Scotland’s independent think tank
Scotland’s independent think tank

The National Care Service may fail as its predecessors did

This article by Alison Payne first appeared in The Times on 7 November 2022

ow can we invest in reforming public services while facing budget cuts? The dilemma was clear at Holyrood last week, when John Swinney’s announcement of £615 million in cuts was followed by a debate highlighting the financial uncertainty around the proposed National Care Service.

The creation of the NCS was recommended by the Independent Review of Adult Social Care in Scotland. But the report also recommended other policies, including raising wages and ensuring that all who were entitled to support received it. The full package was estimated at £660 million per year, increasing to £1.2 billion to include the living wage. Those costs would rise annually because of our ageing population. At least £660 million per year is required to implement social care reform — but £615 million in cuts must be found.

Healthcare is delivered by the NHS and social care by local authorities. This separation has been highlighted as an obstacle to improvement, but simply changing structures will not solve the problem. Indeed, the NCS will be the fourth attempt since devolution at better integrating health and social care.

However, if the review’s other recommendations are not followed, why would this structural change work where others have failed? Social care and healthcare will continue to be the responsibilities of two different services and there has been no explanation as to why removing local government from social care will improve things.

In a country as geographically diverse as Scotland it is unrealistic to expect social care to be delivered the same way everywhere. If we want a care service that meets our needs and offers us dignity, we must accept a considerable cost. If that cost cannot be covered within present budgets, other options need to be considered.

Reform Scotland has called for 1p on all levels of income tax and a cross party commission to develop a new long-term sustainable funding mechanism for care. Difficult decisions must be made, and we can’t afford to keep putting them off.

Derek Feeley’s foreword to the independent review said: “There is a gap, sometimes a chasm, between the intent of that groundbreaking legislation and the lived experience of people who need support.” There is a real danger that the National Care Service will repeat this pattern.