The Common Weal Care Reform Working Group examines the Scottish Government’s Nation Care Service Bill and critiques its provisions.Credits—
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The purpose of this paper is to take a critical look at the National Care Service Bill, as introduced to the Scottish Parliament and explain why as currently drafted it will not deliver the vision of a comprehensive National Care Service (NCS) which we set out in Caring for All and to highlight where amendment would improve it. We also explain why the measures it proposes may make care services worse, not better. Our intention is to assist all those who want a National Care Service worthy of the name to come together and campaign for the changes to the Bill that might enable this to happen, so as well as critiquing the content of the bill we set out the main areas it needs to cover and the issues it needs to tackle.
To say that Common Weal are disappointed with the Bill as proposed would be an understatement. In fact, we consider it quite dangerous: as we have outlined, democracy and accountability have been sacrificed on the basis of building on what is already there in the failed Health and Social Care Partnerships. The Bill removes the role of local authorities, and we would be concerned about their future as a bedrock of democracy – despite all their flaws. Our own alternative is outlined in Caring for All, and we will engage in the consultation process and continue to argue the case for the properly funded and robust National Care Service that Scotland deserves.
Common Weal gratefully acknowledges the advice and assistance we have received from experts, practitioners and trade union representatives in the Scottish care and social work sectors during the writing of this critique.
― Common Weal wishes to strongly note our concern about the undemocratic nature of the NCS Bill process. Many of the key details of the NCS will be determined via secondary legislation which reduces Parliamentary scrutiny and limits the ability for civic bodies and care representatives to make meaningful input at this stage.
― The Bill is an “enabling bill” which will hand expansive powers over care to Scottish Ministers even to the point of giving them the option of direct control over a sector that, until now, has been the remit of Local Authorities.
― The Bill frames the provision of care around new “Care Boards”. We do not yet know how these boards will be set up but if they follow the geographic boundaries of current analogous Health Boards then this will make care provision significantly less local and more remote from Scottish communities than it is and would represent a “power grab” from Local Authorities.
― By even further removing care from communities, this Bill stands in direct contraction to the Scottish Government’s principle of “community empowerment”. Common Weal fundamentally disagrees with the transfer of power from democratic institutions to institutions governed by undemocratic appointments.
― For this reason, Common Weal believes that if Care Boards are set up, their geographic extent must be not less local than their host Local Authority and should ideally be built as locally as possible – centred around Common Weal’s Community Hub model if possible.
― None of the eight principles that Common Weal advocated for as fundamental to care have been mentioned in this Bill, not even a firm commitment to care being publicly owned and free at the point of need.
― There are few references to protections of the workforce in the Bill. Notably, while not ruled out, the principle of national collective bargaining is not protected within the Bill. The availability of training for staff is to be delivered only at the discretion of Scottish Ministers rather than being enshrined as a basic workers’ right.
― The provision of health and safety of workers in the Bill is also almost entirely absent from the Bill and Common Weal considers it disappointing that the lessons learned from the pandemic around the need to protect staff have been so quickly forgotten.
― The role of social work is omitted entirely from the Bill. This is a major omission and a lost opportunity for reform of social work in Scotland.
― NCS Care Boards are to be explicitly including within the scope of Freedom of Information and this is welcome, but Common Weal also notes that private providers of care are explicitly excluded from the same FOI legislation even when they provide care outsourced from the public sector and using public money. Private services delivered via public procurement or other public money should be covered by the same scope of FOI as they would if the same service was being delivered “in house” by a Local Authority, Care Board or Scottish Minister.
― There remain significant questions around the transfer of staff, services and assets from Local Authorities to the NCS, how this will be handled and whether or not Local Authorities will receive fair compensation from the loss of power, responsibility and revenue streams generated through the provision of care.