Searching for a National Care Service


Newsnet Report

One of the few positive themes commentators were able to identify in the Labour Party’s Scottish Parliament election campaign was its call for a National Care Service. The obvious reference to the National Health Service was reinforced by campaign promises that the National Care Service would end the “postcode lottery in care” found in Scotland’s existing system of locally provided social care.

The impression that Labour was planning a radical restructuring of Scotland’s social care received a further boost from an opinion poll published in the the middle of April by AgeScotland, successor to Age Concern Scotland and Help the Aged, which showed that 59% of Scots over the age of fifty wanted to see health and social care delivered jointly by a single national health and care body and a further 16% wanted social care transferred from local Councils to health boards. The publication of the poll results had added significance because the Chief Executive of AgeScotland David Mannion, a former senior Labour Councillor in London, was a leading member of an Expert Panel on a National Care Service set up by Iain Gray in 2010 under the chairmanship of Sir John Arbuthnott, eminent microbiologist, former Principal of Strathclyde University and a serial chair of commissions and inquiries.

AgeScotland’s press release quoted Arbuthnott welcoming the poll results: “This level of support from older people is extremely encouraging, especially as the idea of a National Care Service is still very new”. Mannion has continued to promote the vision of a national health and care body, most recently in this week’s Scotsman where he wrote that the best way of making savings would be by merging health and social care services “and delivering their services jointly by a single national health and care body”. Interested members of the public could be excused for believing that the Labour Party with the support of AgeScotland and Sir John was championing the most radical reform of social care since the 1990 NHS and Community Care Act.

But it is mostly illusion. Despite the election hype and AgeScotland’s press releases there is no Labour plan for a radical restructuring of social care delivery. Beneath the headlines of Labour’s manifesto the proposals are more modest. Farfrom seeking wide ranging structural reform the Labour party is committed to “ shifting the focus of the NHS in Scotland from being a reactive service for ill-health towards being a local, pro-active, patient centred service for health and well-being” capable of providing the right level and type of support to people in their communities and homes to reduce unnecessary admissions to hospitals. The delivery mechanism for this shift is to be the existing Community Health and Care Partnerships suitably reviewed and reformed to meet the criticisms of some of their social partners and of Audit Scotland. The National element of the proposal turns out to be a commitment to develop a national framework of minimum standards and eligibility criteria for social care aimed at reducing the postcode lottery.

These proposals draw on the recommendations of Gray ‘s Expert Group headed by Sir John Arbuthnott and including David Mannion. Their brief and hurried report – which took four months to the Christie Commission’s six – provides a little more detail than Labour’s manifesto. It estimates the total annual cost for health and social care for Scotland’s older people at £4.5bn including a £1.5bn cost for unscheduled hospital admissions and recommends that this latter budget be merged with local Councils’ social budgets (approximately £1bn). The merged budget would then be targeted at preventative care and support in the community reducing the demand for the far more expensive hospital care. But contrary to the impression created by Labour’s headline campaigning and by the statements of Arbuthnott and Mannion the Expert Group emphatically rejects the creation of a new centralised delivery structure in favour of using reformed local Community Health and Care Partnerships led by Councils and local health stakeholders as the means of delivering the services directly or through the voluntary organisations.

These proposals are consistent with the Scottish Government’s commitment to a community based preventative approach as reflected most recently in its £70m.

Change Fund launched last year and elements of its Scottish Futures Fund. Whether the Government will take up some of the other proposals of Labour’s Expert Group will be revealed when it publishes its proposals for closer integration of health and social care budgets expected this autumn.

The party’s manifesto stated that Labour was was committed to shifting the focus of the NHS in Scotland from being a “reactive service for ill-health towards being a local, proactive, patient centred service for health and well-being