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The Care Bill must be stopped at all costs

Robin McAlpine

There is a vision for the future of Scotland that no-one is telling you about, because if you heard it you wouldn’t like it. Yet still onwards drive the people who seem determined to make it a reality. What should worry you is that the Scottish Government is allowing it to happen.

I spent a large chunk of this week editing and getting the Common Weal Care Group’s amendments to the National Care Service Bill ready for publication. It is the first time I’ve been through the proposed legislation in detail and – well, it’s truly awful. I can explain how the worrying vision for Scotland works by explaining what the Care Bill is doing.

The primary function of the National Care Service Bill is to strip local authorities of primary responsibility for running care services and to transfer almost that entire function into government where it will be all-but wholly controlled by ‘The Scottish Ministers’.

It is important to understand the scale proposed. Some of this you may have picked up, like the straightforward creation of a new quango appointed by government to replace democratically-accountable local authorities as the main ‘provider’ of care. The use of the word ‘provider’ I will come back to in a minute.

It also comes with all the punitive, anti-frontline staff provisions that that requires. Without fail, when central government tries to micromanage frontline workers they do it by trying to scare the bejesus out of them. This legislation creates entire new criminal sanctions for care workers. Breaching the dictats of government on how to carry out care could, in certain circumstances, put you in jail for up to seven years once this is law.

I’ve explained many times that the way you centralise services is through the good-old-fashioned methods of Taylorism. For those of you who don’t know or remember what Taylorism is, that’s because, as a management theory, it won so comprehensively that you probably now consider it to be normal.

Taylor took the work of Adam Smith and Karl Marx and converted it from being an observation or a critique into being a doctrine. Very simply, if you want to have maximum management control you cannot afford to have staff who are too powerful. They must be highly controllable.

The problem is that a basically unskilled manager has a clear disadvantage over a skilled worker in terms of negotiation. The solution is what is known as de-skilling. The best known version of this is where you take a process that is complex and carried out by an artisan and break it down into a series of specific tasks which can be automated and so carried out by unskilled people.

In Adam Smith’s famous example, it was the shift from a pin being made by a craftsperson to a pin being made through 18 specific industrial process, no one of which required any real job knowledge. Not only can you speed up production this way, you can also exert significant control over your staff.

While Taylorism has done loads of social (and arguably economic) damage over the years, even its opponents have to accept that it greatly increases the productivity of industrial process. You can just do more, faster if you can automate, and to automate you need to reduce the complexity of individual tasks.

I suspect that by now you’ve clocked that care isn’t divisible or capable of being automated in that way. If you break the manufacturing of a pin down into component tasks and automate each, the product you end up with is basically the same pin as before. 

But if you do that with complex tasks you get one of two things happening (or both at once). Thing one is that you get much worse outcomes because the original task isn’t suited to fragmentation. Thing two is that you actually lose significant amounts of productivity as people have to manage all the bureaucratic elements of this process (which takes time) but without any productivity gain (because you fundamentally can’t automate complex services).

We’ve had a giant experiment in this concept of bringing Taylorism into complex public services. It is called the NHS Internal Market and it has been an absolute disaster. Forget the endless gum-bumping about what’s wrong with the NHS, what’s wrong with the NHS is that modern capitalism is making us sick and when we need a health service, that service is creaking because of the market reforms Thatcher introduced in the 1980s.

Yet this is what is about to happen in care, or more accurately, this Bill represents the final transition to a de-skilled care model. To give you an idea of the scale of central control here, government ministers are giving themselves the power to intervene directly not only on generalities but on specifics. The idea that a minister in the Scottish Government should be able to overrule a skilled social worker in relation to a specific client is a dreadful one.

So what is this really about? Is this power-drunk Scottish Government ministers? I don’t think so. To understand, it is important to understand the concept of the Commissioning State. This is the penultimate stop on a rightwards trajectory, the next stop of which is full right-wing libertarianism where citizens are given money to ‘buy’ public services and are left with only the private sector in which to do so.

In this version you still get public services broadly free at the point of need, but those are never provided in the public domain. All services are delivered privately (at best by the voluntary sector, but that’s not what this is about). The role of government is cut right back to the sole function of buying those services for you.

What happens in this version is that a host of private, profit-making companies become the only provider of public services and the purpose of government is simply to place contracts with them. Full stop. Governments would still need to set taxes and create laws, but in terms of delivering public services, government would all but disappear.

Is this the goal of the SNP? I doubt it. I rather doubt that SNP politicians are really aware that this is happening. I can only repeat over and over – this is a political ideology that only exists among corporations, right-wing technocrats, lobbyists and senior civil servants. No-one has every voted for this stuff because no politician could admit to supporting it and get elected.

We’ve seen this same thing again and again – procurement hubs prolonging PFI in infrastructure building, the transfer of the responsibility for recycling from local government to a private company set up by civil servants who will then give it the entire recycling budget, the non-stop drift towards greater commissioning in the NHS and so on.

I could speculate endlessly about why this is the preferred route of the economic and governmental elites (they always make money out of this personally once they retire, they are contemptuous of the skills of politicians and believe they should be disempowered, there is outright corruption in terms of lobbying and so on). Right now it doesn’t really matter.

Right now what matters is that someone stops this conspiracy between the Scottish Government and the trade body for care homes (as you know, largely another property and services scam much of which is owned in off-shore tax havens and which costs a fortune because where they really make their money is constantly remortgaging their properties and extracting the money, passing the resultant extortionate property costs onto the public).

We saw how close these two groups were when you realise that the vast bulk of Jeane Freeman’s communication during the pandemic was not with care experts but with the commercial lobbying arm of a care industry which rips off the public. This is the merger of government in Scotland with elite commercial interests in Scotland and it is all progressing apace.

It is this straightforward; if I told you the Tories were trying to wipe out direct public provision organised for the public good and replace it with a centralised system where bureaucrats contract public services with tax haven-based corporations that have no experience in the relevant service, you would not only be horrified, you’d be doing everything in your power to stop it.

But it isn’t the Tories. It’s the Scottish Government. If the Cabinet allows the civil servants to get away with this it will not be the end. Rather it will only be one further step on the hollowing-out of the public good in Scotland so an elite group can make stupendous personal profit by extracting more money which they will do by providing a worse service.

I will therefore leave you with this; even the process through which this is happening is frankly a corrupt distortion of both government and the public good. They tried to impose this whole and met overwhelming resistance from the real care sector. So they promise a pause which turned out to be an absolute con, reintroducing exactly the same legislation.

So the parliamentary committee demanded to see promised amendments before the passed Stage One of the legislative process (unanimously on a cross-party basis). The Scottish Government refused and said they’d be published at Stage Two at which point the legislation can’t be stopped.

The committee then asked to see those amendments in advance. The Scottish Government not only refused, this week it announced that they won’t even make many of the promised changes by amending the Bill at Stage Two but by secondary legislation after the Bill is passed, an approach which leaves ministers unaccountable for their false promises.

All that to stop Common Weal inserting the words ‘not for profit’ into the legislation which will shape how you are treated if you develop dementia in your old age. This is a major test of the new political administration in Scotland and if they impose this, hell mend them. For the rest of us, fight this or you will regret it. Probably personally and probably in horrible ways.

4 thoughts on “The Care Bill must be stopped at all costs”

  1. Bill Kerr-Smith

    How, Robin? I have great confidence in your assessment of the proposals and the likely outcome, but I see no significant way to influence the actions of the Sottish Government. I am a 74-year old ex-Green, ex-Labour member who now feels politically homeless, but I do support Common Weal and fervently wish that it was a political party that I could campaign for. What are the options for people like me who have lost faith in the inspirational movements of our younger years but still feel that Common Weal provides a channel for the hopes of a nation?

  2. Fiona McOwan

    I am echoing the above concerns, given the hegemony that is controlling this, how do we intervene?

  3. Regarding Anne’s Law the most appropriate and best legislative process would be by additional Regulation and not through the NCSB as Regulations with similar macro objectives already exist and are enforceable by the Care Inspectorate.
    In any case the wording of Sec 40 of NCSB offers no rights to family and bares no resemblance to the wording of the specific SNP manifesto commitment.

    The key current most relevant Regulation for care homes to Annes Law is “Regulation 4 Welfare of users” One option is to add in a new section e) to Regulation 4 along the lines of this draft:
    “4.— (1) A provider must— (e) where a provider of a care home service, not restrain a service user’s family and significant others contact when similar prevention and control of infection procedures as care home service staff are followed.”

    Guidance could then expand on this new expanded Regulation to ensure contact is in person, indoors, in service users bedroom, numbers at each visit, etc etc.
    https://www.legislation.gov.uk/sdsi/2011/9780111012321/regulation/4

  4. The key to successful implementation of Anne’s Law is to firstly agree that both care home staff and family have EQUALLY valid claims to have access to care homes and that both groups will follow any restrictions needed such as PPE or Testing. Care home staff require access for employment and to support residents. Family require access for maintaining vital family relationships love and support. There is NO HIERARCHY OF ACCESS where family or care staff have a higher or lower need or right of access. One group is not a higher risk to the other or vice-versa and that narrative misusing ECHR to single out family as having a lower priority than care staff for access to care homes, or that only family can pose a risk to life, must be rejected firmly.

    The key to Anne’s Law is implementing the wording of the SNP manifesto promise. “This will include delivering ‘Anne’s Law’ – giving nominated relatives or friends the same access rights to care homes as staff while following stringent infection control procedures, as called for by Care Home Relatives Scotland”
    It is reasonable to expect SG to honour a manifesto pledge as written. The only way to successfully achieving Anne’s Law is linking care home staff access to family access. Then if care staff get into care homes then so do family and vice versa. .Any consideration of mitigations for “exceptional circumstances” should apply to both staff and family – such as deploying PPE and testing – while some mitigations/restrictions would be slightly different such as “barrier nursing” or family visiting only in the bedroom. The wording of Sec 40 of the NCSB or wording of changes to the Regulations administered by the CI should follow the wording of the SNP manifesto pledge which would then deliver Anne’s Law. .

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