Thinktank warns SNP care shake-up could 'exacerbate differences' in quality

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Thinktank warns SNP care shake-up could 'exacerbate differences' in quality
Thinktank warns SNP care shake-up could 'exacerbate differences' in quality

SNP plans to standardise Scotland’s care sector could actually make services less predictable in parts of the country, a leading think tank has warned.

In a new observation paper, the Institute for Fiscal Studies said it was “far from clear” that the new National Care Service (NCS) would improve and harmonise standards as intended.

The shake-up "could exacerbate rather than reduce differences in service quality across areas", it said.

The IFS said the Scottish Government would need to be very careful in how it funded the NCS by shifting £4.3billion a year away from councils, around a third of their budget.

The NCS is intended to oversee the local delivery of community health and social care and ensure “consistent and high standards”, as well as better conditions for care workers.

Nicola Sturgeon said last year it was “arguably the most significant public service reform since the creation of the National Health Service” in 1948.

When the NCS starts operating later in this parliament, the responsibility for adult and children’s social care will move from councils to new Care Boards.

The IFS said this would reduce local government discretion, including the option to spend more than average on services to make them higher quality.

A system that saw care standards converge around a national average could therefore lower the quality of services in relative terms in some places, while leaving residents still paying higher council tax for a better service.

"That could easily be seen as unfair," the IFS said.

In addition, it will not be straightforward to calculate how much funding should be removed from each of Scotland’s 32 local authorities in order to put the cash into the NCS instead.

Calculating the amount based on historic deprivation data may not accurately reflect current levels of care needed in an area, the IFS said.

The thinktank also said it was a mistake to think Care Boards would lead automatically to a more consistent service, as regional health boards delivered varying standards of NHS care.

It said the shake-up represented “a big change in Scottish councils’ responsibilities”, with a careful transition required to avoid financial shocks to local authorities.

“If new centralised funding allocations do not match local needs, the new approach to social care funding could exacerbate rather than reduce differences in service quality across areas,” it said.

However the report also said the scale of the challenge facing Scotland would be greater in England because of more diverse council tax rates there and the pooled business rates system north of the border which meant non-care council services will be less exposed to volatility.

“However, centralising around one-third of Scottish councils’ spending would still be a big deal and careful consideration would need to be given to how to transition to new centralised social care funding allocations,” it concluded.

“A National Care Service would also represent a significant reduction in local spending discretion in Scotland. While this may enable a more consistent standard of service to be delivered across the country, it may not – a lot will be resting on how well the Scottish Government is able to assess the spending needs of different parts of Scotland, as well as the performance of the accountability and monitoring regime put in place.”

IFS associate director and observation author David Phillips said: “The Scottish Government’s plans for a National Care Service reflect a desire for more consistent and higher-quality social care services across the country.

“However, centralising the over £4 billion councils currently spend on these services does not guarantee consistently high standards of care, as experience with the NHS shows.

“Indeed, while councils can use the discretion they currently have to spend more or less to offer higher- or lower-than-average service quality, they can also use this discretion to offset errors in centrally determined spending needs assessments.

“If this discretion is removed, differences in service quality could therefore actually increase if spending needs assessments are not sufficiently robust.

“The government will also need to carefully transition to new funding arrangements – too quick and some councils may need to rapidly cut spending or put up taxes, and too slow could create unfairness in how funding is allocated to Scottish councils.’

Tory MSP Craig Hoy said: “This critical report once again exposes the bureaucratic nightmare of the SNP’s plans to centralise social care services across Scotland.

“The IFS rightly highlight that these plans will strip funding away from council budgets- which have already suffered years of savage SNP cuts- as well as severely reducing local democratic accountability.

“Our social care services are in crisis. The last thing we need is SNP Ministers creating a bloated one-size-fits-all system which will divert money away from crucial frontline services and impose total ministerial control through a National Care Service.

“These findings from the IFS should be another wake-up call for SNP Ministers to realise their plans are going to see scarce resources wasted on administrative reform rather than delivering the standard of care at a local level that patients desperately require.

“The SNP Government should abandon their proposed National Care Service and guarantee that £1.3 billion will instead be spent directly on frontline care during this time of overwhelming financial pressure.”

SNP Minister for Mental Wellbeing and Social Care Kevin Stewart responded: “We’re committed to the creation of the National Care Service and ending the postcode lottery in the provision of care in Scotland.

"The views and experiences of those who receive or provide care services will be central to the development and delivery of the new National Care Service.

“Publishing the Bill, which puts in place the ability for local areas to design services that best meet the needs of their local communities, is the first stage in the process, and we are now developing opportunities for people and organisations to become involved in co-designing the new service.

“We have committed to increase public investment in social care by 25% over the lifetime of this Parliament, the equivalent of more than £840 million of increased investment.

"Our 2022-23 budget confirmed more than £1.6 billion directly from the Scottish Government for social care and integration to lay the groundwork for the National Care Service. This is in addition to the investment that is provided for care services by local authorities currently.”