“There are only three choices: make things happen, watch what happens or wonder what happened” (Tommy Lasorda)

As the new Programme for Government is published, and the Scottish Parliament prepares to debate “A Caring Nation” – including the establishment of a National Care Service – CCPS Chief Executive Annie Gunner Logan blogs about the collaborative dialogue we need to have about structural reform, and outlines the constructive contribution CCPS is already making to that dialogue.

‘Over this Parliament, the Scottish Government will take forward the biggest reform of health and social care since the founding of the NHS, establishing a new National Care Service.’

There it is at last in black and white in the new Programme for Government – a commitment to bring forward legislation to create a national care service in Scotland during the next 12 months. 

There is a long way to go. Even now we have scarcely left base camp. But the idea of such a service is beginning to take shape. And now the hard work begins – and the difficult questions must be faced head on.

The need for social care reform is hardly a new thought. But the pandemic shone a light on the social care sector in myriad ways that pushed that cause kicking and screaming up the policy agenda.

Now, finally, everyone was beginning to understand why social care matters so much – and why those who work in it and are supported by it could no longer be ignored.

As this happened, the notion of a national care service – as distinct from some other kind of reform – quickly became received wisdom in Scotland. Only one of the five parties represented in the Scottish Parliament set its face against such a service in the run up to the election.

But until the Independent Review of Adult Social Care published its report in February, quite what a national care service would look like was far from clear. And even now it remains contested.

In some respects that is not a bad thing. It is after all right, that in a mature democracy, such significant reform should be the subject of widespread and detailed discussion. A lot is at stake – not least the lives of more than 200,000 people who are in receipt of some form of social care support at any one time, and the livelihoods of a similar number of people who provide that support.

But the risk with such discussion is that it becomes a battle of competing interests which narrows options rather than broadens horizons. When that happens the people with the least power get crowded out.

Before the review was commissioned, CCPS had already identified shifting power as one of four key tests to be applied to reform – along with increasing choice and control, improving transparency and accountability, and enhancing sustainability.

We welcomed the review’s findings – especially its shifting of the narrative on social care as an investment rather than a burden, and its focus on realising human rights. We have since welcomed the Scottish Government’s consultation on the National Care Service.

But there are still as many questions as answers – arguably more so since the publication of the consultation because of the proposed broadening of the scope of the service. And there are still major fault lines – even schisms – in the evolving conversation.

One of the most contentious issues is the structural reform at the heart of the proposals – and specifically the future roles of integrated joint boards and local authorities. Not even the most casual observer will have failed to notice that this has got quite heated.

This is not an issue that any of us can wish away. The Programme for Government states that the National Care Service will ‘provide national accountability with strong and appropriate local input and ethical commissioning.’ But how will this work in practice?

For its part, CCPS has made it clear that it does not believe the status quo is an option. We are keen to have a dialogue with anyone who wants to make a national care service work. And we will continue to keep our four tests front and centre of our thinking.

With that in mind, in July we organised – as part of an ongoing series of events – an online symposium in collaboration with Health and Social Care Scotland to explore some of the key issues in depth. Our intention was to focus on the art of the possible – notwithstanding all the attendant complexity, how can we make the national care service a reality? Because we must.

To oil the wheels, CCPS commissioned think pieces from a number of people – Dame Julia Unwin, a member of the First Minister’s Council of Economic Advisers, Neil Crowther, one of the conveners of social care futures, and Ron Culley, Chief Executive of Quarriers. We asked them to draw on their wide experience, and in particular to offer their thoughts on balancing national and local accountabilities.

The symposium generated a rich and open discussion and, perhaps inevitably, more questions.

Can we operate within the current structures and deliver a more sustainable health and social care model? Are we creating a service or a framework? How can localism embrace creativity? How can we avoid a focus on governance at the expense of communities and connections? Does the NHS provide the right model upon which to base a social care service? How can scrutiny be about more than quantification?

Threaded through the conversation was a strong desire to enable people to make their own decisions, and an acknowledgement that we have previously failed to exploit policy levers effectively – not least Self-Directed Support. There was also a recognition that the hyper local really matters and that any national service, no matter how it is structured must encourage localism.

With the Programme for Government now published and the National Care Service Consultation well underway, CCPS’s immediate focus is on responding to that consultation. But with legislation not due to be published until June next year, the conversation doesn’t end there. In fact, it’s really only just begun in earnest.

This week, as part of our ongoing contribution to the conversation, we are publishing the three think pieces we commissioned. I hope you will read them and look forward to hearing what you have to say. As one of the symposium contributors commented, social care is universally used but personally experienced. In both respects, getting it right is something none of us can afford to ignore.