We are only weeks away from seeing the independent review of adult social care in Scotland’s first report – four months after it was set up by Nicola Sturgeon.

Ministers want the panel to outline the options for creating a national care service in Scotland – what could be one of the most significant changes to the way care is provided for decades. But how to pay for it?

Because it is part of the SNP’s latest Programme for Government any hopes the review would be a broad exploration of what the future of adult social care could be in Scotland have been tempered.

Both the Health Secretary and First Minister have strongly reiterated the review is to set out the options for creating a national care service, which presumably excludes other ways of doing things and potentially signals a very dramatic departure from the current set up where private, independent and third sector providers make up 80% of social care provision in Scotland.

The trouble is – according to various stakeholders in the sector – it has never been clear what exactly a national care service means.

Ms Sturgeon has said her government will act quickly on the findings of the review panel, just in time to offer voters in the parliamentary elections in May an understandably tempting, but potentially still ambiguous, promise of a national care service akin to the much-loved NHS.

There are many questions needing answers when it comes to how we look after people who need care and support.

Not least of which some would argue is why government has the time and money for a review into the future of the care system before, and without the lessons of, a public inquiry into what happened in Scotland’s care homes earlier this year.

Residential care lost more people to covid-19 than our hospitals did in the first wave. Opposition politicians and some care providers have said an inquiry should have been carried out over the summer to learn lessons from the first few months of the outbreak and potentially save more lives this winter.

What the independent review might say when it comes to financing a national care service is intriguing.

 

"...at around £2bn, a full buy out of Scotland's 1,000 private and third sector care homes is unlikely – and that’s before adding in care at home and other providers"

 

The pandemic has left us in unprecedented fiscal terrain with UK government borrowing reaching extraordinary levels to try to keep the economy afloat and public services operating.

Just this week, fears were sparked that the Scottish government could be considering a takeover of private care homes after it emerged ministers asked for a valuation of the sector earlier this year.

But at around £2bn, a full buy out of the 1,000 private and third sector care homes is unlikely – and that’s before adding in care at home and other providers.

One option is to increase funding for what we already have.

The University of Stirling economist Professor David Bell branded talk of creating a national care service a distraction from the larger problem of caring for an inevitably rising number of older people in Scotland over the next 20 years.

A paper by Professor Bell published last year concluded the social care sector had been squeezed by real terms local authority budget reductions of 13.9% between 2012-13 and 2018-19.

Continued austerity UK-wide coupled with a lack of strategic planning on the part of the Scottish government, Professor Bells says, has only made things worse and stopped the social care sector from growing as much as it needs to.

The Scottish Social Services Council’s own Chief Executive has said the living wage for social care staff is still too low. And Scottish Care’s National Director Karen Hedge has repeatedly made the case that creating a national service could remove any of the choice and control that good, person-centred social care should offer.

Integration of health and social care – a flagship policy of the SNP – should “absolutely” be given more of a chance, Ms Hedge says, before we consider any form of nationalisation, alongside properly funding current systems.

Given the central role of health and social care partnerships in organising and delivering social care it is a fair assumption that, however ‘national’ any care service is, the partnerships will be responsible for making it work locally.

The most recent figures released just before Christmas show that, partly down to the pandemic, the partnerships that had reported were projecting a collective overspend of more than £76m.

The extreme demands of the pandemic mean it is very unlikely the Scottish government has any money tucked away for the stirring promise of a national social care service.

“I think we have to recognise that social care has been underfunded for a significantly long time now,” Ms Hedge says, “and we have to ask, if there was greater investment into the sector…would we have had a more supported and a larger workforce which might have helped us to tackle the pandemic response better?”

 

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