A national debate – Stephen Naysmith looks at the response to proposals for a unified care service

A NATIONAL care agency is the Scottish Labour Party’s much-touted solution to the coming crisis in care for the elderly, should it win the election in May.

And last week, Sir John Arbuthnott’s report detailing how the proposal might work was published. “It is time to revisit the way in which the balance of treatment, care and wellbeing is provided to best effect,” Sir John said.

However, many key groups have given the plan a lukewarm welcome. The idea has not been greeted with open arms by Scotland’s leading social workers, and nurses and charities remain to be convinced.

Labour leader Iain Gray has pledged to set up a new National Care Service within the lifetime of the next parliament, to parallel the National Health Service and integrate health and social care into a single organisation.

This was the main recommendation of Sir John Arbuthnott’s expert panel on the future of social care. The intention is to end an alleged postcode lottery affecting elderly care and other care provision.

To that end the new service would be governed by national standards setting out the results people should be able to expect, including their quality and efficiency, and how fairness is to be ensured.

As well as ensuring a more consistent level of service across the country, Sir John and his panel suggest that such a service would help manage the rising cost of elderly care, in particular by preventing the crippling cost currently incurred by Scotland in terms of unnecessary emergency hospitalisation of many elderly people.

Mr Gray said such a service would also help stop people being “caught in the crossfire” between the NHS and councils.

However Michelle Miller, president of the Association of Directors of Social Work (ADSW) described the proposals as disappointing and said the report had been overly concerned with the practicalities of how a national care agency might be set up, rather than whether it was a good idea in the first place.

She also bridled at Mr Gray’s suggestion that there was a need to help families cope with a “daily battle with NHS or social work services that vary enormously across the country”.

Ms Miller said; “We know that 89% of older people believe the services they receive are of a good quality and 85% say they have helped them lead a more independent life. We need to make a clear distinction between facts that have been collected and validated by a government agency, and simple anecdote.”

ADSW’s views are fundamentally opposed to the national care agency concept. Ms Miller disputed the assumptions of a postcode lottery in care, but in any case warned against standardising services across the country. “This is something we have actively been trying to get away from, because people who use our services tell us that it is not what they want,” she said.

She added that existing national systems were not a good advertisement for standardisation in any case. “On the contrary, the current social security system and the NHS deliver grossly unequal health, social and economic outcomes across the country.”

Instead, she called for more local decision making to allow relevant local solutions to local problems. Ms Miller said variable local responses did not mean that national standards for social care would not be possible, which would give a clear charter of what citizens can expect from state-funded care.

ADSW is keen to see a redressing of the balance of funding between health and social services, and constant and costly debates between agencies over who funds what and who delivers care.

The ADSW president also warned against siting older people’s social care within the remit of health, as it could produce barriers between those older people and other local authority services, including culture, leisure, housing and education.

More than anything, though, ADSW is keen to see a reassessment of public responsibility and expectations about care and objects to Labour’s plan as it is not likely to encourage that debate. Ms Miller said a national care service was a “rearward”-looking proposal and added: “It does not reflect or encourage changes in attitude regarding reciprocal responsibilities between the state, individuals and communities. We need to change our emphasis from viewing the service user as a passive recipient of state provision to an active participant who takes both control and responsibility.”

Scotland’s charities also gave the Arbuthnott panel’s findings a cool welcome. John Downie, director of public affairs for the Scottish Council for Voluntary Organisations (SCVO) said: “SCVO broadly welcomes the idea of a National Care Service that works with service users and the people who support them, provides value for money and takes a preventative approach to health.

“However we are disappointed to see so many questions from our sector remain unanswered.”

He said culture change was needed to make any new system work – including addressing the problems with existing Community Health and Care Partnerships (CHCPs). “The report points out that CHCPs are seen as adding unnecessary bureaucracy and expensive layers of management. Yet these failing partnerships are the only deliver structure proposed by the report.” .

Mr Downie said more far-reaching changes were needed to tackle the inevitable growth in demand for care, adding: “Failure to implement radical reform will mean failure to deliver care for those who need it most.”

The Royal College of Nursing in Scotland’s director Theresa Fyffe, said the RCN would work with whoever formed the next, but said that nurses remained to be convinced of the benefits of a national care agency: “Support from nurses and other staff for changes on the scale that has been suggested will only be gained if there is strong evidence that the health of older people will clearly benefit as a result.”