Scottish independence supporters should oppose National Care Service

Good evening! This week's edition of the In Common newsletter comes from Robin McAlpine, Common Weal's head of strategic development.

To receive the newsletter direct to your inbox every week click here.

WITH the independence referendum nearly 10 years in the past and no sign of another, independence supporters are left with a dilemma.

What do we do if a pro-independence government is doing things we would otherwise strongly oppose? It is no longer sufficient to say we should keep our concerns quiet for the greater good of the cause.

So surely now we've reached the stage where if the Scottish Government was to introduce one of the worst and most damaging pieces of legislation in the history of the Scottish Parliament, legislation which is opposed by virtually every stakeholder involved in the issue, surely we need to speak up? Because this is happening now.

The piece of legislation concerned is the National Care Service (NCS) Bill and its awfulness should be apparent if I briefly explain its purpose and what it will mean in practice. The legislation was promised during the pandemic at a time that the Scottish Government was under pressure after decanting Covid-positive hospital patients into care homes.

What this new service was for, any vision for it or how it was going to be structured was left out of the announcement and has since been handed to a string of external consultants – millions of pounds of contracts have been placed with the likes of KPMG to design this policy.

The outcome of this is a care bill which has surprisingly little information about what it will be like or how it will work. The legislation is about who will have power and money, not what they will do with it. This means that the bulk of the legislation is what is known as “enabling legislation” – it simply allocates powers and resources.

The impact

The reason this is so damaging is where and how the powers are being allocated. Care is a highly local service by its very nature. If you're taking preventative care (for example, retrofitting someone's home when they develop a disability so they don't fall and hurt themselves) the planning and delivery is always local.

If you're carrying out supportive care (perhaps providing addiction services or holiday relief for an informal carer looking after a loved one) that generally has to be provided where they live. And even if you're providing residential care, you certainly don't want to move someone miles from their home, their families, their support networks.

Plus, care is completely entwined with lots of other public services. Care is about housing. Care is about community safety. Care is about education. Care is about addiction. Who delivers all of those services? Local government does.

The original bill simply stripped almost all power from local government and centralised it in Edinburgh, which caused real anger in the care sector and a showdown meeting. The outcome was a revised proposals for a new tripartite structure for the NCS involving the Scottish Government, the NHS and local authorities.

Except the Scottish Government directly appoints two thirds of these people so retains complete control. Worse, if frontline care workers fail to do what government instructs them to do, the bill contains a suite of new measures that would give Scottish ministers even more power to intervene in the operation of the NHS.

So why on earth is the primary purpose of the Care Bill to strip responsibilities from democratically elected local authorities and hand them instead to central government which will administer them via boards it controls?

The big question

Care is currently split between public provision (which covers most of the examples I gave above) and private provision. That is mainly the profitable residential services like care homes (a substantial proportion of which are owned in offshore tax havens).

These businesses make their money by milking fees and constantly remortgaging property to extract the value of property price rises, distributing the profits to shareholders and passing increased rents on to the public purse.  Private care homes not only consistently provide a worse service, they offer significantly less value for money as both fee profits and profits from property speculation are taken out of the money the public is paying them to look after our own grandparents. Yet they are marginally cheaper than public provision because of lower average quality of care.

I can see why turning the provision of care into little more than a series of commercial contracts handed out by a quango to a bunch of care corporations is preferable to high-quality public provision for KPMG and its clients – but why is the Scottish Government going along with this?

If this legislation is allowed to pass, it will lead to the biggest single act of privatisation in the devolution era, reduce the quality of care we all receive and fragment care services in a deeply unhelpful way. There is no benefit to this system. It is truly, truly awful.

You'd oppose this in a flash if this was Rishi Sunak trying to undermine the entire non-profit care sector. Virtually every single stakeholder remains adamantly against this legislation. Common Weal will soon publish an extensive list of amendments which would make this Care Bill one that Scotland could be proud of.

We hope you will challenge your local SNP politician (all the other parties oppose this) and tell them that this is too far, that you can't stay silent this time.