Action to bring dignity to the workforce and those who rely on it is therefore long overdue. That makes some aspects of the plans for a National Care Service (NCS) in Scotland very tempting.
The Feeley Report, which recommended the NCS for adult care, acutely identified the sector’s problems. Plans like ethical commissioning, sectoral collective bargaining and fine words about union recognition have rightly won trade union support. But, you might ask, could these not be implemented anyway — NCS or not?
In any case, the long fight for a decent pay rise for council workers suggests that funding, rather than structures, remains the root problem.
The Scottish government’s claim that the NCS will be on “an equal footing” with the NHS is hugely misleading. It is not a care service, it is a commissioning service, based on procurement from the private and third sector — and worryingly, also from local authorities — through revamped IJBs.
Why is that worrying? Well, the basis of local democracy is that communities have ready access to hold councillors accountable for local services. That vanishes if the council’s only role is to bid for contracts.
Plans to extend the scope of commissioning are even more worrying. We should be used to the Scottish government’s occasional autocratic ways but its late addition of front-line social work for adults, children (including child protection) and criminal justice to NCS commissioning plans was still a surprise.
The Feeley recommendations made no mention of these services. Feeley consulted widely, engaging adult care service users and the workforce, but there was no consultation at all with the added areas prior to the announcement.
The new proposal, in what now passes for consultation, consists of three paragraphs with no detail other than a wish to address fragmentation — fragmentation caused by the Scottish government’s own IJB system.
It wants “access, assessment, funding and accountability” in one body. In local authorities it usually was. It wants to strengthen links with education and early years, astonishingly by frustrating the existing links in local councils.
The NCS in its current form will embed and potentially extend privatisation. It’s already rampant in social care but it also risks infecting other services and the NHS. Which is why it is surprising that union colleagues in the NHS, who have done so much to bring contracts in-house, are not more critical.
With much of education ring-fenced, social work centralised and potentially farmed out through commissioning, it also raises the question of whether local councils would still be viable.
As for accountability, I can hear the argument that the Scottish government is democratically accountable so people do have a say. But where and how?
A case that starkly exposes the problem is the campaign in Edinburgh to save five council care homes. Despite a waiting list for places, one home will be repurposed in the NHS (without consultation) and four are earmarked for closure. The only replacement will be the private or third sector. Privatisation under any other name.
Unions and communities mounted a fantastic campaign and secured a public consultation on the closures. They won backing from Labour MSPs and persuaded the council to oppose the plan but were astonished that it appeared to have little power over the IJB decision.
Their astonishment increased when it transpired that, unlike the council, the IJB had no real structure for consultation and felt the need to appoint Bedfordshire-based consultants to advise.
Five councillors and five non-executive directors appointed by NHS Lothian constitute the voting members of the IJB. Do you spot the problem here? Five are elected and accountable to the electorate, except for the complication that the ruling SNP/Labour coalition is represented by one each of Labour, Lib Dem, Tory, Green and SNP. The NHS contingent is elected by no-one. Even this pretend democracy will vanish as the new Community Health and Social Care Boards come under direct government finance and control.
The radical left-wing spin the SNP government bestows upon itself is also somewhat shattered by its decision to give Pricewaterhouse Coopers (PwC) a contract to advise on setting the whole thing up.
Aside from the absurdity of the assumption that no-one among the people who actually provide these services would be able to do this, a brief web search will suggest PwC has a somewhat chequered history.
When we campaigned for a Scottish Parliament, we warned that we needed to beware the temptation to “suck up” local services centrally and undermine local accountability. We wanted a Parliament, not a distant centralised council. Our warning has gone unheeded by the Scottish government and also by some in the labour and trade union movement.
We wanted subsidiarity, public services delivered and accountable at the most practical level closest to communities. The fact that the powers we won to do this are being ignored demonstrates that, despite the SNP’s constant plea, it’s not a lack of powers that’s the problem, it’s their policies.
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