National Care Service: Does anyone know what it is?
By Alice Struthers, Programme Director of The Neurological Alliance of Scotland
Two years down the road from the introduction of the National Care Service Bill (Scotland) to Scottish Parliament, it feels like there are as many questions unanswered as progress made. Does anyone really understand what the National Care Service is, what it includes and how it will be funded? Does anyone think that this complete structural upheaval will lead to a genuinely positive, human-rights based and dignified change in the way social care is delivered in Scotland? Will Anne’s law be implemented and protected? Will carers have rights to breaks? Will children benefit from clearer, kinder and fairer social care services? Will children’s services even be part of the NCS remit?
Morale is running low at this point. Many of us have given time to providing insights and evidence over the last two years in an attempt to contribute to and shape the development of the bill. But a bit like a pick and mix, Ministers and officials appear to be taking what they like and leaving what they don’t, proceeding stubbornly with their own complicated and expensive plans.
We are not alone – across the third sector, there has been consistent questioning and challenging of the unknown elements of the bill, mainly ‘WHAT will the NCS include, HOW will this happen and WHO will pay for it’.
Questions about affordability are being repeatedly ignored - and - you could almost go as far as saying, have been deliberately obscured by officials. Local authorities for instance, still need clarity as to whether the NCS will be providing additional funding to support the application of its principles and more broadly, organisations have no clarity over how services will be commissioned. We are all wondering how the NCS will achieve its goals in terms of rights to breaks from care, and developing a proactive preventative service, which will take a front-loaded investment of millions, if not billions of pounds. Where is this money coming from?
Critically, with the amendments proposed by the Scottish Government during Stage 1 scrutiny being unseen until Stage 1 had been passed, we could be forgiven for losing heart in the co-design process as well as in the design, structure, affordability, governance and sustainability of what was initially a very good idea.
The idea of a National Care Service was born from the 53 recommendations drawn up by Derek Feeley (a former Scottish Government Director General for Health and Social Care and Chief Executive of NHS Scotland) in his ‘Independent Review of Adult Social Care’ (note the word ‘adult’ there?). Conducting an independent review was one of the commitments from Scottish Government as part of their Programme for Government in 2020.
According to the Scottish Government, “The principal aim of the review was to recommend improvements to adult social care in Scotland, primarily in terms of the outcomes achieved by and with people who use services, their carers and families, and the experience of people who work in adult social care.” (1)
Creating a social care behemoth equivalent to the size of the NHS was never going to be straightforward, but three years ago, on receipt of the Feely report, Scottish Government decided that this would be a legacy worth creating. The problem is that it has grown multiple arms and legs since then, morphing into something that even today, two years into the process, there is an alarming lack of clarity on.
The opacity of the planning process, which has relied on publishing a framework bill at Stage 1, means a lot of the detail will still be missing at Stage 2 and won’t be added until the legislation has been passed. At that point, detail can be added in the form of regulations to the legislation.
I drew attention to the word ‘adult’ above – in answer to a question from NAoS about whether children’s services will be included or excluded from the NCS, something you’d think might be a clear cut Yes/No answer, the official answer focussed on ‘The Promise’ and ‘Keeping It’. Whilst not giving a Yes/No answer, they do say “we believe the NCS benefits and system improvements should be made available to adults and children equally and consistently across the country.” This sounds more like officials want it to be a yes, whilst not being able to say at this stage that children’s services will definitely be included.
And yet, despite the warm words above and in their longer answer to our question, saying ‘It is critical that the future structure of children’s services supports our overall commitment to Keep the Promise’, consideration of children is actually very low key in the NCS Charter, (bordering on Not There At All) something the Children and Young Person’s Commissioner for Scotland describes as ‘unfortunate’.
So now we now find ourselves in the last few days of the Health and Sports Committee’s consultation period, without knowing whether children’s services are included or not and if they are, to what extent, or how they will be commissioned, or how they will be funded...
Looking at the list of side-lined proposal amendments, draft stage 2 amendments, explanatory notes and the memorandum to this bill, shows how complicated this is. It also raises more questions than are being answered. Will the bill make any difference to the experience of social care today? How will the NCS make a positive difference to those affected by neurological conditions? How will the NCS be funded when the Scottish Government recently introduced emergency spending measures and then announced half a billion pounds worth of budget cuts? How can services be built when this or any successive government will be able to completely change the shape of the National Care Service through regulations introduced at a later date? And critically, WHY is major structural change necessary when all the ambitions within the NCS could be achieved through increased investment into social care within the existing social care structures, at a fraction of the cost of setting up the NCS.
When the Minister came to our meeting in March 2024, we knew that there was no point in asking questions like the ones above which had already been side-stepped. The usual what/why/where/when and how basics were not going to be given to us. We therefore asked some more specific questions which we have shared here below. We received these answers at the end of July 2024. Let’s hope that the Health and Sports Committe can make some sense of the situation from this call to evidence, and as the temperature continues to drop around the enthusiasm for the NCS, guide the Scottish Government in the right direction.
(1) https://www.gov.scot/groups/independent-review-of-adult-social-care/
By Alice Struthers, Programme Director, Neurological Alliance of Scotland
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