Can the Scottish Government save its National Care Service?

In shelving its plan to create a National Care Service, the Scottish Government has quit while it’s behind.

Announced in 2021, the much-debated proposal had backing withdrawn, bit by bit, by unions, councils and, eventually, the Scottish Greens. Isolated and adrift on the initiative, which has already cost the public purse around £30m, ministers have, belatedly, conceded that this one, at this time, is simply not deliverable.

At First Minister’s Questions, opposition leaders asked what had taken so long. But the plan is merely paused, not scrapped, and ministers hope to bring it back in another form next year. If they do this successfully, it will protect at least some of what was supposed to make up a large part of Nicola Sturgeon’s legacy.

It was under Sturgeon that the service was announced as part of reforms aimed at creating a healthier, better looked-after Scotland, post-Covid. In fact, it would be “arguably the most significant public service reform since the creation of the National Health Service,” Sturgeon said at the time, following on from a period in which her popularity skyrocketed amidst strong levels of public satisfaction over her handling of the crisis. “The establishment of the National Care Service will spark much debate and it is vital that we get it right,” she told the Scottish Parliament. “But done well, as we intend, a National Care Service will be one of the biggest ever achievements of this Parliament – and, just like the NHS in the wake of the Second World War, it will be a fitting legacy from the trauma of Covid.”

“Done well” has proven to be the sticking point. On the publication of the National Care Service Bill, GMB Scotland senior organiser Keir Greenaway accused the government of publishing “fag packet plans” which were “in danger of overpromising”. Eileen McKenna, associate director of the Royal College of Nursing Scotland, said ministers must “urgently address workforce shortages” now, not later, in order “for any social care reform to be effective”. Then a “coalition of concern” involving Social Work Scotland, Parkinson’s UK and other stakeholders called for a rethink, raising concerns over design, governance and scrutiny.

And that ball just kept rolling, with Holyrood committees calling for clarity over the costs of the planned service and how exactly it would be paid for, along with how power transfers would work and if children’s services would be affected. As those calls became a chorus, ministers were forced onto the defensive but failed to convince critics. When councils pulled support through umbrella body Cosla, it felt like the beginning of the end for Sturgeon’s headline policy. When unions said they were out, a way back seemed impossible. When the Greens finally pulled their backing, the game was surely a bogey. And now, finally, ministers have conceded.

Amidst the delays and extensive opposition, it is highly unlikely that Sturgeon’s timetable can possibly be met.

There remains, however, a determination to do something. “People from disabled people's organisations, carers, service users are urging us to implement a National Care Service because they are dissatisfied, as I am, with the variation in care around the country, the postcode lottery,” said First Minister John Swinney. “So that is what the National Care Service proposal is about. But the government will take its time to ensure that we get the proposals right and bring forward proposals that can command parliamentary support.”

The shape of those proposals will be watched closely and bound up in finance discussions ahead of next month’s budget announcement at a time when every part of the public sector is crying out for more cash, and when election-facing parties are vying to position themselves as the saviour of the sector.

“There is no doubt that our care system requires urgent reform and sustainable investment,” said Cosla health and social care spokesperson Councillor Paul Kelly. “Council budgets have been cut by the Scottish Government year-on-year which leaves councils no other options than to consider cuts to care and other vital local services. This is having an impact on both those accessing and delivering care support and cannot continue. We must urgently see care valued for the critical role it plays in supporting people and society.”

For her part, Sturgeon has yet to comment on the development. Indeed, as a backbencher she has spoken only twice in the Scottish Parliament since August, neither of which was in relation to the National Care Service. But, with so much of her own political capital invested in it, and after the loss of other flagship reforms such as the introduction of gender recognition reforms, it is unlikely to have come as welcome news.

But to take its programme forward, there is no alternative to stepping back on the National Care Service in its current form. 

On becoming first minister, Swinney pledged to work with rivals to deliver more for Scotland. If this can be achieved, the next iteration of care reforms may make it through parliament. Improved, more equitable, better staffed care is without doubt a prize worth winning. But there is a long way to go.