Nobody could accuse Nicola Sturgeon of trying to lower expectations for the “National Care Service” her Scottish government has promised to build over the next five years.
“This will be, in my view, the most important public sector innovation since the establishment of our NHS,” the first minister told the Scottish parliament last week.
Sturgeon’s pledge of urgent transformation in the way the elderly, chronically ill and disabled are looked after contrasts sharply with the perceived inaction of Boris Johnson’s Westminster government.
Within hours of his election as Conservative leader in 2019, Johnson promised to “fix the social care crisis once and for all”. But the prime minister is yet to come up with even a draft plan for reforming a UK-wide care system whose deficiencies were cruelly exposed by the coronavirus pandemic and rising demand from an ageing population.
Johnson faced heavy criticism for failing to included detailed plans for social care reform in the Queen’s Speech on May 11.
The Welsh government has called on Westminster to act soon or it will have to introduce its own reforms, which are likely to include a big expansion of free or subsidised care.
Health has been primarily a devolved matter ever since powers were transferred to the Scottish, Welsh and Northern Irish national assemblies more than 20 years ago. Social care across Britain is currently provided by a mix of local authorities, not-for-profit organisations and private companies.
Sturgeon’s plans are based on an independent review of the sector by Derek Feeley, a former NHS Scotland chief executive, published in February.
Feeley called for the creation of a National Care Service that would have equal status with the seven decade-old NHS, reporting directly to the Scottish government, and responsible for regulating care homes and services as well as setting the pay and conditions of care workers across the country.
To the relief of some investors in private care groups, Feeley stopped short of calling for the nationalisation of private care homes, recommending instead a “more actively managed market”.
“The National Care Service will bring together everyone with a role to play in planning and providing social care support to achieve a common purpose,” his review said.
Richard Sloggett, a former political adviser to UK health secretary Matt Hancock, said the Scottish National Care Service could provide a template for England on how to improve standards and professionalise a low-skilled and poorly paid workforce.
He added it could fill a gap by building “a central functionality for overseeing standards, supporting the sector and building structures around pay”.
Robert Kilgour, executive chair at care home group Renaissance Care, said that, while the devil would be in the detail, he was “broadly supportive” of the reform efforts.
“The social care sector has been the Cinderella sector for too long,” he said. “It has been NHS first and social care second — and that’s not sustainable.”
The Scottish plans will not come cheap, however. The Feeley review called for better pay and conditions for care workers and the scrapping of all charges for non-residential social care support. Unlike in England and Wales, Scotland already provides free personal and nursing care to all people assessed as needing it, but this will now be extended to cover services such as meal deliveries and community alarms for those living at home.
Feeley estimated that such costs and plans to provide for currently unmet care needs would increase Scottish public spending on care by £660m a year, a 20 per cent real terms rise on 2018/19 outlays.
The manifesto on which Sturgeon’s Scottish National party on May 6 won a fourth term in government promised £800m in increased spending on care over the five-year parliament. But it also ruled out any increase in devolved income tax rates, and the independent Institute for Fiscal Studies has warned the manifesto promises overall were “disconnected” from budgetary realities.
David Bell, professor of economics at Stirling university, said the Scottish government had been more successful than England in reforming social care, but on funding added: “Scotland hasn’t really addressed that problem.”
In England, discussion about care system reform has been focused on meeting Johnson’s manifesto pledge that no one should have to sell their homes to pay for care rather than how to address the broader underfunding of support for elderly and working age disabled people.
As UK health secretary in 2010, Andy Burnham tried to reform England’s social care system but saw his plans shelved as too controversial. Now the Labour mayor of Greater Manchester, Burnham said the NHS’s role as carer of last resort meant social care had to be provided free to all and funded by general taxation. “If you do not provide social care on NHS terms . . . you are storing up problems for the NHS,” he added.
However, not everyone is convinced of the benefits of centralising control of social care. June Andrews, a care sector consultant, said ministerial decisions led to the discharge of coronavirus-infected patients into care homes, which many in the sector blame for high death rates among residents.
Creation of the National Care Service could be “time consuming” and draw attention from rebuilding NHS services after the pandemic, Andrews added.
Still, Natasha Curry, deputy director of policy for the Nuffield Trust think-tank, said the crisis triggered by the pandemic could help build the political and public consensus needed for social care reform across the UK.
“I think we have that opportunity now, post-Covid, where social care is as high as it’s ever been in public and political discourse,” Curry said.