Janice McAlpine

Janice McAlpine

The National Care Service is a Lie

Reading Time: 7 minutes

Unison activist and social worker Janice McAlpine says the Scottish Government’s plans for a misnamed ‘National Care Service’ are a backward step.

In recent weeks the liberal cosplay of COP26 supplied the Scottish Government with useful cover for its failed domestic policy. Our governing establishment will be doubly pleased that the jamboree obscured the close of the public consultation for a so-called “National Care Service” at the beginning of November.

It’s important for the left in particular not to lose sight of the huge missed opportunity – and potential damage – that will come with these proposals for much-needed reform of social care. There has barely been a worse time in recent memory to be in receipt of ‘social care’ services as defined in Scotland, as elderly people’s rights were infringed over the course of the pandemic, disabled people – who make up 17% of the population – accounted for almost 60% of COVID-19 deaths, and drug deaths continue to shame us. These failures are a result not only of bad policy but also a hollowing out of public services over a decade or more of austerity measures promoted by the UK Government and ably transmitted by the Scottish Government to Local Authorities (responsible for the vast majority of loosely defined ‘social care’ services).

If there was hope to begin with that a National Care Service might offer some prospect of improvement, these hopes have quickly been dashed.

Without shame, the SNP have compared the National Care Service to the creation of the NHS when in fact the plans will only bolster the profit motive that already pollutes much of social care provision, remove vital local accountability, will leave workers short-changed and, most importantly, are vague at best on how it will improve anything for people who require support to live their lives to the full.

A boon for the interests of capital

Let’s begin with the profit motive and the convenient misnomer of a “National Care Service”. The interested member of the public – and probably the average parliamentarian – would be forgiven for thinking this was about the nationalisation of care: an idea that rightly attracts support from the public. The reality is that the National Care Service will essentially be a shell-like commissioning body, procuring services (potentially at a huge scale) from third and ‘independent’ (aka private) sector care providers. Indeed it is not even clear what the future role of local authority public provision is, as the precursory ‘Feeley Review’ recommended councils go into competition with independent providers. The Minister, Kevin Stewart MSP, has been at pains throughout the consultation period to talk-up the role of private providers.

Scottish Government submission to the interests of capital is once again barely disguised and the closeness with private providers, represented by Scottish Care, is evident through the private sector’s warm embrace of these plans. Many large providers of care are salivating at the prospect of ever larger contracts (with children’s and justice services likely to be up for grabs too) while smaller community-based organisations look on in concern.

Putting to one side the merits of private vs public provision, the proposals look disingenuous when the SNP made significant pre-election capital from suggesting profit would be removed from care once and for all, as Nicola Sturgeon and then Cabinet Secretary for Health Jeane Freeman were happy for the public to be under the impression that a National Care Service would do what the name would suggest. “Nicola Sturgeon backs plans for national care service as criticism grows of profit-making homes” one Daily Record headline read, while the First Minister hinted at nationalisation of all care services in a live pre-election TV debate. “Sturgeon supports Labour calls to remove profit from Scotland’s care homes” ran The Herald.

The role of the private sector in these plans runs deep, extending even to the design process and analysis of consultation responses, placing capital at the heart of the policy-making process. The kicker came as it was revealed PWC have been awarded a contract for “design of [the] project…and [development of] a high-level roadmap towards delivery of design”. It is a development that one can assume would enjoy the support of Charlotte Street Partners’ Prof. Paul Gray, who weeks before took to the Reform Scotland website to champion the continued involvement of the private sector in the future of health and social care. Of course Gray signed-off that piece with the job titles he once held (chief executive of NHS Scotland, 2013-19 and NHS Scotland Director of Primary and Community Care from 2005-2007) rather than his current role as a ‘consulting partner’ of Scotland’s most influential lobbying firm.

Gray’s journey from an executive position to loyal critic of the system he helped build is perhaps symbolic of Scotland’s very small circle of policy makers and civil society leaders who are currently negotiating the future direction of care services on our behalf. Membership of this club includes predecessor Derek Feeley, author of the ‘independent report’ on which the National Care Service consultation is based.

And in Scotland, most of the major voices have skin in the game (often in the form of direct funding from Scottish Government or hopes of large contracts coming their way) meaning proper scrutiny by civil society is absent. With Holyrood unable to offer any serious challenge, it is even more important that the trade unions, disabled people’s organisations and other organised communities make their voices heard and are listened to in this consultation – but what hope when that listening exercise itself has been outsourced?

Not unrelated, political debate on this is almost totally absent. This should be a fight for the soul of our public services and social security net, yet all it appears we have is a range of vested interests lining up to ensure they do well from the reforms, the Greens (previously proud defenders of localism) apparently silenced, and weak opposition from Labour and (naturally private sector indulgent) Conservatives. As so often, dividing lines in the parliament are cultural and rhetorical – there is broad consensus on concrete matters of policy and rule.

A let down for key workers

The reforms look set to be a complete let down for key workers in social care who are surely the most undervalued public servants we have (whether employed in the public sector or not), barely receiving more than the minimum wage for most front line care roles. Vague references are made to ‘valuing the people who work in social care’ and frameworks of standardisation ‘which providers can opt into’ – more good news for providers.

This all exposes another failed SNP commitment: the commitment to ‘Fair Work’. Despite the Scottish Government’s previous acceptance of the recommendations of the Fair Work Convention (which includes trade union recognition as a key tenet), there is no place for organised labour in the governance of the National Care Service, meanwhile it is recommended that third and private sector providers are brought closer to decision making. It was disappointing to see trade unions welcome the proposals on announcement (perhaps drawn in as were others by the name), but encouraging to see them now engaging more critically in the conversation following further reflection and consultation with members.

A decent pay rise for social care staff seems always to be around the corner and recent (albeit derisory) pay uplifts and £500 ‘bonuses’ for care workers out with national bargaining arrangements demonstrate the Scottish Government currently do have the means to act in this area. We do not need a National Care Service to boost wages and give social care staff a fair pay rise. Little wonder then that predominantly female social care workers, continuing to be among the lowest paid in our economy, are drifting to Aldi, Lidl and McDonald’s, leaving widening cracks in service provision.

The social work profession will be trampled on as the National Care Service appears to move social work into a managed national service by the brief mention offered within the lengthy consultation paper. Love them or loathe them, social workers have provided radical thought and action within public services and the profession, along with its founding principles, must be preserved.

Loss of local control and accountability

The next element the left – and society at large – should be worried about is the enhanced central control and associated loss of local accountability that comes with these proposals for a National Care Service. In 2011, Campbell Christie published perhaps the most important intervention in public service discourse post-devolution Scotland has seen, championing community empowerment, investment in prevention and local integration of services. Despite rhetoric to the contrary, the National Care Service is the Scottish Government’s latest affront to the principles of Christie.

The value of localism is often overlooked by the left in Scotland and the UK, but it is vital that public services remain democratically accountable and that power is dispersed as locally as is practical in social services. Again, large provider lobbies have lined up to decry the ‘false dichotomy’ of local vs national with what seems to have been a successful argument that those in favour of local control of services are a vested interest.

At the most basic level, who will you hold to account when your loved one is let down by the social care system? One look at the faceless NHS complaints system would not fill you with hope. And what about plans such as those in Ayrshire to pursue a Community Wealth Building approach (backed by Scottish Government in theory) to ensure public contracts contribute to the local economy? Care services being run by one large national behemoth may bring confidence to those in St Andrew’s House that they have ultimate control but where does this leave Community Wealth Building and other innovations around community-led support?

Little hope for those who matter most

Finally, and most importantly, the Scottish Government’s plans for a National Care Service simply offer no theory of how the lives of those who receive social care support will be improved. The reforms look very much to be about centralisation and the shuffling of deck chairs while the big questions around the pernicious marketisation of care, how we will pay for services in the future and how society can prepare itself for demographic change are conveniently ignored. As outlined by the likes of Ellen Clifford, the radical energy of organised disabled people’s movements made huge gains which have been wiped out by Tory and SNP austerity at UK and Scottish level. The National Care Service as proposed threatens to be another step back. Even in basic terms, the associated £800m additional funding (over 4-5 years) announced is less than a quarter of what the Feeley Review said was necessary for the social care sector, as pointed out by the STUC.

As with all government initiatives, there is a lengthy road ahead for parliamentary scrutiny, further consultation and so on, before the new service is up and running in a promised four years. So far, what is being offered is not a National Care Service worthy of that title. By now, we should well understand that the government cannot be trusted to deliver. We will need to transform care ourselves.

Janice McAlpine (not her real name) is a Unison activists and social worker

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