Not So Much a National Care Service

When Scottish Parliament Committees dissected the principles of the National Care Service Scotland Bill, they found a dangerous agenda for marketisation and institutionalised insecurity. Stephen Low reviews their reports.

What Nye Bevan didn’t do when constructing the NHS was base it on the idea that markets were the way to improve services, or the belief that the public sector is the second best way to provide services. Say what you like about Bevan, but he was no Humza Yousaf.

At some point later this year, after a second delay ‘to allow for engagement’ the Scottish Parliament will be asked to approve the general principles of the National Care Service Scotland Bill that Yousaf introduced last year. Those “general principles” include structures that eviscerate local government and turn over a vast range of services to (ministerially appointed) quangos. These won’t provide services directly. Instead they will procure services from public, private and third sector providers and all of the services thus commissioned – social care, all of social work and community health – will be on time-limited contracts. Every few years each organisation involved is going to have to tender to be allowed to continue to deliver the service (if they are allowed to: Section 41 of the Bill allows Care Boards to ban Councils & Health Boards from bidding). The scheme makes permanent provision impossible. It’s insecurity for everybody in Yousaf’s NCS.  

As practically everyone has pointed out, little about this scheme makes sense. It is “a press release that has grown out of control”, according to an astute comment from a delegate at the STUC. The Scottish Government does not know if its proposed Care Boards will be liable for VAT. Equally they have no idea whether staff who are transferred out of local government will still be able to contribute to a Local Government Pension Scheme. Private consultancy firms have been given expensive contracts to provide answers to both these questions. This provokes further queries, not just about the lack of thought that has gone into these plans, but about the Scottish Government’s preference for big business opinion rather than in-house expertise. In fairness, this is true to the spirit of the legislation – if it goes through as intended, there will be no in-house public sector provision of social care, social work, or community health (a concept which, like much else in this process, is ill defined). 

Previous SLR articles have looked at the bill and initial reaction to it. Parliamentary committees are now delivering their assessments, which are far from positive. All of the committees criticise the lack of detail, some of them explicitly condemn the ‘legislate now – design later’ approach taken by the Scottish Government. There are calls for any number of issues to be cleared up or published before the Bill goes any further. The lack of a business case is raised more than once. Similarly the financial assumptions, variously unrealistic or absent, attract the attention of several parliamentary committees beyond the Finance Committee (whose scrutiny I return to below). Again and again it is pointed out that the Bill is opposed by a huge range of bodies involved in social care, social work, and community health.

The Local Government & Housing Committee calls for a full business case for the NCS to be published before the Bill is voted on which. “This should set out how the National Care Service will improve services and outcomes for people receiving social care”, it says, “and also how it will improve terms and conditions for the workforce.” 

The Education Children and Young People Committee “did not hear strong support for children’s services being included under a National Care Service”. They were also less than comfortable with the proposal that transfer of responsibility for children’s services to the NCS would be via secondary legislation. “This is concerning’, it said. “The Committee is strongly of the view that the process set out in the Bill is insufficient to allow for appropriate Parliamentary scrutiny.”

The Delegated Powers and Law Reform Committee are tasked with checking whether proposed powers within Bills to make secondary legislation are appropriate. In the case of the NCS Bill, the Committee doesn’t think they are. “The Committee believes the current approach significantly reduces the threshold for parliamentary approval and prevents MSPs from bringing forward detailed amendments. The Committee believes this is unacceptable and risks setting a dangerous precedent, undermining the role of the parliament.” Consequently, the Committee “does not believe the Bill should progress in its current form.”

All of this pales beside the opinion of the Finance Committee. The delivery of their verdict, had parliamentary procedure allowed, would doubtless have been preceded by the convener (the SNP’s Kenny Gibson MSP) donning a black cap. Their task was to examine the Financial Memorandum published with the bill, which deals with its costs. They are critical of almost all of it. They deem currently published information inadequate, saying that “the approach currently being taken of the Scottish Government responding to individual stakeholders’ requests for clarification does not support transparency and proper scrutiny”. Amongst other things they say that the lack of potential cost estimates breaches Scottish Parliament Standing Orders. They criticise the lack of a business case, and say that the ‘legislate first – design later’ approach has “frustrated parliamentary scrutiny”. 

The report culminates in a demand that the Scottish Government publish a new, more detailed and accurate Financial Memorandum before the Bill is voted on as “The Committee finds itself unable to assess the affordability of the Bill.” A new Financial Memorandum has not been produced, so the Committee has repeated a call for this, and invited the new Cabinet Secretary to appear before the Committee.  

While campaigning to be leader Yousaf made a few conciliatory noises about allowing staff to remain employed in local government, and about “local contracts, local co-design”.  It is difficult to make sense of these in the context of both the letter and the intention of the Bill. Saying that staff should remain employed by councils is to suggest, in essence, that councils act as employment agencies for functions that are not theirs. They would become municipal employment agencies participating in local markets for locally outsourced services.

There is no rescuing this shambles on stilts. The Scottish Government should scrap the current Bill and begin a dialogue about creating something that will be – rather than just be called – a National Care Service. 

Stephen Low is a policy officer for UNISON Scotland.