The Case of the Election and the Disappearing Care Service
Nick Kempe looks at the party manifestos and asks why the main parties have retreated so far on their ambitions for care reform and a National Care Service.
One would not know from reading most of the party political manifestos that the care crisis is now arguably more deeply entrenched than it was during Covid and the impacts in some cases worse. That is evidenced by the burgeoning numbers of people living on the street or experiencing mental health problems and the number of health and social care partnerships with massive black holes in their budgets. The paradox is that as the care crisis has deepened most of the political parties have retreated from offering any political solutions.
The most striking example is the SNP. Their 2021 manifesto, Scotland’s Future, stated that “the importance of our social care services has never been clearer” and “we owe an enormous debt of gratitude to our nation’s carers for the commitment and compassion we have seen throughout the pandemic”. It committed to creating a National Care Service “by the end of the parliament”, a “National Wage for Care staff” and to “enter into national pay bargaining for the sector, based on fair work principles, for the first time”.
Their new manifesto, On Scotland’s Side, contains no mention of a National Care Service (NCS) or what the SNP are now proposing following the collapse of their NCS Bill. That is despite there apparently being arrangements in place to announce a final NCS Board after the elections. The reference to a national wage for care staff has been completely dropped from the new manifesto which now merely states an SNP Government would “expand collective bargaining”.
Instead of a standalone NCS, the SNP has subsumed social care under health. Their manifesto makes just one specific social care commitment, to invest £20m in funding adaptations through the Independent Living Fund for those with complex care needs with the aiming of freeing up 400 hospital beds. There are no proposals to fund local authorities to provide adaptations for the thousands of people trapped in their houses by their disabilities.
Scottish Labour has similarly retreated from its 2021 manifesto, heralded as a National Recovery Plan, which committed to extend the founding principles of the NHS to care and to “Create a National Care Service that prioritises national funding and retains local services to ensure that local expertise, accountability and community input are not lost”. Instead, Scottish Labour says it will “Work in partnership with the sector to create a National Care Service worthy of the name, creating consistent standards of quality and service delivery everywhere across the country”. Without further detail it is hard to know what that means but it sounds not unlike the sort of centralised management arrangements that have been promoted by the SNP.
Also like the SNP, Scottish Labour’s primary interest in social care appears to be relieving “the pressure on our NHS” and addressing the delayed discharge ‘problem’. They promise to fund 300 ‘step down’ beds and 1000 extra care at home packages to get people out of hospital. There is no mention of what they intend to do to help the thousands of people trapped in their homes without sufficient care.
The Scottish Conservatives were always against a NCS and while their manifesto is rightly critical of the SNP’s plans to take power away from local authorities, much of what they have to say under ‘Delivering a better social care system’ is on how to reduce delayed discharges from hospital. Their big idea goes further than Scottish Labour’s step-down beds and proposes moving people out of hospital and into care homes on a temporary basis within 48 hours of being declared fit for discharge. The main beneficiaries of that would be the private care home owners who are making a mint out of older people. A small consolation is that the Tories recognise the current system is not working and are proposing a review of attempts to integrate health and social care is needed with a view to creating alternative structures. Just what they would be prepared to consider is not explained.
Reform’s manifesto contains one short paragraph on social care. In this they claim their economic plan will improve the situation of informal carers by increasing national wealth while their “new deal for local government will also give councils greater flexibility and control over their social care services”.
The Scottish Liberal democrats have more to say about care and, following Ed Davey, bill themselves as “the party of care”. Their focus is rightly on the people who provide care, whether informally or in a paid capacity, and unlike the SNP and Scottish Labour they do not subsume care provision to the NHS. Their commitment to pay informal carers another £400 will, however, hardly do anything to address carer poverty.
Meanwhile adding £2 an hour to the national minimum wage of £12.71 for the social care workforce, is slightly less than the £15 an hour Scottish Labour and the Scottish Greens are offering. That £15 an hour was first pledged back in 2021 and, with inflation, is now considerably less than what was offered then. This shows how far even the political parties pledging to tackle low pay in the social care workforce have retreated since Covid.
“One of the most fundamental ethical dividing line in politics is between those who believe we should care for everyone, because we are all people, and those that divide people and claim not all are equally deserving of care”
In their last manifesto the Scottish Greens committed to building a publicly owned NCS based on human rights. Their new manifesto notes the NCS “failed due to a lack of ambition – structural adjustments will not deliver the radical change Scotland needs”. While noting that “social care has been the neglected partner to health”, it does not say if the Scottish Greens are still committed to an NCS.
While retaining their commitment to end the outsourcing of care to private companies and to increase short-breaks for informal carers, they have added detail to their manifesto including commitments to Trade Union recognition, collective bargaining and to improving worker pay and conditions. In contrast to the other main political parties they are also promising an immediate funding boost to health boards and councils to meet their most pressing demands.
The Scottish Greens also make a wide range of other commitments to specific area of care, including young people, mental health and disability, many of which are welcome. That, however, makes it all the stranger that they have developed no overarching proposal for how all these commitments will be delivered.
The only political party which remains committed to a NCS and has set out its vision for what this might look like is the Scottish Socialist Party (SSP). This says it is “for a publicly owned, fully funded, National Care Service, free at the point of use, democratically controlled and fit for the 21st century, with properly trained, well-paid staff and full trade union rights”. That vision most accords with the model of a NCS we set out in Caring for All although the SSP says little about how that might be achieved.
In Caring for All we argued that caring relationships are the glue that hold society together. Based on that analysis, argued the need not just to support informal care and provide care services but also to promote a more caring society. Despite some of the political parties supporting the Promise, which emphasises the centrality of relationships for children with experience of the care system, none of the political parties have acknowledged the implications more generally.
One of the most fundamental ethical dividing line in politics is between those who believe we should care for everyone, because we are all people, and those that divide people and claim not all are equally deserving of care. Part of the explanation for why Scotland is in such a mess is that even among those politicians who believe all are equally deserving of care, who include many in the centre, few are prepared to argue that the needs of people should come before the needs of that control the economic system.
The main exception to that is when the foundations of that economic system are threatened, as in Covid, which helps explain why the idea of a NCS emerged when it did. Hence too why four years after the last elections to the Scottish Parliament proposals for a NCS have almost disappeared from the party manifestos.
The idea of a NCS, however, is still potentially as powerful as that of the NHS and Common Weal’s care reform group remains confident its time will come even if most of our political parties are trying to sweep it under the carpet.