The Scottish government is facing growing criticism and opposition over its proposal to create a new National Care Service (NCS) that would take over the responsibility of social care from local councils. The NCS, which was announced by Nicola Sturgeon in November 2022, is intended to improve the quality and consistency of care across Scotland, and has been compared to the establishment of the NHS in 1947. However, the plan has been met with scepticism and resistance from various stakeholders, including councils, care providers, unions, and some SNP members. The main concerns are the high cost, the centralisation of power, and the lack of consultation and evidence behind the proposal.
NCS bill delayed amid leadership contest
The Scottish government has decided to postpone the introduction of the NCS bill, which was expected to be debated and voted on at Holyrood this month, until June 2023. The delay comes as the SNP is undergoing a leadership contest, following the resignation of Nicola Sturgeon in February 2023. The three candidates in the race, John Swinney, Humza Yousaf, and Kate Forbes, have all expressed their intention to review and revise the current NCS plans if they win the contest. A Scottish government source said that ministers wanted to take more time to get the legislation right and to address the feedback from some of the parliamentary committees. The source also said that the government was still committed to delivering the NCS, which was a key manifesto pledge in the 2021 election.
Councils call for suspension of NCS plans
One of the most vocal opponents of the NCS plans is the Convention of Scottish Local Authorities (Cosla), the umbrella body for the country’s 32 councils. Cosla has called for the Scottish government to suspend the NCS plans, arguing that they are too costly and disruptive at a time of financial crisis. Cosla estimates that councils need an extra £1bn next year to meet their obligations, but the government has only offered an increase of £70m, which amounts to a real-terms funding cut. Cosla also claims that the NCS plans would undermine local democracy and accountability, and would not address the underlying issues of underfunding, workforce shortages, and unmet demand in the care sector.
Paul Kelly, Cosla’s health and social care spokesperson, said: “It is inconceivable that the Scottish government has put forward a budget that would see real-terms cuts to frontline care services, whilst proceeding with centralising structural reforms. Improvements to care could progress faster and with more impact if services were properly resourced and did not face the distraction of structural reform. Instead, we are presented with reorganisation and real-terms cuts, which will have a significant impact on the delivery of care.”
Care providers and unions raise concerns over NCS plans
The NCS plans have also been criticised by care providers and unions, who have raised concerns over the lack of consultation, the impact on staff and service users, and the feasibility of the proposal. The Scottish Care, the representative body for independent care providers, has warned that the NCS plans could lead to the closure of many care homes and services, as they would not be able to cope with the increased regulation, bureaucracy, and financial pressure. The Scottish Care has also questioned the evidence base and the rationale behind the NCS plans, saying that they are based on a flawed assumption that centralisation would lead to better outcomes. Dr Donald Macaskill, the chief executive of Scottish Care, said: “We are deeply concerned that the NCS plans are being driven by ideology rather than evidence, and that they will have a detrimental effect on the diversity, quality, and sustainability of care in Scotland. We urge the Scottish government to listen to the voices of those who deliver and receive care, and to rethink its approach.”
The unions representing care workers have also expressed their reservations about the NCS plans, saying that they are not convinced that they would improve the pay, conditions, and rights of the workforce. The unions have also highlighted the lack of engagement and involvement of the workers and their representatives in the development of the NCS plans. Dave Watson, the head of policy and public affairs at Unison Scotland, said: “We support the principle of a national care service, but we have serious doubts about the current NCS plans. We are concerned that they will not address the fundamental problems of low pay, poor terms, and lack of career progression in the care sector. We are also concerned that they will not respect the voice and the role of the workers and their unions, who are the experts in delivering care. We call on the Scottish government to work with us to develop a better and fairer model of care for Scotland.”
SNP members challenge NCS plans
The NCS plans have also faced opposition from within the SNP, with some members and MSPs calling for them to be scrapped or revised. Alex Neil, a former SNP health secretary, said that the NCS plans were “nonsensical” and would not “address the urgent changes needed.” He said that the NCS plans would create a “huge bureaucracy” that would “suck resources away from the frontline” and would “undermine local democracy and accountability.” He also said that the NCS plans were “not in the SNP manifesto” and that they were “not supported by the majority of SNP members.” He urged the SNP leadership candidates to abandon the NCS plans and to focus on “improving the quality and availability of care.”
Other SNP members and MSPs have also expressed their concerns and criticisms of the NCS plans, saying that they are not well thought out, that they are too costly and complex, and that they are not based on evidence or consultation. Kenneth Gibson, an SNP MSP, said that the NCS plans “seemed like a sledgehammer to crack a nut” and that they would not provide the funding to address the issues in the care sector. He also said that the NCS plans were “not popular” among his constituents and that they would “alienate” many SNP supporters. He called on the Scottish government to “pause and reflect” on the NCS plans and to “engage with the stakeholders and the public” before proceeding.