This month, the National Care Service is back in the spotlight as MPs and MSPs scrutinise the practicalities of launching Sturgeon’s flagship policy. Described as the most significant reform to public services since the creation of the NHS, the plan has ignited debates on the limitations and possibilities of introducing a centralised National Care Service (NCS) across Scotland.
The Service was proposed in response to an independent review of adult social care services published in 2021, which identified limited collaborative leadership and inconsistencies in access to services across Scotland. Announcing this investigation into Scotland’s care services in 2020, Nicola Sturgeon hailed a prospective National Care Service as a tool with which to create a “lasting and positive legacy of a high quality” care that is “fit for the future”. Whilst many have welcomed the Scottish Government’s proposed solution as recognition that the current social care system demands a radical intervention, others remain sceptical of how it will deliver improved outcomes across communities. Recently, the SNP’s former health secretary Alex Neil stressed that the plans fail to “address the urgent changes needed”. Neil’s assessment echoes the complaints made by Cosla’s health and social care spokesman Paul Kelly, that the NCS is “unnecessary expensive structural reform” that does not prioritise immediate improvements.
Whilst this uncharted reform is clearly a fertile topic through which to score political points, it is essential that policy makers maintain a clear view of the practicalities, and possible benefits, of its implementation beyond partisan ideology. Although the Social Care Minister, Kevin Stewart, has refused his opponents’ calls to pause the NCS, he has nevertheless acknowledged that there are “various unknowns” surrounding the scheme’s delivery. Whilst this stasis remains unresolved, the challenges facing the sector will only worsen, with devastating effects on those accessing and providing care. To drive real results for communities and carers alike, politicians of all affiliations must now collaborate with service providers and users to develop a national service that responds to local and sectoral needs.
So what does the ambitious legislation for the provision of care in Scotland? The National Care Service Bill, which was introduced in June 2022, aims to “end the ‘postcode lottery’ of care” by establishing a national framework for the standards and delivery of social care. The Bill will integrate social care services under a centralised body divided into regional boards. In doing so, the responsibility for care services will shift from local authorities to Scottish Ministers by 2026. New care boards will replace the integrated joint boards that currently deliver local social care and community health services, with the intention of improving integration across services. Membership of these boards will be dictated by Scottish Ministers, although further details are yet to be confirmed.
Some have voiced concerns that removing accountability from local areas risks overlooking the community-based expertise that is crucial to developing appropriate and effective services. Indeed, trade unions have branded the plans an “all-out assault on local democracy” and warned that national frameworks are ill-suited to account for regional nuances and respond to local demands. Politicians must also recognise that the cost of delivering care is far higher in some areas of Scotland, and that local quality standards will inevitably vary unless funding takes account of these regional cost differences. However, supporters of the Bill insist that only centralisation can provide the increased oversight, improved coordination, and long-term planning necessary to drive consistent outcomes for communities across Scotland.
Sturgeon’s government has also been keen to highlight how a more robust and centralised funding model has the potential to alleviate the staffing pressures that are currently challenging the social care sector. Although the NCS Bill has not yet detailed how it will fund measures to ensure that carers are “valued for the[ir] critically important work”, it does outline additional channels to improve carer welfare and retention. Specifically, the national oversight offered through the NCS will support the introduction of the Fair Work convention, which seeks to improve wages and working conditions for the Scottish workforce. By including Fair Work within the guiding principles of the NCS, the Bill aims to ensure that ethical working practices are embedded in legislation and thus directly monitored and protected as national KPIs. Furthermore, the government hopes that redesigning social care as a centralised body will characterise Scotland’s care services as a formalised national institution. Doing so will encourage greater respect among the general public for the crucial and challenging work undertaken by carers.
Undoubtedly, key questions remain to be addressed during the co-design process over the coming year: funding, integration, and regional flexibility are all crucial factors that must be accounted for if the NCS is to deliver the improvements urgently required by carers and their communities. However, it is equally evident that the NCS has the capacity to address the shortcomings identified in the 2021 review of adult social care. Particularly as Scotland’s social care crisis continues to mount, it is crucial that politicians, providers, and communities work together to create a streamlined and fair service. The National Care Service should not be a political battleground on which to score ideological points, but instead an opportunity to reimagine the delivery, and value, of adult social care within Scotland.