It seems the National Care Service bill is being driven by the perceived political advantages of a national agency, not by patient needs, writes John Ferry.
Last week’s Audit Scotland submission to Holyrood on the costs of setting up the Scottish Government’s new National Care Service should alarm all of us.
Scotland’s official auditor has highlighted issues with pensions, VAT charges, capital investment and health board transition costs that could see the final bill spiral compared with current estimates.
Audit Scotland says a number of costs associated with the measures have yet to be assessed, and that “the potential for additional cost is significant”. The government initially estimated the new service could be put in place at a cost of half a billion pounds, but Scottish Parliament researchers in October estimated the bill over five years could be up to £1.26 billion.
Over £5 billion a year is spent on delivering social care services in Scotland, but those are at crisis point. Demand far outstrips supply. Staff are overworked and underpaid, which means vacancy rates and worker turnover are high. Scotland’s elderly and others who need care are left dealing with a system that often fails to meet their needs.
In 2020, the Scottish Government commissioned an independent review on adult social care – the Feeley Review. This produced a number of recommendations, including better pay and conditions for the workforce, and a suggestion for a structural reorganisation that would see responsibilities for the planning, commissioning and procurement of adult social care, and accountability for the social care system, transfer to Scottish ministers.
Centralisation, control, and lack of accountability
The Scottish Government has zeroed in on this latter recommendation, with the National Care Service (Scotland) Bill now making its way through parliament.
The bill will take responsibility for running social care services away from local authorities and hand it to the Scottish Government. It will prompt the setting-up of a series of care boards that operate in the same way as health boards, and which will report into Scottish ministers.
And, whereas the Feeley report’s recommendations only related to adult social care, the National Care Service will have the power to expand into other age groups and services (child social care and social work, and criminal justice social work) without new primary legislation.
"Social care has never been in the state it’s in now."
Audit Scotland says the new National Care Service is likely to be hundreds of millions over budget – but Scottish Care’s Donald Macaskill says it will need even more funding. pic.twitter.com/TyZpc5vU7q
— The Nine (@BBCScotNine) November 1, 2022
Another important difference between the proposals in the bill and the Feeley report is that the latter envisioned a national care board, made up of various stakeholders and representatives of people who use care services, undertaking the strategic oversight role, as opposed to boards linked to ministers via civil servants. Feeley wanted the national board to support locally empowered boards.
This points to a fundamental problem with the bill. Centralisation, control, and lack of accountability sits at the heart of what the government is pushing through.
Bill creates a new national bureaucracy
As with the centralisation of the police, it seems the bill is being driven by the perceived political advantages of putting in place a national agency with national branding, rather than pragmatic considerations focused on service delivery.
The bill delivers none of the changes to the front line that are needed now, such as better staff wages and working conditions
Combine this with an administration chain that feeds directly into the centre of government, and that is at risk of political interference, and you can see why a controlling, nationalist administration has fashioned the bill the way it has.
The first minister likes to claim the new system will be as game-changing as the setting up of the NHS. It will not be.
The bill, as it stands, creates a new national bureaucracy and removes even more power from local councils, but delivers none of the changes to the front line that are needed now, such as better staff wages and working conditions. It merely delivers the new, centralised structure, at immense cost to the taxpayer.
It also transfers the budget for delivering social care out of local government and onto the books of the core Scottish Government. That, too, will have political advantages for the Edinburgh government.
Even normally compliant SNP MSPs are concerned
Complaints of tight budgets at the local authority level tend to land at the door of the Scottish Government, which delivers the funding. Tough budgeting decisions emanating from Holyrood get spun as Westminster’s fault. Power centralised is accountability deflected.
Audit Scotland’s submission is merely the latest red flag to be raised on a proposal that could have serious implications for some of the most vulnerable people in our society.
Control over social services could move from local authorities to government. Read our summary of what people and organisations think about the NCS Bill.” We produced this for @SP_HSCS You can read this here 👇 https://t.co/kycYu7OTBe pic.twitter.com/IkfhOLFi5J
— Scottish Parliament Information Centre (@SPICe_Research) November 3, 2022
Michelle Thomson and Kenneth Gibson, who both sit on Holyrood’s finance and public administration committee, have, notably, been critical. Thomson stated recently that she has “no confidence whatsoever” that the government’s financial report on the service represents any level of accuracy or value for money, while Gibson said the policy “seemed like a sledgehammer to crack a nut”, if it does not provide the funding to address issues in the healthcare sector.
When even normally compliant SNP MSPs are raising concerns in this way, the Scottish Government should sit up and listen. That is, if caring for vulnerable people can come before politics.
John Ferry is a regular commentator on Scottish politics and economics, a contributor to think tank These Islands, and finance spokesperson for the Scottish Liberal Democrats
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