Social care is in crisis and not fit for purpose – that much is obvious on both sides of the England-Scotland border. The Scottish government is currently consulting on proposals for a National Care Service, an ambitious proposal to transform social care in this country forever. At least, that’s what it appears to be on the surface.
Anyone who interacts with the present system will testify why a universal model in the mould of the NHS is so necessary. Services are fragmented and privatised as for-profit providers dominate the sector. Care staff are poorly paid, with many on zero-hour contracts. Austerity has seen services underfunded at the worst possible time – if anything, the level of demand and need for specialised service is only increasing as our population ages.
Boris Johnson’s solution is to chuck at least a bit of money at the problem by raising National Insurance Contributions, which will disproportionately impact the low-paid, but without pushing any meaningful reform. The Scottish government claims it wants to be more radical than that. An Independent Review of Adult Social Care was published earlier this year and a mammoth 138-page consultation duly followed for a National Care Service, which closes November 2nd.
First Minister Nicola Sturgeon has said setting up a National Care Service will be “one of the biggest ever achievements of this parliament” and “just like the National Health Service in the wake of the Second World War… a fitting legacy of the trauma of Covid”. The evocation here is significant: giving social care genuine parity with the NHS would mean a comprehensive, publicly owned service that is free at the point of use. Labour stood on this commitment in the 2017 and 2019 elections under Jeremy Corbyn.
Unfortunately, that is not what is being proposed by the Scottish government. What the Scottish government lays out in the consultation is a proposal for a national care commissioning and procurement service, rather than the National Care Service they claim to want to create. Last year, Sturgeon indicated she supported calls to “remove the profit motive” from the care home sector. However, if anything, the level of outsourcing in the sector would expand under these proposals.
Currently, 63% of Scottish care homes are run in the private sector – for care homes for over 65s, the figure is 74%. There is nothing in the Scottish government’s proposals to indicate this will change. In fact, the new National Care Service will be “responsible for the commissioning, procurement and contract management of national contracts” and responsible for “market research”. That means care staff would not be employed by this service, in stark contrast to the NHS.
When it comes to contracts, it’s not clear that bodies in the public sector, such as councils, will even have preferred bidder status. Tendering would profoundly expand under the current proposals: the scope of the new national care body would extend to children’s services, community justice, alcohol and drug services, social work, and an element of mental health services.
This is the wrong move. The current market-dominated model of ownership is broken and must not continue. An investigation by The Ferret in 2019 found at least 44 Scottish care homes were owned by companies based in tax havens. Money and resources that should be going towards the care of the most vulnerable people in our society are being looted by tax avoiders, yet there is nothing within the consultation on tackling offshore ownership. Any proposed National Care Service cannot live up to its billing unless it addresses this glaring problem.
There’s no doubt some will see a suggestion to nationalise the whole sector as “extreme”, but private and third sector providers are in real financial difficulty on both sides of the border, and hundreds have collapsed or handed back contracts over the past few years. The net cost of bringing these under public control would be lower in the long run.
Scotland is often believed to be a social democratic beacon to many on the left in the other parts of the UK. However, as it stands, the public debate around social care reform here is just as narrow. We need to be advancing the argument now that public ownership is the only safe way to secure the standard of care we need for our elderly, vulnerable and disabled people – in all parts of the country.