The Scottish Parliament now has before it the ,National Care Service (Scotland) Bill, which aims to :

transfer social care responsibility from local authorities to a new, national service. This could include adult and children’s services, as well as areas such as justice social work. Scottish Ministers will also be able to transfer healthcare functions from the NHS to the National Care Service.

Previous attempts to reform social care in Scotland with an Integrated Health and Care System, has been mixed. With the 2016 reforms, Boards were established in each local authority but combining two different ways of working, the NHS and the providers of social care (which are many and varied) has proved to be a very expensive and difficult task.

Social care covers a huge number of services with very different providers: local authorities, charities, private, family/kinship, etc. It’s never been properly funded and relies heavily on the work of volunteers and low paid workers. Despite that many of the services provided in our communities do excellent work.

When the pandemic struck in March 2020 politicians began to realise the importance of social care in our communities, particularly as the shocking rise in Covid related deaths in our Care Homes became apparent.

And now before the Scottish Parliament is the Scottish Government’s Bill to again try to reform our social care services by making them into one national body – as happened with the National Health Service.

Except this isn’t 1948, and social care is not medical care (although it may include that).

This is what the Scottish Government said back in 2016 when the Integrated Health and Social Care Boards were created:

Integration is the most significant change to health and social care services in Scotland since the creation of the NHS in 1948. Integration aims to improve care and support for people who use services, their carers and their families. It does this by putting a greater emphasis on joining up services and focussing on anticipatory and preventative care. 

So that wasn’t really working as they hoped it would and after only 6 years the new idea is to have a National Care Service.

This is what the new National Care Service Bill states:

Care or health services that are transferred to the new service could be delivered nationally or locally. New bodies called “care boards” would be responsible for delivering care locally.

There are to be 2 different kinds of Care Board:

1. A Local Care Board – this covers a specific geographical area, Scottish Ministers will decide what they regulate
2. A Special Care Board – for certain services that cover the whole of Scotland

Right – so where you live, the Bill would get rid of one Integrated Health and Social Care Board and replace it with : A Local Care Board and several different Special Care Boards.

It is complex trying to reform such a diverse range of services but what the Scottish Government is doing is coming at this from the top down.

The Bill has already met with opposition from the trade unions with Unite calling it a ‘recipe for disaster’.

Unite general secretary Sharon Graham said:

 “The Scottish Government could not have drafted a more incomprehensible, incoherent and dreadful Bill. The plans to transfer services, people and property from local authorities to the Scottish Government are a recipe for disaster and represent an all-out assault on local democracy. 

“This is wasted opportunity for the Scottish Government to build a public, accountable care service that genuinely serves the needs of the people of Scotland and leads the way across the UK. Unite is determined that we will force a rethink because these proposals risk making a bad situation for social care even worse.”

Unite is raising further serious concerns over the lack of detail on how Care Boards (Local and Special) will interact under the terms of the National Care Service. 

Nick Kempe of Commonweal accuses the Bill of lacking vision and what it actually represents is a ‘new community health service which incorporates care’.

“The new care boards, which will take over care from local authorities, are therefore a misnomer.  This is probably to help disguise the fact that the bill represents a takeover of care services by NHS mandarins and their advisers in Price Waterhouse Cooper and KPMG.  As an illustration of this, while the bill enables local authority staff to be transferred to the care boards, clause 31 (2) specifically excludes health staff being transferred from health boards.  “

National Care Service (Scotland) Bill

The trade union Unison has said that comparing the creation of the NHS in 1948 with this National Care Service Bill is a ‘sham’.

Unison state: “It locks in social care as a commodity in a market rather than a public service for citizens. In doing so it confirms profit from care as a founding principle of the National Care Service

“It has profound implications for the future delivery of social work and social care services with strong potential to extend the market.”

And for local authorities, it strips away power. For the likes of the Islands Authorities where people are used to very good levels of social care being delivered and managed locally – this Bill is a major Power Grab.

Commenting on the Bill, Social Care Minister in the Scottish Government Kevin Stewart said:

“One of the key benefits of a National Care Service will be to ensure our social care and social work workforce are valued, and that unpaid carers get the recognition they deserve.

“When this Bill passes we will be able to have the new National Care Service established by the end of this parliament. In the interim we will continue to take steps to improve outcomes for people accessing care – working with key partners, including local government, and investing in the people who deliver community health and social care and support.”

Perhaps Kevin Stewart should start to listen to the serious concerns raised by those representing the workers affected by this Bill.

Wendy Dunsmore, Regional Officer, Unite the Union said:

“The proposals represent the biggest power grab by the Scottish Government in the era of devolution. Scottish Government Ministers will be able to unilaterally decide what services are to be delivered nationally or locally. Yet, there is next to no detail on major elements of these proposals including how local and special care bodies will work independently and with each other even if it’s at a ministers sole discretion. The proposal to make local authorities a ’contractor’ for a service they currently provide by one of these care bodies is just simply bizarre. 

“Unite has for some time been severely worried about the emerging framework surrounding the National Care Service and we have had every right to be. These proposals will be vociferously challenged and ultimately defeated.“

Fiona Grahame