Social Care in Scotland: we need the case for change, not a battle for custody

I listened with keen interest to both the Prime Minister’s BBC News interview with Laura Kuenssberg on Sunday and his first speech to the UK Labour Conference as PM. It’s certainly good to see social care reform at the top of his agenda. I can’t help but applaud the Prime Minister’s political tenacity and drive, whilst recognising his very personal commitment to seeing better support available for all. The renewed focus on reform acknowledges what those of us working in care and support have known for years: that the current system faces profound challenges which cannot be ignored indefinitely.

Of course, social care is a devolved policy area and the Prime Minister’s social care plans (if not his pension plans) largely relate to England. But there are important reflections to make, this side of the border, in the wake of his outline commitments from the last few days – commitments which come in the same month as our First Minister’s Programme for Government.

Now, anyone who has been working in social care in Scotland will hear the words “National Care Service” in England and experience an involuntary twitch and a slight raise in blood pressure. I would urge Health and Social Care officials in Whitehall and Dame Louise Casey to spend time in Scotland with us, and key partners, to learn the lessons from how the promise of the Feeley Report turned into the failure of the National Care Service Bill. But I would urge the Scottish Government to do the same (more on that later…).

And, yes, whilst the Prime Minister is starting to sketch out what reforms will mean for England, including an indication of how he intends to raise at least some of the money he’ll need, none of this is going to happen before the next election – and even then, his proposals will take time to deliver. This does mean that Scottish politicians need to stop hoping that Scottish social care will be saved by increased Barnett Consequentials any time soon. We don’t have time for the vague hope of extra funding that may, or may not, come after 2030.

But we do need hope and the passion to implement solutions that improve people’s lives on their terms. We also need decision-makers to understand the real purpose of social care to change those lives, and to champion the economic potential of investment in the sector. And we need consensus for bold improvements in Scotland.

And this is what really struck me in the BBC interview on Sunday: the Prime Minister’s statement that “we do have to build consensus”. Here is a man who, at least for now, is sitting in Westminster with a majority of nearly 160 – yet, who is still seeking political consensus for change.

With that in mind, let’s turn back to Scotland again.

Our governing party is seven seats short of a majority. There is no formal parliamentary agreement to boost those numbers to get the most controversial elements of public service reform through our parliament – including social care reform. We have council elections (at least, we are still assuming we do…) next May which could result in a seismic shift in local representation that may reduce the influence of the SNP to implement local change – however many councils we might have.

The fact that the National Care Service Bill failed does not mean that social care – currently the statutory delivery responsibility of local government, but with policy and funding driven by the Scottish Government – is all OK.

We need major changes even more than we did when the National Care Service Bill was laid before the Scottish Parliament. Our recent reports on funding and governance show just how complex and inefficient our systems are. Change is beyond urgent.

The Scottish Government knows this too – and that is why, in principle, we welcomed the announcement of a new attempt to reform the sector earlier this month.

But the Scottish Government needs consensus too – not because it would be nice, or good optics, or the only means to ensure longevity of change through parliamentary cycles. It needs consensus to make the parliamentary maths work.

Last time – through the National Care Service process – they just didn’t have the numbers. They entered a fight with both local government and the Trade Unions and didn’t win. They didn’t make enough concessions to opposition parties, then lost their majority with the ending of the Bute House Agreement with the Scottish Greens. They then didn’t have the votes. They had options to improve the Bill which many of us tried to promote over three years, but which ultimately weren’t adopted. Time, drive, trust, political capital and valuable cash was wasted.

So, this time must be different. But will it?

My concern at the start of this process, is that – at worst – the same context for reform is being recreated and – at best – mixed messaging from the Scottish Government is leaving open a door for consensus that may shut through confusion and dissipation of drive.

When the First Minister stood in the chamber on the 1st September to announce his ambitious five-year Programme for Government and opened a conversation on the future of social care over three months, he said:

“I do not seek to be prescriptive, but I cannot see us resolving the fundamental challenges facing social care without a single line of decision-making, accountability and funding, with the NHS taking the lead”. 

Now that statement wasn’t in the written Programme for Government and could mean a multitude of potentials.  But, as one of my members said: “Here we go again”. And it does feel like that.

Whilst COSLA has committed to engage, battle lines have again been drawn. The COSLA statement following their initial talks with Ministers noted: “Council Leaders have once again reaffirmed that social care and social work services must remain within Local Government and be accountable to local communities”.

The hopes of consensus (again) seem very fragile indeed and the focus (again) seems fixed on accountability and power. This is not hopeful.

But it has left me deeply thoughtful and not just asking “how are we here again?”, but “how do we get out of these opening positions to ensure positive change?”.

My answer for a route to real change is threefold.

Last week the Minister for Community Care, Alison Thewliss MSP, came to meet our members and reform inevitably came up.  I shared that it feels, just now, like social is part of a bitter custody battle. The two big statutory partners are (again) fighting for who owns us with arguments which seem rooted in the politics of control.

But who is really setting out why social care matters?

Who is laying out their vision for what can be better for people who need social care (and I mean the 1 in 25 Scottish people who need social care each year, not only those who are waiting to be discharged from hospital) and how this could be achieved?

Who is showing supported people and their loved ones that their life outcomes matter above all else?

Who is demonstrating to (not just telling) staff who deliver care and support that they are valued for their work and for their contribution in building a caring and cohesive society?

I know that both national and local politicians care – they show this with passion when we meet. But starting a conversation with who controls the money and decision-making doesn’t communicate that publicly. It doesn’t help us reach consensus.  Indeed, dare I say, Self Directed Support legislation suggests that power and control is meant to sit entirely elsewhere.

So, in this three-month conversation period, my first plea is this: tell us why social care really matters; demonstrate an intimate understanding of the scope of social care’s potential to all who need support; show us you really understand the issues that need fixed and be honest and open about what isn’t working – and only then tell us why your option for system design is the one for us all to deliver this together.

My second point relates to the commitment to conversation.

Consensus goes beyond the balance of parliamentary votes. Change needs consensus and ownership to drive improvement from those who will deliver it. Whilst our members had an excellent meeting with the Minister for Community Care recently, this is not a replacement for in depth engagement with us on the shape of change.

It is almost one month on from the First Minister’s announcement and I still don’t know how CCPS will be engaged in detailed discussions, what questions are to be answered, and what format we can submit our ideas for improvement. I can see detailed discussions ongoing between local and national government, and clearly that matters. But this is not all that matters. Please don’t leave us till last (again). Engage in the detail with us now because the expertise, drive and experience to improve sits in organisations like CCPS and its members. Civic consensus matters if implementation is to succeed.

This brings me to the last of my three points as this conversation period continues: we won’t wait for the opportunity to speak to present itself.

Our membership is full of extraordinary leaders who work with their staff and the people they support (often against all odds) to deliver social care that works. They also know what stops them from doing so much more.

And although we don’t know exactly what the Scottish Government wants of us in this three-month period, or how we will be involved in detailed design discussions, we are getting on with setting an agenda anyway.

Already we have entered a period of intense work to develop proposals for major improvements in social care building on our members’ voices and our many years of policy work. We will draw on wider research and an autumn engagement programme with our community, our partners and politicians from across the spectrum.

Our focus, initially, is on major funding reform, significant workforce improvements and effective commissioning around families and communities. These are the three areas that we think need immediate attention to build a social care and support system that will enable people of all ages to thrive. Who runs that, and how, is the secondary question.

We are getting ahead to set an agenda for bold improvement in collaboration. We will propose credible and deliverable solutions, rooted in our passion for what social care can do.  And our members have the vision to genuinely be part of the solution in Scotland.