“Scotland needs a new approach to social care to make these aspirations a practical, everyday reality across the country. We need to create a National Care Service that is based upon a new narrative, replacing crisis with prevention and wellbeing, burden with investment, competition with collaboration and variation with fairness and equity. And we need to put people at the centre of it: people who use social care supports, their families and carers, and people who work in social care services. If not now, when? If not this way, how? And if not us – who?” – Professor Derek Feely, Independent Review of Adult Social Care in Scotland, Feb 2021

What will be retained is some reform of the way care is delivered in Scotland:

• A new non-statutory advisory board – comprising of people with lived experience of accessing care, social care workers, care providers, trade unions, the NHS and local government – will be established to provide guidance and drive improvement within the sector.
• The introduction of Anne’s Law, which upholds the rights of residents in care homes to be visited by families or friends
• A right to breaks for unpaid carers
• Improving information-sharing across health settings 
• For individuals to access and manage information about their care
• Plans for a national social work partnership.

It is a major climb down for the Scottish Government. Social Care is delivered differently across Scotland: the private sector; the Local Authority; and Third Sector Organisations.

It was recognised during the Covid-19 pandemic that social care needed reform. On 16 March 2020 the first death in a Care Home attributed to Covid was registered. By the end of March 2021, 3774 residents in Care Homes had died due to the virus. At the start of the pandemic, many Care Homes were totally unprepared for coping with a highly infectious virus. Staff were lacking in training and coping under the extreme stress of watching those they care for succumb to the virus, whilst they themselves had limited Personal Protective Equipment. Care workers also died. Unbelievably and shockingly vulnerable patients were being transferred to Care Homes from Hospital without being tested for Covid. It was known that the virus could be deadly for older people. Relatives and family members during the height of the pandemic were either not permitted to visit or had those visits severely limited.

£30million has been spent by the Scottish Government in consultations and working towards a National Care Service. Maree Todd, Social Care Minister, told MSPs that although that money has gone:

“The 2024-25 budget provided a £2 billion investment for social care and integration, which means that funding for social care has increased by more than £1 billion since 2021-22.”

The charity Age Scotland is disappointed that the Bill has been ‘watered down’. CEO Katherine Crawford commented:

“This was the opportunity of a lifetime to really reform how social care is delivered but this substantive element of the plan has been dropped altogether. The key tests of better public accountability, responsibility, how care is invested in and consistent high standards across the country have not been met in what is now being presented.
 
“With a system crying out for reform, it’s incredibly disappointing that the Scottish Government has decided to water-down its National Care Service plans to this level. The politics behind this has resulted in a collective failure of our older generation of today and tomorrow.
 
“Saving elements of the Bill such as supporting care home visiting and improving carers’ rights is very important and must be upheld.
 
“The challenges facing social care are only getting greater, with huge waits to receive it, an increasing number of people having their packages pulled overnight, and thousands of older people spending months in hospital because they can’t get the vital care they need and deserve at home.
 
“As it stands, this Bill won’t fix any of that.
  
“Without really fixing social care, the Scottish Government’s attempts to reform the health service will happen with one hand tied behind its back.”

In February 2021 the Independent Review of Adult Care in Scotland, commissioned by the Scottish Government, and led by Professor Derek Feely, was published. The core remit of the review was to “recommend improvements to adult social care in Scotland”. It’s recommendation was for a National Care Service.

In the foreword Professor Feely stated:

“We describe how a National Care Service can drive consistent, high quality social care support in partnership with people who have a right to receive that support, unpaid carers and the workforce. We also look carefully at funding and make some recommendations about investing in social care support and ending all non-residential charging for services. To achieve that new system, we need the structural change and the new accountabilities that a National Care Service will bring and we need more. We need a new narrative for adult social care support that replaces crisis with prevention and wellbeing, burden with investment, competition with collaboration and variation with fairness and equity. We need a culture shift that values human rights, lived experience, co production, mutuality and the common good.”

In summing up, the report looks towards the Scottish Government to provide ‘courageous leadership‘ and continues “it needs to act, we hope with support for improvement from across Scottish civic and democratic society, to deliver a system of social care that takes as its central aim the realisation of every citizen’s right to participate fully in society, whatever their needs for support. And that system needs to work in full partnership with other aspects of our public services, not least the NHS but not only the NHS either: housing, and justice, education and economic development are all central too.”

Faced with increasing budgetary pressures, opposition by some MSPs to the very concept of a National Care Service more interested in scoring political points than working together ‘to create a system of social care support where everyone in Scotland has the opportunity to flourish‘, the Scottish Government has paused the plans. The ‘courageous leadership’ is not there. The niggling petty politics infesting Scotland ensures that the support needed to make a much needed National Care Service, is not there.

It is an opportunity missed, and will have consequences for decades ahead.

Fiona Grahame