A Summary Report of our Caring For All Policy PaperCredits—
Common Weal Care Reform Group:
Craig Dalzell, Jeanette Hill, Kathy Jenkins,
Nick Kempe, Marion MacLeod, Robin McAlpine,
Prof. Mark Smith, Colin Turbett, Neil Watson.
The Scottish Government has announced its intention to create a National Care Service, in part to recognise the sacrifices made by the people of Scotland during the pandemic. This clearly echoes the creation of the National Health Service to recognise the sacrifices citizens made during the second world war. If Scotland’s National Care Service is created without that level of ambition it will represent a betrayal of the sacrifices which have been made – and current plans do not have that level of ambition.
That is why Common Weal set up a Care Reform Group which has now published its blueprint for a National Care Service (NCS). Caring For All: a National Care Service for Scotland is a plan which is comprehensive and ambitious but realistic and achievable. It reveals that at any given time about one in five people in Scotland need care (not including children without additional needs) but that about 90 per cent of them do not get any support with care. At any given time about two million people in Scotland either give or receive care and, over our lifetimes, every single one of us will be one of those people. Shortchanging them would surely be unthinkable.
The report is a very substantial document produced by a team of care experts over a period of 18 months. Its key conclusions are as follows:
― Care is the glue which holds society together and the vast majority of care is informal, citizens looking after family and friends. But sometimes informal care goes wrong or isn’t enough and in these circumstances people need formal care support.
― But care services are currently in a critical state and not fit for purpose – underfunded, rationed, fragmented, centralised, top-down and risk averse. Staff are undertrained and underpaid, morale is low and turnover high.
― To fix this Scotland needs an all-ages, comprehensive, not-for-profit National Care Service which is free at the point of need.
― While coordination, strategic planning, financing and the delivery of a range of support services (along with political accountability) must take place at the national level it must be organised and delivered at the local level through local authorities.
― To make care accessible it should be delivered through Local Care Hubs where, exactly like GPs’ surgeries, anyone with need can make an appointment and discuss their needs with a professional and either get services on the spot or be referred on to them where necessary.
― While human rights matter in care, if rights are not matched with resources, responsibilities and relationships, they won’t result in change.
― Relationships are crucial because care is a relationship-based activity so care workers must be publicly trusted and respected – which cannot happen if staff turnover is high, they’re insufficiently trained and are allowed to support people, not be constantly enforcing rules on people.
― That means staff must be trusted as professionals and the top-down, risk-averse bureaucracy of the current system must be stripped away.
― There should also be a 24-hour national phone line for emergency care issues (like NHS 24) and emergency response services to people’s houses (like a ‘care ambulance’).
― Part of a National Care Service should be dedicated to reducing the need for care by taking a ‘public care’ approach to encouraging a society which creates less need for care in the first place and by supporting informal carers.
― Early interventions to prevent care needs getting worse is also crucial.
― All of this combined would create a revolutionary ‘womb to tomb’ service that everyone would access at some point in their lives, from parenting support at conception through to end-of-life residential care and anything in between, from addiction issues to incapacity to housing needs to psychological services.