robin McAlpine – February 24th 2021

Is Scotland going to get a real National Care Service? There are few times in the history of Common Weal where the answer has been a stronger ‘it depends on you’. It really does.

In 2020 we received an ‘article’ from care expert Nick Kempe about what had happened in Scotland’s care homes at the start of the pandemic. Except it wasn’t an article, it was much more than that. We asked Nick to rewrite it as a policy report and he did (over one weekend). It broke much of the detail of what had been happening in care homes right across the UK.

It led almost immediately to a group of people with various kinds of expertise in care issues coming together to form our Care Reform Group. When the Scottish Government announced it was going to create a National Care Service, that became the focus of the work. Over 18 months the Group met weekly to devise and write a blueprint for what a care service should look like.

We published it at the weekend and it is one of the most important things Common Weal has ever produced. It creates a vision of a truly transformative ‘womb to tomb’ care service which would save lives and so much more.

But why should you care about care? There are so many reasons. Absolutely everyone will need care over the course of their lives and anyone can end up needing care at any moment. In Scotland there are about two million people who are either giving or receiving care.

And if the need for care or to be a carer does arrive in your life suddenly (a partner with a debilitating illness, a teenage child with addiction problems, a parent developing dementia or many other scenarios) it can have devastating effects, turning your life upside down overnight.

When we fail to get care right, the problems very often spiral. A lot of problems that could be addressed through an early and inexpensive care intervention end up impacting much more expensively on the NHS or policing. In fact we tend to treat the NHS as if it is already a National Care Service, mopping up care failures out of the NHS budget.

A National Care Service can help to transform our society for the better. Before the NHS, health problems weren’t something we would have thought about until we had them, but the NHS had a public health agenda which was there to raise our awareness of what helps make a society that has less need for health interventions.

In the same way a ‘public care’ approach can do the same for care, opening a real national debate about what we all need from our society to be the kind of care-givers we hope to be.

Because the vast majority of care is informal, delivered by loved-ones who have often had no training or support to be good carers. Care is about relationships and no relationship doesn’t come under strain when we are tired or stressed or angry. So all of us can and will get care wrong sometimes, or need to give or receive more care than can be provided by us or our loved ones.

That’s what a National Care Service is for. In Common Weal’s vision, when you need that help, that care, it will be as easy to access as it as it is to access the NHS for your health needs. You could walk through the door of a Local Care Hub, exactly like the door of GP’s surgery. If you need emergency help, you can call a phone line exactly like NHS24.

If your need can’t be dealt with on the phone and is urgent enough, a ‘care ambulance’ could be sent to help, just as with our other emergency services. None of this means that you can get all the care support you might want. Resources are always limited and so need must be triaged, again exactly like with the NHS. 

And exactly like the fear of not being able to cope with ill health or extreme poverty was greatly lessened by the creation of the NHS and the welfare state, so the fear of the need for care landing on you, with no capacity to cope with it, would be largely removed with a National Care Service.

This – and so, so much more – is our vision for a National Care Service. You might not even realise what a difference this could all make to your life, now or in the future. But it can and for most of us it will.

So why do we need your help? This is the problem. The proposals on the table from the Scottish Government are nothing at all like this vision. In fact they are really little more than tweaking and rebranding what is already there, even though the proposal was created because what is already there is not good enough.

And some of what is being proposed is even worse than what is currently there, centralising control and placing even more bureaucracy on those who deliver care. Current plans in no way create a care service that can stand next to our health service in any way other than echoing the name.

All the organisations involved in care know this. While they may not say it (though some have), they know this isn’t really a proposal for a proper National Care Service. This means that, understandably, they are looking at the proposals defensively – if this isn’t making things better for us, how can we make sure it doesn’t make things worse.

As far as we can tell no-one apart from Common Weal is developing a vision for what a care service ought to be, rather than arguing against what a care service shouldn’t be. Add it all together and what results is almost certainly to be a failure.

It doesn’t need to be like this. Even recognising the high costs of doing this right, we’ve created a model which can be delivered now within the resources available. It won’t initially be everything a care service can be but it would be a very good start.

But it is reliant on looking at a lot of what we’ve been getting wrong in the past and making sure we get it right this time. This should not be beyond Scotland to do.

It won’t just happen. It needs political pressure to be applied if a bodged job is not to be done. For the next few months Common Weal will be dedicating its campaign capacity to doing this, but it won’t be enough without wider public pressure.

That’s where you come in. There is a range of simple things which you can do to make a difference and they’re not time-consuming. You can download an activist briefing on our campaign page which will give you loads of information about how to help make this happen – or you could just drop an email to your MSP and tell them you want them to look seriously at Common Weal’s proposals.

If you do, you can become part of building a National Care Service which will change the future in the way the NHS changed the future in 1945. It will be more than worth the ten minutes of your time it takes you, probably for you, almost certainly for someone you care deeply about, definitely for our society,

3 thoughts on “Is Scotland going to get a real National Care Service?”

  1. Ian Davidson

    A constructive approach to avoid a policy making debacle might involve:
    1. Persuading Scot Gov that it needs to “pause” on the hares already running to allow a more fundamental debate as envisioned by CW;*
    2. Allowing for a more limited short term plan to keep NHS and social care “alive” until more fundamental reforms. Eg: immediate boost to social care wages and conditions; increase in funding via local govt?
    However, this would require Scot Gov to concede that they have mishandled the NCS debate thus far and wasted money on inadequate consultancy reports etc. In turn, other political parties would have to allow Scot Gov to do so graciously and not rub their noses in it (too much!)? The issues involved are too important to be left to the vagaries of Scotch-politik and personalities.
    How we rescue the NCS debate from the party politicians is the challenge?
    (*one “opposition” MSP has already indicated to me informally that the CW blueprint is akin to their own policy; good news but not helpful if it becomes a narrow political party attack esp. in the context of May “local” elections?).
    Another complexity is the Covid public inquiry which will inevitably result in Scot Gov adopting “defensive group positioning” to any significant critique, and not to forget the visceral nastiness of any run-up to an autumn 23 indy ref 2 (real or imagined!)? Here’s hoping.

  2. florian albert

    The key problem is how to pay for an improved care service. Realistically, it involves increased taxation. The obvious group from whom more could be required is the property-rich and pension-rich middle class. (I do not see a ‘wealth tax’ as feasible.)
    Sadly, there is no political will to act here. We live in a society where a huge proportion of the population has done, and continues to do, very well materially BUT is unwilling to accept that this is the case. Covid has made the problem worse, as a significant section of the population was able to increase its wealth during lockdown; savings trebled in that period.

    We have an unequal society by the voters’ choice. Politicians know and accept this.
    The problem is not Westminister, or the Tories or neo-liberalism. It is our selfishness as a (Scottish) society. The Scottish left, having – to all intents and purposes – opted out of electoral politics, needs to face up to this.

    1. Ian Davidson

      Florian. I agree. You only have to read the Herald or Scotsman to see that many folks are obsessed with the value of their house, whether they can afford to send kids to a private school, how to reduce tax on investments etc. I believe this middle age/middle class aspirational bias (of which I confess, I am a product) is one explanation of why the SNP have drifted to the right as they are scared of alienating pro indy “middle class” voters. We Scots ain’t as radical as we like to think!

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