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The “Co-Design” for creating a National Care Service and what to do about it


Lead Author: Nick Kempe

Contributions from the Common Weal Care Reform Working Group

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The co-design process for the NCS, launched after the NCS bill was published, has not worked.

This is, partly because co-design means different things to different people and partly because there has been little consideration of how the concept might apply to the complex world of care. This paper has attempted to set out a more comprehensive framework for considering how co-design should apply to care provision at the individual, service and policy levels.

For co-design to work, it needs to be properly resourced and for co-design processes to start at the local rather than the national level. But, more radically, if we are to have co-design of services in Scotland, power needs to be devolved to those involved at the front-line within nationally agreed frameworks (e.g., around pay and conditions). Real co-design fundamentally requires much greater democracy and would provide an opportunity to re-invigorate local government in Scotland with much further devolution of power within local areas.

This paper lays out recommendations for how the co-design process can itself be redesigned to ensure that Scotland creates a National Care Service worthy of the name.


― Common Weal was part of a coalition of organisations involved in the delivery of care services in Scotland who called for a pause in the process of developing a National Care Service so the Scottish Government could return to the drawing board and use a co-design process which involved frontline staff. The Common Weal’s Care Reform Group has been monitoring progress since.

― There are substantial doubts that the Scottish Government is actually committed to a co-design process and there are strong signs that the changes are cosmetic while the Scottish Government can continue with the outsourced design process it was previously using.

― There is no clarity on the difference between co-design, collaboration and consultation (entirely different processes and the government approach conflates these seemingly at will).

― The process continues to exclude completely the experience of the pandemic, even though that is nominally what triggered the policy.

― Far from ensuring that there is mutual consent for changes being proposed, the Scottish Government is contravening its own pre-existing policies, not only not ‘co-designing’ significant parts of the proposals but progressing with them without even basic consultation.

― There are repeated instances where the Scottish Government claims to be pursuing a co-designed solution but has entirely excluded key stakeholders.

― Despite promising a co-design process, the government continues to spend large amounts of money on private sector consultants – but has dedicated no resources to the co-design process itself a part from civil servant time.

― Again and again the assumptions that the Scottish Government brings to the design process betray a refusal to give up any direct Ministerial control.

― Some of the unilateral decisions made by the Scottish Government are very controversial. For example it had created new criminal penalties for carers in the NCS Bill – staff who failed to share information without even consulting them.

― The Scottish Government has been widely criticised for centralisation throughout the process of designing the National Care Service, but is doubling-down even further, centralising control over services and driving involvement from the top down. This flies in the face of the standard process for co-design which they are supposed to be following.

― There are real concerns that the Scottish Government is deliberately trying to pit those who receive care against their carers to retrospectively justify a policy position the government is nominally in the process of reviewing with an open mind.

― Instead, to give the impression of listening, the Scottish Government has created a convoluted mess of working groups, with over 70 at the last count and no coherent way proposed to pull their work together.

― People who have tried earnestly to engage with this process have been getting increasingly frustrated and are largely losing confidence:

― The convoluted mess of processes means that progress is glacial, to the extent it raises questions as to whether the government wants the process to succeed or not.

― The underpinning principle of the National Care Service remains ‘rationing’, not universal availability like the National Health Service. There appears no way to change this via the co-design process.

― Beyond even that, where the co-design process is being used at all, what it is allowed to examine is still restricted what the Scottish Government wants, not what frontline staff or service users want.

― The research and evidential basis for the Scottish Government’s proposals are threadbare. Policy is being ‘designed by anecdote’ rather than through rigorous, consistent, respected methodologies of research.

― This is particularly concerning because of the limited cohort from whom these anecdotes are being derived. They are ignoring and excluding care workers and instead listening primarily to ‘care experience individuals’. Almost all of these have special and intensive needs and their experience of care will be different, and they are self-selected. In addition, many in this cohort are children (sometimes as young as three), or adults with dementia, severe learning difficulties or addiction problems.

― If the Scottish Government was serious about a co-design process it wouldn’t just be allowing people have ‘a say’, it would be giving them power.

― The report concludes with a detailed series of proposals for how to reverse this process and convert it into one which is genuinely driven by the principles of co-design.

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