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Colin Turbett – 14th October 2021

In early August the Scottish Government published a consultation document on its proposals for the National Care Service that had featured in the May Holyrood election as a manifesto commitment.  This developed the ideas suggested in the Feeley Report (Independent Review of Adult Care) published in January, a response to the awful levels of deaths in care homes from the Pandemic.  Common Weal had lots of differences with Feeley, including its exclusive focus on adults, its acceptance of a market in social care that would include a private-for-profit sector, and its assumption that integration between health and social work services had been a model worth continuing.  The new proposals have dealt with the first of these: the proposed framework would take in children’s services (not education), justice services and alcohol and drug services in a comprehensive “cradle to grave” care service. So far so good, but from here on the plans begin to creak at the edges. 

The consultation document, all 140 pages, contains 95 questions that are grouped together in a fashion suggesting little knowledge by its authors of current structures, issues or services provided. The notion that a service based on the current integration model of Health and Social Care Partnerships (HSCPs) and their managing Integrated Joint Boards (IJBs) has worked (not according to the Audit Commission amongst others), and should be embodied in the new structure, suggests an unwillingness to rethink failed strategies rather than create something new and bold. The structure proposed, although vague in detail, rebrands HSCPs and creates a larger national IJB on which all members (including those with “lived experience”) would have a  vote. Whilst this sounds like democracy in action its actually far from it: the new bodies would include local authority representation, but Councils would hand over their current social work and social care responsibilities in their entirety. Where this leaves the current workforce is unclear. The new service would be accountable to a government minister, meaning more centralisation and less ability to manage and control services at a local level – something we were promised with Police Scotland but which never happened. 

The consultation exercise also seems to be an exercise in faux democracy.  Going over the heads of elected political representatives at national parliament and local council level, online consultations have taken place around themes surrounding the proposals, and in localities across the country.  Anyone can sign up for these and it seems likely that responses will be so diverse and, in some cases, very personal to experience. Not that this does not have its place, but if it pushes aside expert opinion based on working experience and research, then it’s not as useful as it sounds.  The consultation paper itself, for those who are up to working their way through it, is likely to result in a large variety of interest-driven and predictable responses.  We have already picked up negativity towards local authority provided services – no surprise given constant cuts in budgets over the years, but hardly the fault of Councils, their staff, or their elected members. There is a real danger here that this will drive forward the government’s centralisation agenda. In combination it is likely that the responses will cancel each other out, leaving the government’s intentions largely intact.  Whether they will proceed further through parliament remains to be seen as the proposals do not address the complexities and issues surrounding care and possibilities for a national service.

The questions in the consultation are narrow and prescribed leaving little room for alternative proposals.  There are glaring omissions and odd inclusions: whilst Chief Social Work Officers (CSWOs – statutory appointments in each local authority area) receive not a single mention, respondents are asked to consider the role of new senior nursing inspection appointees who would oversee standards in Care Homes.  The omission of the CSWOs is interesting and illustrates the side-lining of social work expertise through the whole exercise – last week it came to light that the contract for designing the new service had been given to the Edinburgh branch of Price Waterhouse Cooper (PwC), the multinational business and financial advisory giant.  PwC globally have been associated with incompetence in auditing, helping companies avoid tax, and in other cases, misuse of public funds.  

Questions about alcohol and drug services are mostly confined to ones about the existing Alcohol and Drug Partnerships (ADPs) rather than the scope and detail of services themselves.  There are questions about commissioning (the process of giving out contracts to providers) which assume the continuation of a private sector delivering public services (80%  of the care sector in Scotland, from which profit will continue to be extracted).  The technical detail of the commissioning questions will be over the heads of most of us.  There are proposals and questions concerning the social care workforce that will be welcomed by those who work in this neglected sector, but with little detail about the processes through which respect for their role, their pay and conditions will be improved. There are other proposals that will be welcomed by many – the establishment of a National Social Work Agency to improve the status of social work sounds good, although it may lead nowhere if the present Health-interest integration model dominates the new NCS, as it currently does the HSCPs (Health and Social Care Partnerships) and IJBs (Integrated Joint Boards). 

Whilst weary of the whole consultation exercise for reasons, amongst others, offered above, Common Weal suggest you do get involved and make responses to at least those areas of the consultation in which you might have an interest.  To help the process we have launched the first in a series of briefings to guide responses to various aspects of the proposals. These cover Social Work, Valuing the Workforce, and Drugs and Alcohol Issues, and are based on policy papers already published and those which we are working on.  A fourth Briefing on Carer Issues will follow shortly. They can be found here.

We are also working on Common Weal’s own “Blueprint for a National Care Service” – a detailed and comprehensive  proposal that will cover areas neglected in the government proposals: it will define what “care” should actually mean, and describe what a free publicly provided, relationship and community based service, should look like. 

Colin Turbett is a member of Common Weal’s Care Reform Working Group  


  1. Colin. It is a humongous consultation exercise designed to confuse and wear down! Any guidance to this is welcome. As an advice worker I met lots of unpaid and paid carers. However it is only the direct experience of being an unpaid carer which destroys the final illusions. I was “only” a part time carer and knew how to negotiate the system. Even so, I found the four years very tough and Covid has added on a layer of “unresolved” emotional “stuff”. It is important that any SG strategy for unpaid carers takes on board social security/equality issues. Whilst most benefits will remain UK controlled, the SG will have full control of Carers Allowance well before 2026 so they will have the power to make it better (in various aspects) for a wider group of (mainly female) carers. No doubt they will come up with reasons for not doing so including cost in the devolved Scottish SS budget? However, if the review is serious it must take holistic needs/services/budgets view. Eg: if an unpaid carer (usually a family member) is caring on a 24/7 basis for someone who would otherwise be receiving state care, then he/she should be receiving benefits (really a “social wage”) and NI credits which reflect, to some extent, the sacrifices made and the savings on state financed care? We need transparency about actual needs and costs of care because it is a labour intensive and expensive activity, much more so than most folk appreciate. Paid carers (mainly female) should be employed on wages, job security and conditions which reflect the work they do which is more demanding and skilled than currently recognised. Etc!

  2. I worked in the care sector before I retired 15 years ago. I believe in a National Care Service because it is unacceptable that if you have an illness that is uncurable , like dementia, that you will have to pay for your care, The profit made from Private care provision is also unacceptable. There should have been a National Care Service in place years ago.

  3. Care in the Sheltered Housing context seems to have been ignored. Sheltered Housing for vulnerable seniors is too often neglected, under funded and seriously under resourced. Yet it is care option that offers some care support while allowing an independent living option. But there’s the rub. In too many cases inappropriate ” Independence” means shameful neglect. Please do not ignore the Sheltered Housing sector with Care!

  4. Kirsty Duncan

    I have worked in Social Care for 30 years and while I welcome the idea of an National Care Service, I am horrified that private care companies have so much power. If there is a profit margin or a shareholder to be considered, it will not be good for the client.
    You cannot run services like businesses because they are SERVICES and should not be run for profit.
    What we need is training, pay and conditions which reflect the skill and responsibilities of our very important jobs.

  5. The proposed ‘national care service’ is basically ‘the named person scheme’ on steroids. It is offensive, discriminating and insulting to suggest that disabled, sick, vulnerable (including elderly) adults, should be treated in the same way & with the same standards as children, prisoners, alcoholics and drug addicts. Having attended an art college in the early 80’s, with it’s drug & alcohol fuelled, hedonistic environment, by contrast friends training to be staff nurses, did a strict form training/apprenticeships akin to national service over 3 years. The quality of care at that time & their professionalism was far superior to the airy fairy ignorance which our universities are now rolling out with little hands on experience prior to working on the wards. Now they are ‘too posh to wash’. I have every respect for an old style, well trained nurse & can easily spot them in about 3 minutes flat. They also make the best care home managers as they have a better understanding of physical care issues. Many art students in the 80’s could not find employment afterwards, and a lot went into ‘social care’. There are also a lot of middle managers who took early retirement & thought they could ‘dabble’ in social work. Could this be the reason why there is such a lowering of standards in ‘social care’? There is definitely a lack of structure, training, knowledge of illnesses, physical disabilities & what constitutes good care. Many want to draw pictures or sing with them, but not help dress, wash or toilet. I have no time for some of these ‘third sector’ organisations, which are very disorganised, unprofessional & in some cases down right dangerous to the people they are allegedly supporting. Lots of money for the CEO’s, financial, business & marketing people though. There is also a very lax and almost sentimental attitude towards alcoholics & drug addicts, with little or no thought to the impact this has on those living next door to them. During the pandemic, prisoners were treated better & given more human rights, than those in care homes. Obviously those making policy from their ivory towers, live in their ‘green’ middle class homes & have never had to live next door to addicts & experience the violence, or give care themselves.

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