In context: National Care Service Bill

What’s it about?

Introduced to parliament in June 2022, the bill looks to shift social care responsibility from local authorities to a new national service, under the discretion of ministers.  

Then-health secretary Humza Yousaf called the legislation, which was published following an independent review of adult social care triggered by the pandemic, the “most ambitious reform of public services since the creation of the NHS”.

When will it be delivered?

Initially, the service was to be set up by 2026. However, in December social care minister Maree Todd revealed in a letter to the finance committee that the flagship bill had been delayed until 2028-29 after finding the costs had doubled to more than £2bn.

Its stage one debate has also faced four pushbacks, only taking place in February despite being initially set to be complete by March 2023.  

Have there been any changes since?

Yes. In July last year, following concerns that the proposed measures risked “excessive centralisation of decision-making”, a new deal was agreed between the Scottish Government and local government umbrella body Cosla.

Under the new agreement, care staff would remain employees of local authorities, while legal responsibility for the service would be shared between councils, the NHS and the government.

Also, when Todd delayed the service by three years, she proposed a series of scalebacks to bring down costs. These included abandoning plans for regional care boards and creating a national board to manage the shared accountability process.

So how much will it cost?

At first the government said it could cost up to £500m to set up the service.

However, in October 2022, Scottish Parliament researchers found the government had significantly understated the total costs of the service, revealing it was estimated to be between £664m and £1.26bn over five years.

Later that year the finance committee raised concerns over the budget, revealing it was difficult to assess whether the bill was “affordable or sustainable” as the financial memorandum had failed to provide an overall estimate of the costs.

The convener of the committee, SNP MSP Kenneth Gibson, said the gap had “frustrated the parliamentary scrutiny process” and called for a revised memorandum to be published before the bill was considered at stage one.  

Since then a number of committees including the local government committee have raised concerns over the lack of clarity on the bill’s budget.

Last year a new financial memorandum based on Todd’s refreshment plans indicated the cost stood between £631m and £916m.

And earlier this month it was revealed that the creation of the service has already cost the taxpayer £28.7m.

But has it not been backed by MSPs?

Technically, yes.

In February, the health committee backed the principles of the national service yet highlighted that the lack of information on how it would work in practice was “concerning.” 

The committee said this had limited its scrutiny and called on ministers to “explore the possibility of establishing an expert legislative advisory group for the bill to help guide the proposed co-design process”. Members also said that the committee would require additional time to take further evidence on the content of any forthcoming amendments.

Later that month, Scottish Labour deputy leader Jackie Baillie put forward a motion to stop the bill from progressing through parliament, claiming details about substantive amendments planned for the bill had not been forthcoming.

However, MSPs voted by 64 to 52 against the motion, which would have seen the bill referred back to the health committee for further scrutiny. 

The following day, during the bill’s stage one debate, members agreed to its general principles by 65 votes to 50.

What’s the row with councils?

Last month council leaders withdrew their support for the bill, claiming the amended version did not reflect “a model which local government can support”.

Cosla’s health spokesperson councillor Paul Kelly said that while councils had been committed to working with the government on developing proposals, the revised legislation did not “effectively represent that partnership”.

The decision followed on from trade unions GMB and Unison also withdrawing their support for the bill.

What’s next?

During FMQs earlier this month, opposition leaders pressed First Minister John Swinney to scrap the “botched” service.

Scottish Tory leader Russell Findlay said it was “basic common sense to ditch the plan” and to “put the money directly into frontline care”.

Scottish Labour leader Anas Sarwar called for an “alternative plan” to fix the crisis, describing the current one as an “absolute disaster”.

However, Swinney confirmed the government would pursue the propositions put forward to parliament.

The bill is currently going through stage two of its parliamentary scrutiny.