The National:

This is the second edition of the new In Common newsletter from the pro-independence think tank Common Weal. To get it sent direct to your inbox every week, click here.

This week's edition comes from Nick Kempe.  Nick was a social worker who became head of service for older people in Glasgow and, since retirement, has been trying to reform the care system as part of Common Weal’s Care Reform Group.

Successive Scottish governments have been trying to reform social care ever since the creation of the Scottish Parliament in 1999, basically in an attempt to do more with less. It hasn’t worked.

The social care system was in severe crisis before 2020 but unravelled during the pandemic, as both Covid inquiries are reminding us.  It was out of that experience that popular demand arose for a National Care Service (NCS) to rival the NHS.

Reluctant to commit to an NCS, the Scottish Government asked Derek Feeley, a former civil servant responsible for the system, to “independently” review adult social care. Feeley’s recommendations, published in February 2021, advocated more top-down management of resources, exercised by ministers through strengthened "integration" structures and the continuation of private profit in care. But it is exactly that approach which had driven down pay, drained money from care into corporations, frustrated planning and fragmented data. 

Mindful of the public mood, Feeley also suggested expanding the scope of his recommendations to create a NCS, and this was included by the SNP in their 2021 election manifesto.

Meantime Common Weal’s Care Reform Group had been developing a blueprint for a very different type of NCS. Our vision, set out in a report Caring for All, was for a not-for-profit care service, free at the point of need, centrally financed like the NHS but locally controlled and with power devolved to frontline staff and the people they work with.

In the year before the publication of the NCS Bill in June 2022 the new Scottish Government initiated some consultation, set up numerous internal working groups and, behind the scenes, engaged KPMG to design a secret “Target Operating Model”. That may explain why the NCS Bill took the Feeley recommendations much further, removing care from local authorities and handing extraordinary powers to Scottish ministers.

Opposition to the bill quickly developed. It promised nothing to service users and carers apart from words, failed to meet trade union demands, and alienated local councillors from across the political spectrum. On top of all that, MSPs started asking searching questions about the costs and benefits.

In January 2023 Common Weal, the STUC and others publicly called for a halt the bill. In March it was postponed to June and then in June was “paused” to January 2024, ostensibly to allow further time for services to be co-designed. 

READ MORE: Major changes in plans for Scottish National Care Service

Real co-design implies devolving power, to enable people to design services from the bottom up, but what’s happened to date appears little different to any standard consultation, albeit more extensive and with dozens of civil servants involved. A series of “co-design” events were held over the summer leading to a national forum held in Glasgow on Monday where five “themes” were discussed. 

While it's positive the Scottish Government has created spaces where officers can hear what the social care system is really like, ministers’ responses have been to reiterate the need for respect and dignity. That cannot happen without far more fundamental changes to the system and the Scottish Government has still not explained how these discussions might affect the draft bill. 

The only area where the Scottish Government’s legislative intentions have become clearer results from its volte face and deal with Cosla in the summer, that local government should retain responsibilities for social care. The talk is now of a tripartite National Care Board, comprising national government, local government and the NHS, with an “independent” chair and including representation from various stakeholders. The composition looks similar to what we proposed in Caring for All but it is not clear where the real power might lie, up or down.

READ MORE: Common Weal: What to expect from our newsletter with The National

The National: Maree Todd

The proposal in the bill to create a National Social Work Agency has also been developed somewhat. On Monday the responsible minister, Maree Todd (above), talked about using the agency to turn social workers into “human rights warriors”, but to do that she needs to repeal all the legislation that has turned them into gatekeepers for the system.

Since the UK Government dropped its proposal to increase NI contributions, the prospect of a properly funded NCS has receded considerably. That makes it even more important that the Scottish Government uses its powers to stop profits being extracted from the system even if it cannot fix the total funding gap. 

Almost every other aspect of the NCS, however, lies within the powers of the Scottish Parliament. We could therefore move towards the blueprint set out in Caring for All by changing how the system uses existing resources. For example, basing staff in accessible community hubs; empowering care workers to take decisions with the people they care for; replacing competing services with locally based services co-designed to meet collective needs. 

In short, we could empower the people who should be helping and providing care to do just that, the opposite of the top down managerialist approach still embedded in the NCS Bill.