A major union representing care workers across Scotland says a National Care Service must commit to a major expansion of care provided by the public sector, in order to safeguard the people of Scotland and the economy from the ‘failing’ market model.

A new report commissioned by UNISON Scotland says that the current system where private companies provide the bulk of care services has allowed a ‘race to the bottom’ in terms of pay and conditions.

It argues that a major expansion of publicly-owned and operated social care provision could counterbalance the private model based around resource extraction and create a financially transparent alternative.

Lilian Macer, UNISON Scotland Regional Secretary, writes in the foreword to the report authored by the Association for Public Service Excellence (APSE) that the need for change is urgent:

‘Our care system is struggling. It is underfunded and beset with a crippling staff recruitment and retention crisis that is having an impact across the length and breadth of Scotland. Structural problems make themselves felt on the quality of services being received and on the working lives of care staff.

‘Funds are drained by profiteers who see those accessing care services not as vulnerable people to be helped but as a source of revenue. Equally they see the staff providing services not as an asset to their community but as a resource to be exploited. We cannot keep spending public money on such an inefficient and unjust system.’

The report says creating a truly person-centred wrap-around care service is unlikely to happen in a system dependent on market mechanisms to provide large swathes of provision – and that the Bill to establish a National Care Service has failed to address this root problem.

Lilian Macer, UNISON Scotland Regional Secretary, says in the foreword to the report authored by the Association for Public Service Excellence (ASPA) that the need for change is urgent:

“Our care system is struggling. It is underfunded and beset with a crippling staff recruitment and retention crisis that is having an impact across the length and breadth of Scotland. Structural problems make themselves felt on the quality of services being received and on the working lives of care staff.

“Funds are drained by profiteers who see those accessing care services not as vulnerable people to be helped but as a source of revenue. Equally they see the staff providing services not as an asset to their community but as a resource to be exploited. We cannot keep spending public money on such an inefficient and unjust system.”

 

Rid the sector of private-sector dominance, says union

Around 79% of care home residents in Scotland live in a privately-owned care home, while 44% of care at home hours are provided by the private sector.

The union says that as much as 20% of income into the sector ‘leaks’ into the hands of owners and financiers, with even more money lost in the ‘tax efficient’ structures used by some large care companies.

The inflationary impact of contract failures when there is no alternative in the public sector and the hidden costs of contract management and procurement also contribute to high costs, according to the report.

It argues that Integration Joint Boards should be supported to expand their publicly owned care services, either by taking over failing providers, buying-out providers of concern and developing brand-new provision.

This, the report says, could be supported by a ‘National Insourcing Strategy’ which would work to rebalance care provision in favour of the public sector by offering financial capital support and initial revenue support.

A recent agreement between NHS boards, local authorities and ministers to share accountability for care provision in the future ‘bodes well’ for this approach, says the report.

 

The National Care Service

UNISON Scotland has been calling for the NCS Bill to be withdrawn since it was introduced in June 2022.

Lilian Macer, Regional Secretary, told Holyrood’s Health and Social Care Committee last month that the union does not believe that the Bill in its current form values the workforce:

“There is nothing in the Bill about workforce matters. There is one mention of fair work. There is nothing in the Bill about ethical procurement; it talks about ethical commissioning and about setting up a process to establish what that looks like.

“The Bill does not give us the assurances and guarantees that we need for our members, and it does not give guarantees and assurances for the population of Scotland.”

She also highlighted the failure of government since 2019 to make progress with sectoral bargaining, which she said has deepened the crisis in the sector.

At an evidence session earlier in October, Minister for Social Care Maree Todd told the health committee that sectoral bargaining has been “probably the toughest area to deliver” within the National Care Service and is yet to be finalised in any detail

UNISON’s report states that a National Care Service which fails to renew public sector provision will ‘miss a major opportunity’ to move the care sector away from relying on a model it says works at the expense of Scotland’s people and economy.

Ms Macer told the committee that public provision must be a core element of a national care service, but the Bill has failed to give proper clarity on procurement and ethical commissioning:

“For me, radical change means public provision of services and public control of those services, so that we do not see that leakage and so that the moneys that we spend—public sector and taxpayers’ money—go back into local communities, where they belong.”

 

Read more: First Minister urged to rethink social care pay rise; Outstanding questions stall NCS scrutiny; Urgent workforce reforms needed for Scotland’s NHS

 

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