Sturgeon’s National Care Service Bill fails patients – and staff

Plans to centralise power have serious implications for vulnerable citizens

Audit Scotland’s submission to Holyrood on the costs of setting up the Scottish Government’s new National Care Service should alarm all of us. Scotland’s official auditor last week highlighted issues with pensions, VAT charges, capital investment and health board transition costs that could see the final bill spiral compared with current estimates.

Audit Scotland says a number of costs associated with the measures have yet to be assessed and “the potential for additional cost is significant”. The government initially estimated the new service could be put in place at a cost of half a billion pounds, but Scottish Parliament researchers in October estimated the bill over five years could be up to £1.26bn. Over £5bn a year is spent on delivering social care services but those are at crisis point. Demand far outstrips supply.

Staff are overworked and underpaid which means vacancy rates and worker turnover are high. Scotland’s elderly and others who need care are left dealing with a system that often fails to meet their needs.

In 2020, the Scottish Government commissioned an independent review on adult social care – the Feeley Review. This produced a number of recommendations, including better pay and conditions and a suggestion for a structural reorganisation that would see responsibilities for the planning, commissioning and procurement of adult social care, and accountability for the social care system, transfer to ministers.

The Scottish Government has zeroed in on this latter recommendation, with the National Care Service (Scotland) Bill now making its way through Parliament. It will take responsibility for running social care services away from local authorities and hand it to government. It will prompt the setting up of a series of care boards that operate in the same way as health boards, reporting to Scottish ministers.

And, whereas the Feeley Report’s recommendations only related to adult social care, the National Care Service will have the power to expand into other age groups and services (child social care and social work, and criminal justice social work) without new primary legislation.

Another important difference between the proposals in the Bill and the Feeley Report is the latter envisioned a national care board. It would be made up of various stakeholders and representatives of people who use care services undertaking the strategic oversight role, as opposed to boards linked to ministers via civil servants. Feeley wanted the national board to support locally empowered boards.

This points to a fundamental problem with the Bill. Centralisation, control and lack of accountability sits at the heart of what the government is pushing through.

As with police centralisation, it seems the Bill is being driven by the perceived political advantages of putting in place a national agency with national branding, rather than pragmatic considerations focused on service delivery.

Combine this with an administration chain that feeds directly into the centre of government, at risk of political interference, and you can see why a controlling, nationalist administration has fashioned the bill the way it has.

First Minister Nicola Sturgeon likes to claim the new system will be as game-changing as the setting up of the NHS. It will not be. The Bill, as it stands, creates a national bureaucracy and removes even more power from local councils but delivers none of the changes to the front line that are needed now, such as better wages and working conditions. It merely delivers the new, centralised structure, at immense cost to the taxpayer.

It also transfers the budget for delivering social care out of local government and on to the books of the core Scottish Government. That, too, will have political advantages for the Edinburgh administration

Complaints of tight budgets at the local authority level tend to land at the door of the Scottish Government, which delivers the funding. Tough budgeting decisions emanating from Holyrood get spun as Westminster’s fault. Power centralised is accountability deflected.

Audit Scotland’s submission is merely the latest red flag to be raised on a proposal that could have serious

implications for some of the most vulnerable people in our society.

Michelle Thomson and Kenneth Gibson, who both sit on Holyrood’s finance and public administration committee, have, notably, been critical. Thomson stated recently she has “no confidence whatsoever” the government’s financial report on the service represents any level of accuracy or value for money, while Gibson said the policy “seemed like a sledgehammer to crack a nut”, if it does not provide the funding to address issues in the healthcare.

When even normally compliant SNP MSPs are raising concerns in this way, the Scottish Government should sit up and listen. That is, if caring for vulnerable people can come before politics.

■ John Ferry is a regular commentator on Scottish politics and economics, a contributor to thinktank These Islands, and finance spokesperson for the Scottish Liberal Democrats

Nicola Sturgeon claims the new system will be as game-changing as setting up the NHS

CRITIC: SNP MSP Michelle Thomson has raised concerns about the Scottish Government’s National Care Service Bill now before Holyrood.