Scottish Government scraps national care service restructure

The Scottish Government has ditched plans to restructure adult social care in the country into a ‘national care service’ (NCS).

Social care minister Maree Todd said that she was scrapping the flagship Scottish National Party (SNP) policy because of a lack of support within the Scottish Parliament, in a ministerial statement issued this week.

She said that ministers remained committed to creating an NCS in Scotland, and would proceed with its National Care Service (Scotland) Bill, but shorn of any structural reform, meaning responsibility for adult social care will remain with councils.

Plans for ministers to take responsibility for sector

The SNP’s original plans, issued in 2022, were for ministers to take control of adult social care, with services commissioned nationally through regional care boards, which would be under ministerial direction.

At the time, the then cabinet secretary for health and social care, Humza Yousaf, said the NCS would “end the postcode lottery of care in Scotland”, to ensure “everyone has access to consistently high-quality care and support so they can live a full life”.

Another plank of the proposals was the creation of a national social work agency to oversee social work education, professional development, improvement, workforce planning and terms and conditions.

Widespread opposition leading to policy shift

However, the plan ran into widespread opposition, including from social work and local authority leaders, leading ministers to make significant revisions.

Notably, in 2023, the government said it would share accountability for the NCS with the NHS and councils. Local authorities would remain responsible for employing adult social work and social care staff and for their existing buildings and assets, under an agreement with local government body COSLA.

Instead of creating new care boards under ministerial direction, the government proposed reforming existing integration authorities – partnerships between councils and health boards that are responsible for adult social care and primary and community healthcare.

These would be accountable to a new national care service board, which would be responsible for overseeing the NCS, as delivered by integration authorities.

Revisions to national care service legislation

Then last summer, ministers announced proposed amendments to the bill to put its reformed approach into action, including creating the national board.

Under the plans, the board would have been subject to ministerial direction, while also being able to intervene in local services to drive improvement.

The proposals prompted COSLA to withdraw support for the bill, on the grounds that it risked a “restrictive centralised model which removes key local decision-making, prioritises increased national monitoring and reporting”.

In her statement this week, Todd said the Scottish Government was now scrapping the plan for the board and all other structural changes planned under the legislation.

Proposals ‘not supported by Scottish Parliament’

“We made considerable effort to find compromise and a way forward. But it is clear those proposals are not supported by this chamber,” she told the Scottish Parliament. “I have concluded that we must deliver our Scottish national care service without legislating for structural reform, securing a different means to deliver our goals.”

This includes creating a non-statutory NCS advisory board, including representation from people with lived experience, councils, unions and the NHS, to advise ministers on using their existing powers to drive improvements to adult social care.

Other elements of the National Care Service (Scotland) Bill – including a duty on care home providers to facilitate visits to and by residents, action to facilitate information sharing between services and new rights to breaks for informal carers – will remain, Todd added.

Positive response from local government leaders

In response to the changes, COSLA’s health and social care spokesperson, Paul Kelly, said he welcomed the fact that the Scottish Government was “listening to the many voices who raised concerns about aspects of the legislation and in doing so have set out what appears to be a more promising and positive direction”.

He also backed the continuation of reforms to carers’ breaks, care home residents’ rights to visits and information sharing, a view backed by sector leadership body Social Work Scotland.

However, the changes raise questions about what will happen to the planned creation of a National Social Work Agency.

Planned creation of social work agency

The reformed version of the bill put forward last summer would have placed the existing chief social work adviser role into statute and arranged other civil servants into an executive agency called the national social work agency. But this is within the part of the bill that is now being removed from the legislation.

Following this week’s announcement, the Scottish Government said there was a need to “future-proof reform to support the whole social work profession”.

It added: “The social work sector agrees and, along with the social work workforce, we all believe we must work differently. We must work in partnership to drive lasting improvements that support the vital role of social workers across Scotland.”

Discussions on future of social work

This statement was welcomed by Social Work Scotland, whose director, Ben Farrugia, said: “We were heartened to also hear specific references being made to a partnership approach to social work, and the commitment to improvement for generations to come.

“As a key partner in discussions around a future national social work structure, we believe that securing the right partnership approach – empowered by local and national politicians and accountable to social workers, will be critical to ensuring that legacy of support and improvement for the profession, and can contribute a significant co-ordinating role in addressing systemic issues like poverty and mental health across our communities.”

In its response to the changes, the Scottish Association of Social Work voiced support for the plan to create an executive agency for social work, working in partnership with the sector.

It said this was “the clearest route and best opportunity to create that greater consistency and continuous improvement in social work across Scotland”.