If this is the start of a National Care Service, god help us

by | 28 Oct 2021

The Scottish Government consultation on a National Care Service is a rambling mess. If the rest of the process of developing an NCS is like this the chances of it being fit for purpose aren't high.

Consultations can tell you a lot, but sometimes they tell you more about the body consulting than those who are being consulted. I’ve no idea how many government consultations I’ve responded to in my career but sometimes you just look at them and think ‘ah, so you’ve already made the decisions and you want approval’ or ‘you really don’t want this to happen and you’re looking for cover to scrap it’.

I’ve now finally been through in detail Common Weal’s response to the consultation on a National Care Service and my conclusions is simple – whoever produced the consultation document has no idea what they’re doing.

I don’t meant the civil servants involved don’t understand the care sector or social work issues (which presumably they do). I mean they’ve been set the task of creating a care service but have clearly had next to no political guidance on what that means.

By default, if you ask a civil servant to produce a plan with no real guidance about why you’re doing it or what it is supposed to look like they will default to a kind of ‘how’s my driving?’ approach. They will take what’s there and ask you ‘do you like this bit? How could it be better?’.

It’s not a criticism to say ‘bureaucrats manage the status quo unless clearly instructed otherwise’, it’s kind of their job. You’d be a bit bothered if civil servants fundamentally redesigned the NHS without specific political direction. So when I suggest that the National Care Service consultation is one of the worst I’ve ever read, I really want to be clear why that is.

First, it’s crazy-long. There are 96 individual questions spread over more than 140 pages. They delve down into pretty obscure details about existing services – but don’t bother to ask simple thinks like ‘what is a National Care Service for?’ or ‘how should a citizen experience and access the National Care Service?’.

It is all multiple choice questions and frankly we left lots of them blank because it was asking us to choose between bad options or was the wrong question in the first place. So for example we get a question like: “What are the drawbacks of Alcohol and Drug Partnerships? (Tick all that apply)”.

Unfortunately, among the possible answers you won’t find the fairly fundamental option of “they’ve failed’ and so Common Weal has to explain it in the comments box: “Since the inception of Alcohol and Drug Partnership in 2009, drug deaths have skyrocketed whilst alcohol deaths have increased steadily”.

I fear that the development of the National Care Service is turning into a case study of what’s wrong in government in Scotland

Some of it just seems totally fragmented, like it was produced via a game of ‘pin the tail on the donkey’. There are seven questions asking about whether a given function should or should not be included in ‘Community Health and Social Care Boards’ before being asked in question 58 whether these are a good idea or not (they’re not…).

Another major concern is that the content of the consultation document appears to have little relationship or possibly even knowledge of international good practice or the very substantial body of research and other academic work on what makes care successful. This is managing bureaucracy, not transforming care.

And if all this isn’t dispiriting enough the whole thing is going to be assessed and summarised and conclusions drawn by whichever private sector consultancy wins a £100,000 commercial contract.

In two previous analysis pieces I argued that among the many reasons that the Scottish Government is so mired in failures is that it lacks a core political mission and that it is too driven by announcements and way not focussed enough of the detail of what an announcement means.

I fear that the development of the National Care Service is turning into a case study of what’s wrong in government in Scotland. A crisis leads to lots of people say ‘we should have a National Care Service’ – so some spin doctor is sent off at great pace to write a press release announcing one.

But because it hasn’t been thought through any more than that it is dropped on a civil service with woefully insufficient guidance and so they revert to tweaking the bureaucracy and chucking money at big private consultancies and accounting corporations to tell them what to do.

Driven by PR, it is all founded on headlines rather than any deep understanding of care, how it works or what makes for real success. But the machine grinds onwards through the processes and stages which legislating requires and produces – well, something. The ‘something’ could end up being fit for purpose, but right now I wouldn’t put any money on it.

We really need a way of approaching and making policy in Scotland that rises above this shallow way of doing things. When it comes to care we’re dealing with one of the most crucial services delivered by government and which those most vulnerable in society rely on, sometimes simply to stay alive. This matters enormously.

There is time still to get this right, but it’s going to need a better approach. If this consultation document is the shape of things to come, it may be good to lower your expectations early.

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