Getting It Right: A National Care Service for Scotland

The creation of the National Health Service has been instrumental in ensuring the health and wellbeing of people in this country. Increasingly threatened by the UK Tory Government’s creeping privatisation and underfunding, we have experienced just how valuable the service is during the Covid pandemic. Managing health is devolved to the Scottish Parliament and we have NHS Scotland.

The Covid pandemic also highlighted our care services, a mixture of private, local authority and charity run organisations. In some places these are working to a satisfactory standard but not in others. Across the whole Care Service there are huge challenges due to staff shortages and limited funding. The Scottish Parliament has before it now a Bill to nationalise care services in Scotland.

As there was with the establishment of the NHS there are conflicting views about nationalising the complex and varied services which fall under the remit of Care. The Bill is currently at Stage 1 which means it has a long way to go, making its way through committees, before any decisions are made.

The Bill allows Scottish Ministers 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

Scottish Parliament

The Scottish Government’s reasons for wishing to create a National Care Service are explained here: Policy Memorandum National Care Service (Scotland) Bill.

The Tories in Scotland are opposed to the Bill with Chris Hoy MSP calling it “reckless and unaffordable legislation”. In his criticism of Scotland’s Health Minister, Humza Yousaf, Chris Hoy said:

“He ignores the present funding crisis in local government and social care. He dismisses concerns from a workforce that is underpaid, worn down and burned out. He overlooks the acute lack of staff and provision in care at home. He sets aside the skills and workforce crisis in residential social care and ignores the crisis in drug and alcohol services. Instead of taking concrete steps to properly fund social care at the local level, the SNP wants to embark on a massive restructuring, which will divert the millions that are needed to invest in staffing away from the front line and into the pockets of civil servants and administrators.”

Highlands and Islands SNP MSP Emma Roddick has described the Tories reaction to the establishment of a National Care Service as ‘infantile’. Emma Roddick said:

“The introduction of a National Care Service will be the biggest overhaul of public services since the creation of the National Health Service. It is overwhelmingly backed by the public and all parties should be celebrating the opportunity it brings to improve care across Scotland.

“The Conservatives’ opposition is inconsistent and infantile – they call for us to do more for the care sector, then criticise us for spending money on it. They are simply up to their old tricks.

“I, of course, understand that we must get this right. Scrutiny at this stage means we can design the best possible service, and my colleagues and constituents can have full faith in me spending the rest of this process making sure Highland and Islands voices are heard and that local expertise is taken forward.  But to ditch the policy now would be a great shame and the wrong move.

“The Conservatives voted against the creation of a National Health Service twenty-two times. I really do urge their current representatives to consider whether they want to be on the right side of history this time around – I would have hoped in 2022 that we wouldn’t need a world war for all parties to get behind looking after our citizens.”

Reforming the delivery of Care is extremely complex, interlinked as it is with health and other services which support people when they need it. What we have today is struggling and often failing to deliver both locally and nationally. The formation of Integrated Health and Social Care was an attempt to improve the delivery of services but that’s not been able to live up to the fanfare which followed its creation in 2016:

“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. “

Scottish Government

Orkney Constituency MSP, LibDem, Liam McArthur said:

“Few dispute the need for reform of our social care sector to meet the needs of an ageing population. However, hollowing out even more powers and funding from local authorities only risks putting more strain on already stretched services.

“I have long had concerns about how the Scottish Government’s centralised model might work in an island setting like Orkney. However, as parliament’s finance and health committees heard this week, those concerns are now being expressed clearly and consistently across the board.

“As the price tag for this power grab soars so the fears deepen about what it could mean in practice for the delivery of care services. The continued lack of detail is adding to the uncertainty and it is clear that the wheels are coming off these reckless plans.

“Rather than set up a billion-pound bureaucracy, Scottish Ministers should abandon plans to centralise and instead invest that money in boosting pay and conditions and empowering local services to drive up the quality of care.”

There is much to be done listening to, consulting with and discussing the implications of a national care service. The Scottish Government’s memorandum on the Bill states:

The Scottish Government is committed to engaging with people with experience to co-design the detail of the new system, to finalise new structures and approaches to minimise the historic gap between legislative intent and delivery. For that reason the Bill creates a framework for the National Care Service, but leaves space for more decisions to be made at later stages through codesign with those who have lived experience of the social care system, and flexibility for the service to develop and evolve over time.

Scottish Government Policy Memorandum

When we have people today in Orkney and across Scotland not being provided with the care they require what we do not need are politicians turning this into a political football. Brexit has resulted in us losing care workers who returned to Europe because they either no longer felt welcome here or because they lost their work status. As a result providers, like local authorities, have had to ‘buy in’ outside workers to provide the essential care at home that people need. That is expensive and a drain on limited funds. In many communities there is also a housing crisis. The growth in multiple home ownership, private lets for holiday accommodation and empty homes is a significant barrier in the recruitment of care workers in rural and island locations.

It is interesting that many of the same arguments being made against a National Care Service were also made about establishing a National Health Service.

Views such as those of Tory MP Joan Davidson were typical.

“To my mind this Bill saps the very foundations on which our national character has been built. It is another link in the chain which is binding us all to the machine of State. It is giving more power to the Minister and to the caucus. It is depriving the individual of yet more of his long-fought-for freedom. The Government believe that they can do as they like, because of the large majority sitting behind them. But the majority of today may be the minority of tomorrow. “

Hansard, National Health Service Bill 1946

Even views expressed in favour of national health service were similar to the ones we are hearing today about a National Care Service. For example, the Labour MP Hyacinth Morgan:

“This is not my ideal Health Bill, but I must say that I like it very much.

I hope when the Minister is making his regulations, he will make them as elastic, fluid and workable as he can, so as to secure the good will of the health workers of the country. I refer not only to the doctors, but the dentists, pharmacists, nurses and everyone else in the health institutions.”

Hansard, National Health Service Bill 1946

As this Bill for establishing a National Care Service makes it way through the committees of the Scottish Parliament it is essential that those we have elected to represent us, at every level, no matter which political party they represent, engage with the vision of the legislation in a meaningful and constructive way.

“Social care and social work services should deliver consistent, high quality support to every person who needs it, across Scotland. Those services must have human rights at the heart of the system, enabling people to take their full part in society and live their lives as they want to, while keeping individuals and communities safe.”

Scottish Government Policy Memorandum

The above quote is a good start. Now we expect our politicians to deliver on their promise to represent us and to put the best interests of the people ahead of their political ideologies.

Fiona Grahame