Orcadian Column, 30 January 2025
Last Thursday, as the last rites were read over the Scottish Government’s flagship, National Care Service, few tears were shed. This hapless attempt by the SNP to centralise care services proved singularly unpopular, pulling together the widest possible coalition of opposition from staff and trade unions through to local councils, academics, legal experts and the third sector.
Conjuring up comparisons with the creation of the NHS fooled no-one, not even the Ministers making them, who looked increasingly desperate and disingenuous as the inevitable demise grew closer.
Centralisation seldom works in the interests of rural and island communities, who invariably find themselves expected to make the best of arrangements tailored to the circumstances if not the explicit demands of those living in our more densely populated areas. In the case of the NCS, however, those in the central belt have been equally unimpressed.
Of course, the SNP have a track record of believing in the immutable benefits of centralising and homogenising. It’s not to say that cost efficiencies don’t exist, but the optimism bias of this government when it comes to centralisation has been off the scale. Some argue that the leadership has adopted the same approach to governing the country as they deployed, up until recently, in managing party discipline.
That is not to say, there isn’t a credible case for reform of social care, which is under unprecedented strain. Indeed, support for the recommendations of the Feeley Review, which gave rise to the National Care Service Bill, was strong and widespread. The problem, however, as Jeane Freeman, the former SNP Health Secretary who commissioned the review, observed at the weekend, was not the recommendations but her party’s approach to delivery. Ms Freeman expressed anger that her successors had lost sight of the fundamentals; namely the needs of those receiving care and the resources, training and support available to those delivering it.
The tragedy of all this is not measured in the embarrassment to the SNP, but rather the £27m that this ‘vanity project’ has consumed over the past three years as ministers sought, and failed, to wrestle control over social services away from local authorities in a bureaucratic reorganisation.
Talk of trying to address a ‘postcode lottery’ in care sounds laudable until you consider that in an age of self-directed support the notion of a one-size fits all approach to delivering care makes little sense, even if the need for consistent standards absolutely does. Sadly, the money squandered in pursuing this ill-fated restructuring could have paid for 330,000 weeks of care or packages for around 6,000 Scots.
Calls for an inquiry are loud and growing but by the time any such inquiry reports, the focus will have moved on, as will many of the individuals involved, and the money will still have been spent. That’s not an argument not to have an inquiry, but a reminder about what it might ultimately achieve.
Yet as budgets get ever tighter, it’s crucial that lessons are learned and safeguards put in place to avoid similar waste in future based on a ministerial belief that they know best. In terms of the bill, it should now be used as a mechanism for refocusing on the needs of those in receipt of social care as well as a workforce crying out for some care and attention itself. That will inevitably involve pay and conditions that better reflect the roles as well as the importance of building and sustaining a workforce equipped to meet the growing demands of an ageing population in the decades ahead. If that is the approach the Scottish Government chooses to adopt, it may still be possible to rebuild confidence and a coalition of support for reform.
Meanwhile, years behind schedule and many millions over budget, another actual flagship, the MV Glen Sannox finally set sail recently with actual passengers on board. The fanfare was more muted than the one that greeted her premature launch back in 2017, replete with painted on windows. All of which provides a timely reminder for those of us exercised about the National Care Service debacle, that when it comes to financial mismanagement by Ministers, worse things often happen at sea.