NCS Bill Still Isn't Dead
Craig DalzellThe Scottish Government has announced that the National Care Service Bill shall remain in limbo for an unknown period of time.While Common Weal and many other stakeholders pulled their support for the Bill as written (though we have not pulled our support for a National Care Service – just the one this Bill would have created) the death knell for the proposed legislation was the Scottish Green conference the other week where members voted to pull their support for the Bill. This should have been a point of change. Indeed, there had already been enough pressure placed on them to force that change long before now but I have a nagging feeling that this announcement came now not because they recognise the flaws in their legislation or even that they’ve acceded to demands from care stakeholders – including the people who NEED the care that the NCS will deliver – but that they’ve merely looked at the Parliamentary maths faced by a now-minority Government and are doing what they need to do to not lose a vote. It might yet be a step along the way of getting what we want but it’s not exactly a shining example of priorities and principles rising above party politics.Nevertheless, after fighting against (rather than, as we’d prefer, for) the NCS Bill we’re now at a point where we should be focussing on actually improving care rather than fixing care legislation.
What has happened and what will it mean for the NCS?
The Ministerial Statement today wasn’t much of anything. Rumours had been flowing around care stakeholder circles (to the point that I had heard them independently from multiple credible sources) that the Bill was going to be scrapped entirely, that only Part 1 (the framework section on the NCS itself) would be scrapped, or that the Scottish Government’s amendments were going to be substantially amended but we actually got nothing at all. The only thing Care Minister Maree Todd did was stand up and restate the pause she announced last week. We didn’t even get an update on when the Bill could come back other than that it will be some time next year.Well, she also spent some time blaming the whole thing on Cosla for “ignoring disabled people” – quoting extensively from an open letter by the Disabled People’s Movement published yesterday and clung to by the Minister as if it was a rhetorical life raft rather than the condemnation of the Government that it actually is – and for blocking more powers for Ministers which is probably another sign of the Scottish Government’s ongoing contempt for local democracy. Another point was a hint that the government doesn’t actually understand the main priorities in care with the speech mentioning the problem of delayed discharge from the NHS as a main priority of the NCS – it is not. That might be a side effect of the NCS, but trying to use it merely as a tool to empty hospitals is an attitude that is deeply disturbing and risks repeating the horror of the Scottish Government’s discharging of Covid-positive patients into locked-down care homes during the pandemic, which led to numerous deaths and what has been described as “the single greatest failure in devolved government since the creation of the Scottish Parliament”.
What The Scottish Government Must Do Next
Step One:- Tackle the Care Crisis Now
Step one, is doing everything we can now to fix care. As scathing as we’ve been, the NCS Bill as proposed (especially in light of the proposed Government amendments) wasn’t all terrible. In our recent policy paper Tackling The Care Crisis we identified the areas of the NCS Bill (both as it was written and in light of the Scottish Government’s then proposed amendments) that were actually positive and suggested mechanisms whereby they could be retained. Some could be progressed through changes to government policy or ministerial guidance though some may need primary or secondary legislation and we suggested three options to do that. The first is to legislate each separately – something that would maximise scrutiny but also the time required to pass everything which there may not be given the looming election in 2026. The second option, and on balance our preferred option, is to collect these policies into a “Care Reform Bill” that could be scrutinised and (hopefully) passed relatively quickly. The third option – the one that the Greens preferred and which the Scottish Government appears to be following – is to take the existing NCS Bill, strip out the framework of the Care Service itself and leave only the policies that can be passed. The obvious advantage of this process is time – the Bill needn’t be sent all the way back to Stage 1 but could be progressed from where it is.The significant downsides of this come from several places. For one, the risk that either too much or too little is cut out. Too little and there may be critical aspects like Ministers centralising too much power away from Local Authorities to deliver the policies that remain. Too much and we just don’t get critical services that we need to tackle the care crisis. There is also the problem that some of the “good” policies are, as written, themselves in need of significant amendment and the rush to get a stripped down Bill passed might not allot for the level of scrutiny these policies need.
Step Two:- Talk to care stakeholders. Listen this time.
The “co-design” process that we’ve been working to was a sham. It was announced relatively late in the design process basically to shut stakeholders up and very little that came out of that process ended up in the Bill (even steps like the Verity House Agreement that would have ensured some role for Councils in running the NCS instead of granting full diktat to Ministers was a move negotiated behind closed doors without the involvement of carers and those with care needs). Add to that what we now know about the “Target Operating Model” the government was working to after commissioning KPMG to write it and you can see that right from the start we were on the wrong course to deliver an NCS worthy of the name.The Government must start talking to care stakeholders much more earnestly not just to avoid losing the vital work put into the Bill process to date but to ensure that the NCS can come back to Parliament in a much better state.
Step Three:- Bring back the Bill
It sounds obvious when you put it like that but there is a subtly here too. We absolutely cannot be put in the position again of being given an inadequate or even outright harmful “framework Bill” and a promise to “fix it in post”. The Government must use Step Two to develop an actual working NCS Bill that will – at least if we get our way on it – deliver a care service that is publicly-owned, not-for-profit, free-at-the-point-of-care and where care is delivered locally. Legislation should be drafted, scrutinised and properly developed by (not merely with) care stakeholders BEFORE it comes back to Parliament to start the party political process that caused so many problems for the current Bill. The Government has to start delivering a reformed care sector as quickly as is feasible but the way to do that is not by ramming an unworkable Bill through Parliament and then complaining when stakeholders are upset with it.Once we have a Bill that will result in a National Care Service worthy of the name, there will be parliamentary support for it and it will pass. There is very little time left to get that all done in this Parliamentary session so I think it’s likely that it’ll be pushed into that nebulous zone of post-election politics where the promises get bigger but, if anything, the prospect of delivery gets even smaller. Indeed, we may not even get that far if the budget next month isn’t agreed or if it only passes as a result of votes from parties (looking at the Lib Dems and Conservatives) who are ideologically opposed to the Care Service.
Step Four:- Caring For All
It’s hard even for me to see how we get to there from where we are just now but Common Weal still has a grand and worthy vision for care. Our blueprint, Caring For All, promises a Care Service that won’t see public money shunted into tax havens via private care homes, won’t see Ministers pulling local powers away from local democracy and won’t see people continue to not have their care needs met at all.Scotland is made up of four groups of people. Those who care for folk, those who receive care, those who do both and those who don’t yet need either but almost certainly will in the future. We all deserve better than being told by the Government that we’re simply not grateful enough for their beneficence. We need the Government to come back to the table of stakeholders and start listening to those who evidently know more about designing a care service than they or their KPMG contractors do. It’s that or we really do have to wait until the next election and roll the dice to see if some other politician is willing to do better while in the meantime fighting for those who need care now as best we can.
