The responses which have been coming in to the National Care Service consultation so far do not inspire a lot of hope in Scotland. They seem nervous, defensive, conservative and frankly quite change-averse. They do not paint a picture of the revolution in care we’ve been promised.
I have some sympathy with this, for more than one reason. First of all, it is a really poor consultation document in the first place. Trying to answers its many fragmented and sometimes incoherent questions does not leave much scope for articulating an exciting vision.
Even more so, care has been a woefully neglected service in Scotland. Some of that you’ll be familiar with (the incredible burden placed on individuals who give informal care with little or no support, fragmented and underfunded services) but some has less public profile (for example, social work services are how you try to avoid the need for care and they’ve been decimated in recent decades).
And at the bottom of all of this is the fact that care is largely a local authority responsibility in a country which has constantly centralised power and cut funding to local authorities (this administration is the worst for it but this pattern stretches back to the start of devolution).
What this leaves us with is a rammy of vested interests, not many in a particularly strong position, each concerned that they are going to lose what little power and resource they already have. Others (particularly private providers, including the semi-corporate NGO sector and even some government agencies) are little empires which must be defended and expanded.
For all these reasons and more, the tone of what is coming out about a National Care Service so far is about the threats and risks with little about the opportunities. Cosla is rightly worried about centralisation. Local authority professional bodies fear the disruption of child services. Unison is a bit sceptical, Social Work Scotland seemingly concerned about further downgrading of the role of social work.
And of course the private care home operators are lobbying left, right and centre to keep their lucrative contracts going. In every instance that I can see so far the sense comes over that everything that could change is seen as a threat or risk.
There is good cause for that. The current Scottish Government is very highly centralising, showing signs of believing that any source of alternative power (no matter how small) is a threat. There is also a poor track record of delivery of ‘new things’ (the merger of Police Scotland is poorly regarded by almost everyone, big initiatives like The Promise turn into indecipherable fudge and headline announcements like the National Energy Company simply disappear once the PR is over).
Two reasonable rules are ‘if they see it, they’ll want to control it’ and ‘if they try to do anything they’ll almost certainly screw it up’. But it’s more than that. It is the structure of devolution Scotland.
Starved of proper funding and quite often bereft of real political guidance and leadership a nominally transformative change has been proposed and dropped onto the ‘care empires’ with little serious thought or consideration
After devolution happened, many of the forces which brought about that change wanted to make the change work for them – particularly the voluntary sector and the trade unions, but also (differently) many in the public sector. Released from the battle against Thatcherism and for a parliament, their minds turned from idealism to cynicism. It led to the empire-building.
These are empires which have been through a decade of austerity. And as we know there is nothing more defensive than an empire in decline when another empire is rising (look at Biden’s foreign policy…).
Starved of proper funding and quite often bereft of real political guidance and leadership a nominally transformative change has been proposed and dropped onto the ‘care empires’ with little serious thought or consideration and throwing up at least as many threats as opportunities.
The result looks like territorial pissing, everyone setting out boundaries which represent their current role with fences erected round them saying ‘this far, no further’.
I do get it. I actually have sympathy. Most of those involved mean really well, some (like the carers’ associations) are looking at it narrowly because they think the might get one substantial win (a ‘right to respite’). It’s a perfectly natural reaction.
But it has consequences. As far as I can see no-one (other than Common Weal) is working on or articulating a vision of this care service as a great, new, real possibility. They expect it to be another acre of their empire annexed.
That is far too representative of Scotland in this era – loves to talk about change, petrified to attempt to change, moans about what is wrong, moans if anyone proposes to fix what’s wrong. We have a system which keeps reproducing itself in fear that taking a chance to be better is really just the risk that it will get worse.
It would be quite easy to place all the blame at the feet of the Scottish Government. God knows they deserve most of it. Out of everyone they talked to over the last seven years, who exactly said to them ‘care will work better if you centralise it and break the link between care and housing services, care and education services, care and community support services’?
It is the Government which trumpets ‘world-leading change’ and then leaves underfunded professionals to fight over scraps. And it is the Government which makes a mess of it anyway.
But it isn’t just government, it’s more fundamental. The conditions which created it may be multifarious but the result is the same; Scotland is a land of territorial pissing, its social geography defined by what people won’t give up rather than what they want to build.
I fear a National Care Service is going to be the next victim of a Scotland that, well, doesn’t appear to be capable to doing great things just now.