The review, appointed by the First Minister in September and led by Derek Feeley, published its report reported on Feb 2nd. The report recommends makes many recommendations which would improve conditions for staff in social care. These include sectoral collective bargaining with national terms and conditions established via a national job evaluation exercise. Workforce planning and development will occur at a national level.
National Care Service(NCS)
It recommends setting up of a National Care Service(NCS). This is to be an oversight body rather than a national, and certainly not nationalised, service delivering care. There will still be IJB’s and a ‘mixed economy’ of care provision involving private voluntary and public sectors, although in a centralising move the role of local authorities is to be diminished.
Some of the recommendations will require new laws to be put in place. Others, including many of the staffing and procurement proposals could begin being acted upon immediately.
The report urges a change in thinking about care; that it should be seen as an investment in society rather than a cost on society, be based on relationships rather than transactions, enabling rights rather than managing need, and produced via collaboration rather than competition and markets. The necessity for a better deal for staff working in care and their role in improving the system is stressed throughout.
Working in care.
There is a strong emphasis throughout the report on improving staff conditions, and an entire chapter on Fair Work. Rapid implementation of all of the recommendations of the Fair Work Convention’s report into social care is urged. The body established to do that should also create national sector level collective bargaining on terms and conditions (including for personal assistants). This should include a national job evaluation programme – as well as sick pay, time off and travel time. The NCS should establish ‘mandatory parameters’ for IJB’s when they commission care which include minimum fair work standards. The link between improved working lives for staff and improving the quality of care is stressed throughout the report.
National Care Service – what it is & what it’s not.
Despite a deliberately similar set of initials the NHS the NCS will not itself deliver care. Created by statute with a government appointed board (inc workforce reps) and a minister with specific responsibility it will mainly be a body overseeing those who commission and procure care – primarily IJB’s. NCS will have responsibility for workforce planning and development, and initiatives to raise quality and standards. The Care Inspectorate and SSSC will become part of the NCS. Which will be therefor both an inspectorate and a regulator. The aim is an “actively managed market” featuring more engagement with IJB’s before a service can be registered. Scottish Ministers rather than local authorities will be legally accountable for adult social care support.
Recommendation is that IJB’s are directly funded by Scottish Government rather than via Councils & Health Boards. They will employ their own senior management accountable to the IJB itself rather than councils & Health Boards. Every member of the IJB, inc TU reps, should have a vote. Strategic commissioning plans are to put greater emphasis on prevention and working with other services such as housing.
“Delivery Partners” – who provides care?
As now, a mix of public, private and third sector bodies commissioned and procured by IJB’s. Whilst the report talks of “unease” at private profit and private domination of the “care home market largely led by business decisions” and a wish to shift from competition toward collaboration The aim is maintain a market based system but one that is more “actively managed” – by the Care Inspectorate. The only mechanisms proposed to tackle the leakage of care funding as practiced by large private providers are that commissioning and contracts specify requirements for financial transparency and levels of reinvestment. Commissioning should be collaborative and ethical (UNISON’s ethical care charter is praised). The hope being that, together with the emphasis on improving staff terms and conditions may act to encourage some of the more aggressive corporations out of the sector.
Investment – in care, in jobs, in growth.
“There is clear evidence that social care support is not a drag on our resources; it creates jobs and economic growth. It enables people who access care and support, and their carers, to seek and hold down employment themselves.” (p88). The report makes the point that 84% of adult social care is public money.
The commission recommend the Scottish Living Wage for all staff working in adult social care – and estimate that the price tag for every £1 per hour raise above that to be £100m.
The recommended increase in funding is 20% (an additional 0.66bn). In making this case the Commission point to adult social care directly employing 148 000 people, with another 51 000 jobs generated as a result of adult social care. Reports are cited estimating the value of social care spending. Every £1 spent on social care generates £2 in other sectors. A UK wide increase in social care expenditure of 1% of GDP would create three times as many jobs than a similar spend in construction and generate tax and NI payments almost 50% higher. A number of potential tax schemes to fund the expansion are suggested but none are recommended.
Some of these proposals align closely with UNISON Scotland’s vision for Care after Covid, others much less so. Many of the staffing proposals can be welcomed unequivocally, the structural proposals though require a more complex response. Despite condemning a market based system, the report advocates leaving one in place – although much more regulated. Work on many of the staffing and procurement proposals could begin immediately.