How the basic building blocks of health and care services are being outsourced
Nick Kempe reveals how fundamentals of healthcare that should have been under the control of patients and the National Care Service are instead being outsourced to private companies.
Image Source: Carlos Muza, Unsplash
In Caring for All (see here) , Common Weal explained the importance of caring relationships to all our lives and set out proposals for a National Care Service. This, we argued, should be designed to promote a caring society, support all those who provide care informally (most care is provided in this way) and to provide care directly where there is needed. As we observed then “The scale of unmet care is not well measured but it is very large – possibly as many as one in five people need care or support of some kind but about 85% of them receive no formal care at all”.
Perhaps the fundamental reason for creating a National Care Service (NCS) is we need to collect data on need across Scotland, identify what resources would be needed to meet those needs and then allocate the resources required to local authorities (who in turn would allocate resources, based on the data on need to local areas). We might not have stated it explicitly but our assumption in Caring for All was that understanding the needs of its citizens should be a fundamental duty of the state.
This week East Renfrewshire Council initiated a process to outsource that responsibility to the private sector. On Monday it issued a tender to the private sector to produce a Strategic Needs Assessment covering all age groups on behalf of the local Health and Social Care Partnership (HSCP).
In the early decades of the development of private care market ideology, the concept of the “purchaser/provider” split ruled. The duty of local authorities, as the purchasers of care services, was to plan for what was needed and then commission services, whether internally or externally. As financial pressure on local authorities increased, so did the pressure to outsource to the voluntary and private sector which paid their staff less. Commissioning, which in the NHS mainly refers to the development of new public health services, in social care became synonymous with outsourcing and procurement. Local authorities nevertheless retained some responsibility for deciding what services they should be buying. Now, East Renfrewshire’s tender effectively outsources that responsibility to the private sector too.
This is part of a wider process that has been going on for over a decade or more. Not long after Caring for All was published we wrote about how the Scottish Government had brought in KPMG – which at that time was being investigated by the UK Government – to design how the NCS would operate. KPMG’s proposed Target Operating Model may have disappeared from sight but their power over health and care services appears to be increasing. Recently as “independent advisers” to the Scottish Government they produced a report on how to address the financial crisis at Grampian Health Board (see here) which helps fund several local HSCPs. The KPMG report cites two causes for this crisis, an ageing population requiring more care and high levels of temporary staff (although the report also notes staffing numbers had increased). Instead of addressing these issues, the report is focussed on financial performance and scatted with references to the need for further work to understand what is happening better – i.e more contracts to KPMG and their like. Among the proposals, number offer further opportunities to the private sector, most notably their recommendation that 40% of back office staff could be replaced by AI. This is a good example of how, step by step, the private sector is extending its tentacles over health and social care services in Scotland.
“Besides all the data protection and value for money issues, outsourcing responsibility for strategic needs assessment to the private sector will do nothing to improve our understanding of the real level of care need in Scotland.”
The apparent paradox is that, far from being hollowed out, the civil service is larger than ever before. Part of the explanation appears to be that the private sector consultancies now planning and managing public services require access to data still held by the state. Hence, in par,t the rush to take control of that data directly. A recent example of that is the award of a £27,852,000 contract to work on the Digital Front Door for NHS National Education Scotland (NES) to CGI Canada, a multinational information technology firm.
The East Renfrewshire tender states the strategic needs assessment should be based on "key demographic, planning, socioeconomic and health data". That is ALL data which it currently holds. Indeed, since the Social Work Scotland (Act) 1968, local authorities have had a statutory duty to assess the needs of anyone they believe might be in need of care or support. They also have a legal duty to notify appropriate housing organisations and the NHS where as a result of that assessment they believe a person has housing or health needs. The latest monthly data Public Health Scotland (see here) shows that on 3 November 2025, there were officially 7,806 people waiting for a needs assessment, “an increase of 30% from the estimated number of people waiting this time last year”, and another 3,309 waiting for a service. This is just the tip of the iceberg when it comes to care needs as eligibility thresholds for assessments and services continue to rise. However, it is local authorities that should have all this data. Besides all the data protection and value for money issues, outsourcing responsibility for strategic needs assessment to the private sector will do nothing to improve our understanding of the real level of care need in Scotland.
Assessing care needs is a complex process which was done far better 30 years ago by local authorities than it is now. Strathclyde Regional Council had a paper form, the CC (Community Care) 4 on the back of which social workers had to identify all unmet care needs and these were then collated centrally to inform service planning. Our priority should be to develop new Scotland wide systems to do this and social care should learn from the NHS which is still very good at collecting data on health needs. Those needs are identified and determined by professionals, rather than managers, and information about them is then used to drive service development, including preventive services like breast or bowel screening. At present the care system in Scotland operates very differently, with services planned by managers to fit with budgets and according to levels of perceived risk not need
Common Weal believes the answer to getting a much better picture about the levels of unmet care needs across Scotland lies in personal data stores, where all the information about each of us as individuals is in the one place. That detailed information could then be shared between services, where the person consented, to improve “joined up” working, but could generate anonymised outputs for planning purposes. The main barrier to developing personal data stores is they wouldn’t offer much money to all the private businesses trying to increase their profits at the expense of the public and public services. The East Renfrewshire tender is another step in the wrong direction.