SUBMISSION TO SCOTTISH PARLIAMENT COMMITTEES (STAGE 1 BILL SCRUTINY)
Social Work Scotland is the professional body for social work leaders, working closely with our partners to shape policy and practice, and improve the quality and experience of social services. The National Care Service (Scotland) Bill (“the Bill”) represents an unparalleled opportunity to put Scotland’s social work and social care systems on a road out of the current crisis, through recovery, to a sustainable, effective future. We have therefore considered the Committee’s questions carefully, and afforded as much time as possible for our members to reflect on the Bill, arguing its merits alongside its flaws.
Overview of Social Work Scotland position in respect of the Bill at Stage 1
The conclusions we have reached, and set out in our responses to the Committee’s specific questions below, should not be interpreted as a position for or against a ‘National Care Service’. Social Work Scotland seeks reform and investment to redress the multiple crises which are impacting social work and social care. We support the intent of the Scottish Government to make changes which will embed human rights and social justice into the operation of social work and social care. We acknowledge the democratic mandate the Scottish Government and Scottish Parliament have to establish a National Care Service in Scotland, and we are committed to engaging with energy and openness in its development.
However, the Bill, as currently drafted, does not provide a robust process for delivering reform of such significance. Particularly in respect of the financial investment that will be needed in social work and social care. It is our hope that, in reviewing the feedback we and others are providing to the Scottish Parliament, Scottish Ministers will reconsider the approach they are taking to the development of a National Care Service, withdrawing or pausing this Bill until the detail of proposals has been properly considered and costed. If Scottish Ministers are unwilling to adjust their strategy, we recommend that MSPs reject the Bill at this initial legislative stage.
We believe an alternative approach to developing a National Care Service is possible, still based on a genuine partnership between those who rely on social work and social care, and the staff who provide social work and social care. If this Bill was ‘paused’, all parties, including local government, should be able to engage in reform discussions constructively. The strands of co-design work necessary for the development of a National Care Service, many already identified by Scottish Government, could still begin immediately, with the lived experience of supported people, carers and staff helping to determine the detail. In fact, with the Bill set aside those strands would be freed from a political and legislative timetable which feels too restrictive, and proper consideration can be given to the strands sequencing and interdependencies, encouraging better policy development.
We appreciate that the Bill also includes sections which are not directly related to the development of a National Care Service; we recommend that Scottish Government use the upcoming Programme for Government to detail how these aspects can be realised in the near term (while the National Care Service co-design work progresses). The Programme for Government could also detail how a National Social Work Agency will be established as a public body, separate to Scottish Government.
With the Bill ‘paused’, a pace for the co-design work could also be set which acknowledges the hard realities of the current context. The Scottish Government’s current approach to developing a National Care Service appears oddly detached from the pressures which Scotland’s people are grappling with. Social work, social care and health services (those impacted most directly by the National Care Service proposals) are in the midst of the most serious capacity and delivery crisis in living memory. Waiting times for assessments, support and treatment are all increasing. In some social work teams over 30% of posts are unfilled, with vacancies receiving no applications over multiple recruitment cycles. A similar situation persists in social care. Sickness absence adds further workload on the remaining staff. Inflationary pressures are effectively cutting public sector budgets at a time when public demand for assistance is rising. And further budget reductions are now having to be identified in many critical public services. Most importantly, social work and social care staff are, like everyone, experiencing a cost of living crisis, and the continued adaptation we are all having to make to a post-pandemic world. Indeed social care staff, and the many para-professionals and administrative staff that support social work, are likely to be on relatively low rates of pay, and therefore under acute stress. A process of co-design requires the informed, active engagement of people. In the present context, invitations to co-design a National Care Service risk adding to existing stress and undermining the wellbeing of the very people this Bill purports to be about; staff, carers and supported people.
A more considered and outcome focused approach to NCS development will also allow for decisions around children’s and justice services reform to be made, and for those seismic decisions to be properly incorporated into NCS policy development. In parallel to a cooperative programme of co-design, a rigorous plan for the investment in social work and social care can be developed and shared, indicating levels of funding over future years and setting out how funds will be sourced or raised. The ambition of a National Care Service will be determined by the extent of the resources at its disposal, not only by its underlying principles or governance structures. The Financial Memorandum accompanying the Bill now before Parliament is largely taken up with organisational changes which are estimated to cost up to £500 million by 2026-27. The reforms that will really matter to people, for example around eligibility, are not included. We therefore do not know if a National Care Service is really going to represent a break with the recent history of systematic underfunding of social work and social care; largely because the investments needed have not yet been costed. Nor can we say whether the combined organisational and service investments indicated in the Policy Memorandum (but not all included in the Bill) are actually deliverable, from the perspective of the public finances. Indeed the seriousness of current crises demands that we consider where limited public resources might be allocated with the most value. The up to £500 million set aside for organisaitonal restructuring may well be needed to protect Scotland’s social work and social care services, as inflation steadily eats away at their budgets over the coming year. And if we are really intent on addressing social care workforce issues, some of the money could be put towards a higher ‘Fair Wage’ rate than is currently in place.
In considering how a National Care Service might be realised, or perhaps more importantly, how we can improve the availability of high-quality social work and social care services, we believe the potential to evolve existing structures should be explored more fully. Scottish Government may feel they have reviewed all the options and identified their current proposals as the only viable one. But that was a process done largely behind closed doors, without any real input from those responsible for delivering these services, or those who make use of the services. After years of personal, political and financial investment in health and social care integration arrangements, should we not be exploring the potential to build on these towards a National Care Service, rather than throwing them out and leaping towards unknown and untested arrangements? We do not believe that reform of Integrated Joint Boards is necessarily the right next step; but it is a viable one. We suggest it to the Scottish Parliament as an example of an alternative approach which, to date, has not been properly considered by Scottish Government.
Co-design work at a national level, involving organisations, professions and individuals with diverse interests, is unlikely to deliver consensus. We understand and expect that Scottish Ministers will eventually need to make decisions, not all of which will necessarily be our preferred option. But with a programme of reform as significant as this, our priority – and we believe the Scottish Parliament’s priority – is to ensure that the Scottish Government’s approach marries ambition with evidence, experience and practical reality. The decisions which Ministers take should follow detailed, transparent, collaborative policy making. If legislation is needed to give effect to those decisions, then a new Bill should be introduced to Parliament, complete with the detail MSPs require to provide proper scrutiny. The approach proposed by the current Bill precludes both good policy making and scrutiny, and therefore is not the best approach to delivering a National Care Service that will improve lives in Scotland.
For Social Work Scotland’s members the establishment of a National Care Service, while important and significant in many ways, remains secondary to the core objective of improving the lives of the many thousands of people who require support from social work and / or social care. We believe Scottish Government shares this core objective, and it is therefore against this objective that we have evaluated the Bill.