I mentioned yesterday that it is hard to overstate how bad is the National Care Service (Scotland) Bill currently grinding its way through Holyrood. There has been so much written about this in detail now that I fear it means you may struggle to get an overall picture of what is going on, what it means or why everyone hates it.
And everyone really does hate it. Barring a squeak or two from the private sector (which I presume doesn’t want to be seen salivating over what could be mass privatisation) and one or two supine comments from the inevitable Scottish Government-funded NGOs, this is uniting pretty well everyone against its proposals.
There is so much to be said about this and you can read through analysis for hours (the Common Weal Care Reform Group alone has patiently picked apart what is wrong and explained how it ought to be done at a length even I struggle to keep up with). So let me pick out a few themes to help give you the compressed version of it.
First, what is proposed? Here there are two interlinked problems (which in turn interlink with other problems). The first is that the Bill barely tells you what it is you’re voting for. It is the worst kind of ‘enabling legislation’. It doesn’t explain what a National Care Service will really be like, how it will be run, what difference it will make. It primarily gives powers to Government Ministers to do what they want when they want.
This increasingly common practice of using (generally) tame parliamentary majorities to pass legislation that enables the creation of policy-by-decree when there is no longer any scrutiny is becoming a real problem. Properly-functioning parliaments are meant to respond to the request to ‘give us power to do whatever we want, whenever we want to’ with a firm ‘no’. It’s not how parliamentary democracy is meant to work.
That second problem is that we therefore just don’t know what vision they have for this service. But there is one clear visionary element that they are keen to push, and that is major problem number two – it is a centralising model based around the capacity for cover-ups.
This is a second theme Scottish democracy should be increasingly concerned about, the continual erosion of checks and balances. In the National Health Service a gang of insiders appointed directly by government ministers (Health Boards) now act like a political line of defence against the problems in the NHS.
The efforts of Health Boards and Public Health Scotland to obstruct the provision of information, direct health services for political interests and to spin health statistics have been extensively documented (go and do a web search for NHS Scotland followed by Cdiff, bullying, blood infusion scandal or any number of distorted statistics from Public Health Scotland).
And this is the model being proposed for care. The Scottish Government will be able to appoint Care Boards which will have the same power to cover up problems for the government. The NHS now spends a shocking £6.6 million on spin doctors to manage bad media on behalf of Health Boards. That money would take more than 3,000 people off the 92-week waiting list for cataract surgery. Presumably ‘care spin doctor’ is about to become a high-growth occupation sector.
Serco will be running child adoption and fostering services before you know it
This means that so far we are looking at granting a government almost unrestricted power to design a care service which will protect the government from political fall-out from care failures. That alone should see this binned.
But its the next thematic problem I’d urge you to focus on. What is proposed is not only mass centralisation but potentially mass privatisation. The Scottish Government outsourced almost the complete conception work for this proposal to private interests closely associated with private care providers. Over £1.6 million has been given to big accountancy firms to devise a scheme in which their clients have a financial interest.
And what do you know? They’ve come up with a commissioning model. At the moment there is commissioning in care services but only in limited areas. Most of it is delivered directly by local authorities. What is proposed is that these budgets will all be centralised in the hands of the political appointees of (dear god) Kevin Stewart (yup, the smoke detectors guy).
It is his hand-picked place people and them alone alone who will decide who is given this money. Local authorities will now have to bid to government to run services and the Scottish Government’s own procurement rules will probably require this to go to open tender. Serco will be running child adoption and fostering services before you know it.
This strips all local democracy from care. This is just policy illiteracy because care is inextricable linked to local services such as housing and education, and so is better run by local authorities. Adult care alone now represents nearly 40 per cent of local authority budgets. That is about to be taken away for them and given to the man who thought everyone could get hard-wired smoke detectors installed in three months during a pandemic.
So just to recap, this is a bill to give a government total power to create a privatised care service which it can engineer to protect itself from having to answer for care failures by stripping away local democracy and slashing local government budgets by 40 per cent (probably more if they stick to including child services).
Then thematic problem four – they clearly don’t know what they’re doing, or they do and they’re not being honest about it (though spoiler, it’s the former). They produced a financial statement to go along with the Bill which is so loose and vague it means nothing.
The Scottish Government commissioned a report on the VAT implications of all of this, but only after introducing the legislation. To explain this, when a local authority delivers care it is VAT exempt because local government is VAT exempt. If you centralise this and run it on a commissioning basis you lose your VAT exemption.
For not one of the Scottish Government, KPMG, PWC or the rest to have realised this in advance is worrying. That they seem to have failed to understand this despite having made exactly the same mistake over centralising Police Scotland is beyond belief. It is this shoddy document which pushed SNP MSPs on the finance committee beyond credulity.
It’s not a question of if this fails, its a question of how badly it fails – or actually its a question of how much harm it does to vulnerable people as it fails
So its badly written, anti-democratic, cover-up focussed privatisation, and yet there is still one more major thematic issue I’d want you to hold in your mind. This one is simple; it is a bad, bad idea in the first place, like so many other bad, bad ideas from the Scottish Government and so many other good ideas ruined by the Scottish Government.
It is (like so much) based on little more than something that popped into the First Minister’s head. She announced this was happening but then outsourced it to others to interpret what she meant. None of this was based on a sound understanding of the science of care, its practices or what is actually wrong with care services as they are.
In the aftermath of a Covid care home death scandal the First Minister appears to have grabbed an idea to distract. I can see why; that the Scottish Government tested people for Covid, found them to be positive but then dispatched to care homes anyway is unique, a gross error that I am not aware happened anywhere else. It is, to my mind, absolutely clear criminal negligence.
But here’s a selected record of ideas the First Minister has snatched out of the air and how they went; massive education reforms (almost completely failed), poverty tsar (disappeared when inconvenient), Universal Basic Income pilot (three years to conclude what everyone knew – it can’t be done in Scotland), build ferries (you know…), being a world leader in 5G (total rubbish), a National Energy Company (never even tried), a Ukraine refugee scheme (interred them on a boat then closed down the scheme).
There are loads more, none have worked – and yet now we get a ‘care revolution’, an idea retrofitted to a soundbite by a corporation so dodgy even Boris Johnstone wouldn’t touch it.
This is the future of care in Scotland unless parliament stops it. It’s not a question of if this fails, its a question of how badly it fails. Or actually its a question of how much harm it does to vulnerable people as it fails.
Me and many others urged the Scottish Government to see sense over the education reforms but it refused, and we were proved right. Now almost everyone (I mean really, almost everyone not bribed to say otherwise) is urging the Scottish Government to see sense. Its track record suggests it won’t. The only hope is for parliament to force it to.
Here’s the dilemma though; the proper way to make policy isn’t to ask big free-market consultancies to run wild but to engage properly with the workforce, the experts who understand how care works, the many people who pick up the pieces when it doesn’t, the local authorities with the experience of doing this. What they will tell the Scottish Government the Scottish Government doesn’t want to hear.
Organisations have now converged on a call to ‘pause’ this work. They all want it to be scrapped and never see the light of day, but they also know that if the Scottish Government doesn’t get its photo-op the Scottish Government isn’t interested. Ten seconds after its education agenda collapsed the First Minister simply abandoned the mission and cut funding for education.
Care is in crisis and if the Care Bill goes down the tubes, care will disappear from the agenda altogether. So people call for a pause in the desperate hope that at some time this government will see sense.
But it won’t. The only real chance I can see is to scrap this disastrous Bill now and hound this government until it learns its lessons and addresses the crisis in care properly.
After all, if I told you Suella Braverman was asking for unlimited power to cut 40 per cent of the budgets of local government to put in her hands so she can privatise the lot of it, that’s what you’d be doing. The fact that it is the SNP doesn’t change matters one jot.
(If you want to know more about why care services in Scotland are under such pressure and how to create a proper National Care Service you would do well to read Common Weal’s Caring For All.)