What we need from a National Care Service

In this, the second of our series of posts on the care crisis, Kathy Jenkins looks at what we need from a National Care Service and how the Scottish Government’s planned service, currently before Parliament, fails in almost every respect.

A National Care Service for Scotland

Trade unions and others are expressing many serious concerns about the Scottish Government’s National Care Service Bill. 

In responding to previous government consultations, both Scottish Hazards and my Unite Edinburgh Not for Profit branch have put forward the following 12 principles.  I have added in italics our concerns about the Bill as it stands.

1. An NCS should provide care from the cradle to the grave. The Bill does not specifically include children’s services and justice services.  It says there were be further consultation on this.  The concern is that this might be a signal that they might not be included. 
2. An NCS should be provided free at the point of need, as is the NHS. If this is not possible immediately, there should be a firm commitment to this as a medium-term goal included in any legislation. There is no commitment to this in the Bill, particularly with regard to care home provision.
3. Scottish Government should begin properly funding local authorities in order for them to build up the necessary infrastructure to absorb not only the current private/ third sector provision of social care in the medium term but also the increasing demand of social care in the long term. Eg building care homes, investing in training and recruitment, investing in community and community development resources. This is not being done.  It appears from the Bill that the opposite may be going to happen.  Local authorities may become just another provider which has to bid for funds alongside the third and private sectors. 
4. An NCS should be a public service.  All of it should be not for profit, most delivered through Local Authorities and some through the 3^rd sector. There is no commitment or even mention in the Bill  of moving toward a not for profit service.
5. The NCS at Scottish Government level should be tasked with: 
6. providing adequate ring-fenced resources to provide good quality care to those needing it and fair pay and working conditions to those providing it; The bill makes no absolute commitment regarding funding.  It says Ministers ‘may’ provide financial assistance to Care Boards.
7. establishing collective bargaining involving the NCS, employers and trade union representatives to agree national pay and conditions; although the Scottish Government has said in press releases and verbal statements that this will be done, there is nothing in the Bill that says it will. 
8. design and provide good education and training for all those working in the sector, including a level of education prior to employment and then continued training and education throughout the time of employment; the Bill only says that Ministers ‘may’ provide training
9. Create a good single IT system including individual health and social care records and collection of data on need, provision, cost, etc; the Bill does largely commit to this
10. Set national standards for care and for social care contracts. This is not explicitly stated in the Bill although it does go some way toward improving governance
11. Within this national framework social care services should be the responsibility of democratically elected and accountable Local Authorities.  The Bill takes away responsibility from Local Authorities and gives it to unelected Care Boards, a development of current Integration Joint Boards, despite the many problems that have been identified with them and despite this disconnecting care from other related local authority services such as housing, environment, education, leisure, community development…
12. Local Authorities should then further devolve provision of services to local community hubs which can actively involve service providers, those needing care and those with lived experience to create local, flexible, inclusive services. The Bill does say “services provided by the National Care Service are to be designed collaboratively with the people to whom they are provided and their carers“ but with no detail of how this would happen
13. The IJB / CHSCB model should be abandoned.  Primary and community health services should continue to be part of the NHS and work closely at local level with LA services.  The NCS and the NHS should be separate, parallel services working closely together. The opposite is happening with Care Boards positioned to take over much of LA services and some NHS ones
14. We agree that human rights should be at the core of the service, but they will only be meaningful if accompanied by resources that are sufficient to provide services which can meet need, clarity about where responsibilities lie and a system that prioritises the development of good, sustainable relationships between those providing care and those in need of it. The Bill gives no assurance that these 4 R’s will be met. 
15. Regulation and enforcement are an important element of any service.  The Care Inspectorate and SSSC should be merged and work closely with the Health and Safety Executive whose remit of protecting the health, safety and welfare of social care workers (and those being cared for) is equally relevant. The Bill does not say this, however, it does go some way to strengthening governance. 
16. The NCS should fully incorporate and make real all dimensions of Fair Work. Social care staff must be treated as respected and skilled workers, have fair and secure jobs and access to good education and training. Although a commitment to Fair Work is included in the principles laid down by the Bill, there is no detail of how this might be made real, including, as stated above, no commitment to collective bargaining and national pay and conditions
17. Effective Voice will be crucial to a high quality NCS.  Strong collective bargaining must be at the centre.  Social care workers should be encouraged and supported to join trade unions, acknowledged in Scotland and internationally as the most effective way to ensure Effective Voice.” Nothing in the Bill recognises this.   In fact in the discussion of ‘co-design’ of services it is not clear whether social care workers are included.  

There is major concern that there will be no finance to properly fund a National Care Service.  It was estimated that the NI increase would bring approximately £1.3bn to Scotland and this was meant in part to fund the NCS. This increase is now not going to happen and more cuts from the UK Government are anticipated.   

I have a concern that there is a potential split among those unhappy about the Bill as it stands (including unions).  Some are saying we should campaign for the Bill to be scrapped.  Others that we should build an alliance calling for major amendments to the Bill.  A compromise would be an alliance calling for major amendments and if that fails a call to scrap the Bill.  It feels important that we develop a united response.

Kathy Jenkins
Scottish Hazards and Edinburgh Unite Not for Profit Branch
27 October 2022