It is ten years since the Scottish Parliament passed what many at the time described as one of the most significant pieces of social care legislation anywhere in the world. Building on the civic communitarianism of the 1968 Social Work Scotland Act the progressive Social Care (Self-directed Support) (Scotland) Act 2013 [1] sought to bestow upon the individual who required support and care new rights guided by the principles of participation and dignity, involvement and inclusion, informed choice and collaboration. It aimed to change practice from assessing what someone needed to maintain and survive life to determining what outcomes would enable that individual to flourish and thrive. Budgets were to be in the hands of the supported person; new models of innovative, community-based supports would be developed as flexibility, creativity and diversity were written into Guidance and advice. It was all designed to allow folks to live the ordinary lives they wanted and to participate as full citizens of their local communities.
The fact that 8 years later Derek Feeley in his Independent Review of Adult Social Care in Scotland[2] sought to redesign the whole system whilst acknowledging that self-directed support was a key foundation stone for the new was a declaration that the implementation of the dream had failed. In reference to the Christie Commission Principles, he stated:
‘In order to ensure that prevention, investment in people, learning, fairness and accountability are driven by national strategy and national partnership, we need a National Care Service. To get different results, we need a different system.’ (page 21)
It was clear from the Review and from the experience of many of the stakeholders who had engaged in its processes that the implementation of Self-directed Support (SDS) was symptomatic of the failure to embed progressive social policy within the existent political and governmental systems. SDS failed and is still failing in part because of the impacts of austerity and economic downturn and later the pandemic but in truth the faultiness are a lot more local. Social care as delivered today and Self-directed Support as initially conceived has been and is hampered and limited by the current model of local government in Scotland.
From the vision of Feeley we have been offered the deadening soulless entity which is the current Bill for the National Care Service[3]. As I write we are in the push-me pull me political debate over its proposals. It has some semblance of a relationship to the ideas of Feeley but at best it pays lip-service to his broader vision of a more inclusive rights-based, citizen-autonomous model.
What needs to change? The heat and hot air in much of the recent debate is around the dynamic between national and local control, oversight, and power. With others I am not at all convinced that centralising the system albeit with a nod to nascent Care Boards at local level is what is going to lead us out of the current malaise. Neither am I desirous of a continued status quo because we would not be in the trouble we are if all in the garden had been rosy before now. Change is needed. For me that means a fresh and vigorous focus on the local democratisation of care in order to give citizens real control and choice.
Derek Feeley noted in his Review that:
‘There is a maxim in improvement science that ‘every system is perfectly designed to get the results it gets’. The real point being made is that if you want different results, you need a different system.’ (page 20)
Social care supports and services are inherently local and personal by their very nature, so whilst national quality and improvement models and approaches have some merit, what makes the difference for supported people is the extent to which they can exercise control and power over daily decisions around their social care support close to home. Indeed, such personal localism is a key human rights concept.
I simply do not think local government in its current iteration offers such personal and local control. Elected members seem both distant and detached from the daily social care decisions folks have to make and live with. We need to start thinking and imagining outside the box. True localism means giving citizens control and decision-making authority as close to home as possible. We have a real opportunity to do so and to engage in radical re-design because of the significant advances in technology. In so many parts of our lives we are used to making decisions, influencing, voting, choosing, determining choice with an immediacy and an impact we have never had before – why not in the decisions that matter most to us?
The daily advances in technology, in digital accessibility and in AI in particular offer us the opportunity to dramatically change local democratic decision making. This is what those living their lives with support are increasingly demanding and experiencing – not a one size fits all approach but a person-led approach which grants daily autonomy and choice, control and independence to the individual.
Is it too much to imagine that a reformed and reshaped local model of democracy could be led and framed by a democratised social care system? Care Boards and a National Care Service will not democratise care, the revolution needs to start at the grassroots and with a root and branch re-design of local governance.
Dr Donald Macaskill is the Chief Executive of Scottish Care.
[1] Social Care (Self-directed Support) (Scotland) Act 2013 https://www.legislation.gov.uk/asp/2013/1/contents/enacted
[2] Independent Review of Adult Social Care in Scotland , February 2021 https://www.gov.scot/binaries/content/documents/govscot/publications/independent-report/2021/02/independent-review-adult-social-care-scotland/documents/independent-review-adult-care-scotland/independent-review-adult-care-scotland/govscot%3Adocument/independent-review-adult-care-scotland.pdf
[3] National Care Service Bill (2022), National Care Service (Scotland) Bill – Bills (proposed laws) – Scottish Parliament | Scottish Parliament Website
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