A NEW vision for a national social care service featuring new surgeries and an emergency response service has been revealed as ministers push a project that one respected think tank says lacks ambition, is underfunded and is a “betrayal” to Scotland.
A respected think tank has raised its concerns about the proposed National Care Service (NCS) after 18 months of work in devising its own “revolutionary” service delivered through the formation of local authority controlled local social care hubs which would provide services in the same way as a GP surgery does in health care.
It comes as data shows that Scotland is faced with a growing population of older people, with the numbers aged 75 or more expected to rise by 85% to over 800,000 by 2039.
The Common Weal blueprint would involve not-for-profit care provision, a 24-hour national phone line for emergency care issues like NHS 24 and an urgent response service with ‘care ambulances’.
And they say that the service should not be centrally controlled as envisaged and that delivery must remain at local level.
It has warned that action is required in the short term as the service is currently in a “critical state, not fit for purpose – underfunded, rationed, fragmented, centralised and risk averse”.
They say that staff are currently undertrained and underpaid with morale low and employee turnover high.
Common Weal, which has had an interest in supporting the care service design, says financing of the Scottish Government blueprint for a service operational by 2026 with a 25% increase in spending and “more than £800m in increased support” is nowhere near enough.
It says that for proposals to work it has to have the same level of ambition as the report by Sir William Beveridge 80 years ago that led for the formation of the National Health Service with free medical treatment for all as part of a new system of “cradle to grave” social security.
They say that the NHS did not “shortchange” people in 1945 and so as long as the new care service appears to be a “rebranding exercise” it will be a “betrayal of people and the sacrifices they have made”.
Any new system for social care will have to deliver the complex system of services and support for society’s most vulnerable either at home or in separate accommodation such as nursing and residential homes.
Nicola Sturgeon said in September that the plans for a National Care Service will be “one of the biggest ever achievements of this Parliament — and, just like the National Health Service in the wake of the Second World War, it will be a fitting legacy of the trauma of Covid”.
There have been more than 13,000 deaths in Scotland where Covid was mentioned on the death certificate and around a third occurred in care homes.
While a Scottish Government survey showed there was positivity about the concept, there are concerns about how it works in detail.
Council representative body COSLA and other local government representatives have said there is a need for more engagement with their sector and have expressed disappointment that they were not involved in the development of the proposals.
It is estimated that the true cost of a national care service would exceed £1.5bn.
And Common Weal says while human rights matter in care, if rights are not matched with resources and a proper structure they won’t result in change.
A joint briefing by the Accounts Commission and the Auditor General for Scotland says some services are in ‘near crisis’ now and cannot wait five years for the creation of a new organisation.
But according to Common Weal analysis there remains concerns for the hundreds of thousands of Scots who need formal care support but get none.
At any given time there are something like two million people in Scotland either giving or receiving care.
As of March last year there were 1,069 care homes for adults 20% fewer than ten years ago.
And the study estimates that while about one in five people in Scotland need some kind of care support at any given time – 85% of them receive no formal care services at all.
Now the Common Weal’s Caring For All, analysis produced by a group of care experts have come up with a blueprint for a service with the formation of local care hubs, which would support people from conception to end of life care.
While co-ordination, strategic planning, financing and the delivery of a range of support services must take place at the national level the think tank says services must be organised and delivered at the local level through local authorities.
Lead author Nick Kempe said what is currently on offer was a “betrayal” and added: “The funding alone is nowhere near enough and there needs to be a fundamental rethink.
“What we have is not ambitious enough. They had the opportunity with Covid for an ambitious vision. What they have done is tinkered with a few things.”
Co-ordinated nationally but delivered locally through the hubs, new Common Weal blueprint would be overseen by local authorities and would be the first port of call for an appointment to discuss their care needs, like the role of the GP’s surgery in the National Health Service.
There they could access a full range of services from parenting training, psychological services and personal elderly care through to addiction services, home adaptation and financial problems.
A team of professionals led by social workers would assess people’s needs and negotiate a package of care with them which balanced the availability of resources with the effective support they require.
If services or support cannot be delivered by the local care hub, people would be referred on to specialist services, just like the NHS.
And like the NHS there would be a 24-hour phone number which could arrange for emergency support so people can remain at home and avoid unnecessary hospital admissions.
The UK government will transfer some of the £12 billion available for health and social care spending to devolved administrations through the operation of the Barnett formula. Under the Barnett formula, the devolved administrations receive a population-based share of any UK additional government spending in devolved areas, such as health and social care. So, if the UK government spends an additional £10 billion on health, the Scottish Government could expect to get roughly £1 billion in Barnett consequentials.
Common Weal says that the Scottish Government has to use all that money and more on top of the extra £800m to be able to fund the new care service.
Common Weal’s head of strategic development Robin McAlpine said: “Rebranding the mess which currently exists would not be fit to bear the name.
“We believe this report is every bit as visionary as the Beveridge Report which gave birth to the NHS and we believe that the impact of a National Care Service set up as proposed in it would have an equally big impact on people’s lives. But Scotland needs to unite around a real will to do something of that scope if this isn’t to be another missed opportunity.
“A National Care Service should be a fresh start for Scotland post-Covid, not a fudge and not a stitch-up.”
Analysis of potential risks from the proposed scheme have highlighted concerns over the potential loss of the voices of people accessing care and support and care workers. There are concerns over a loss of an understanding of local needs and local accountability.
A Scottish Government spokesman said: “The National Care Service is the most ambitious reform of public services since the creation of the NHS. It will be designed round the needs of those who use and deliver social care services, creating a comprehensive community health and social care service that that promotes quality and consistency of care and provides support for all.
“Local accountability and participation from people accessing care and support are key to our proposals. Services will continue to be designed at a local level, with an approach designed around delivering outcomes based on individual needs.
“The recent consultation on the plans revealed strong support for proposals to establish a National Care Service accountable to Scottish ministers. We are reflecting on all the views put forward by the public on our proposals and will respond in due course.
“However we are not waiting for the NCS to start improving social care and we are taking steps now to improve outcomes for people accessing care and support and care workers. We are committed to increasing funding for social care by 25 per cent by the end of this Parliament.
“We have taken action to tackle winter pressures in the system including an additional £300 million of funding, which includes funding for increase to care worker pay, furthering our Fair Work Commitments and support for unpaid carers. In addition we have committed additional funding to Local Authorities that will enable a minimum hourly rate of £10.50 to frontline adult social care staff in commissioned services from April 2022.
“Meanwhile we are working with partners in local government, the third sector and independent providers to attract more people to the care sector and a new £1 million fund has also been established to support projects which look after the wellbeing of staff working in social care.”