A leading academic says moving too quickly to set up a National Care Service risks repeating the mistakes of the past and creating a model that ‘won’t work significantly better’ than the integrated system introduced less than six years ago.

Richard Kerley, Emeritus Professor of Management at Queen Margaret University, says the consultation on government proposals for a NCS which closed in November should be the beginning – not the end – of examining how care can best be delivered alongside health across Scotland.

Professor Kerley says what is being proposed is too big to be delivered quickly:

“I think the disadvantage of having such cross-party enthusiasm for a national care service is that the government can rush through changes.

“I understand that, if you’re responsible for something, you have a desire to improve it and change it. And the quicker you can make that happen, the better, because then you have either career enhancement for the ministers concerned, or benefits for the government as a whole.

“But, as I suspect the current model won’t work significantly better, then it’s to no benefit.”

Professor Kerley says that the new Integration Joint Boards were heralded as a magic bullet in the run-up to their creation in 2016, but were not equipped to deal with the complexity of delivering an integrated health and social care service at community level.

Analysis by the Nuffield Trust suggested there had been little progress towards the early aims of integration.

The academic is urging ministers, armed with the multiple responses to their care service consultation paper, to now begin a further round of face-to-face discussions:

“It’s about getting together those people and organisations that have achieved progress and asking them what they did that worked. Was it staff time or facilitating alternative arrangements? Was it about sharing information?

“There needs to be a whole series of roundtables, face-to-face and in public, so people get a sense of what is possible, what are the limitations and what are the boundaries.”

Professor Kerley accepts that reorganising the NHS and creating a new National Care Service at the same time would be too great a task. However, if Scotland is serious about delivering change, he says the decision needs to be made to both prioritise – and fund – health and care services in communities, and to stop treating the NHS and care providers so differently.

“I thought, Derek Feeley’s [Independent Review of Adult Social Care] report had some very interesting ideas, and very interesting thoughts. But it by no means produced the kind of blueprint for change that that some might have expected.

"Instead it produced a kind of general direction of travel. And then that was picked up by the government and opposition parties as being for a National Care Service – capital N, C and S.

“At the moment, it's still very much a small n, c and s.

“It is subordinate, and it will be subordinate, in so many different ways to the National Health Service, including the terms of employment, pay, the manner in which people are treated and the manner in which they are viewed as institutions.

“It is, if you like, the privileging of health as opposed to care, and the privileging of the staff who work in one the setting over the other.”

 

Richard Kerley is Emeritus Professor of Management at Queen Margaret University and Co-Chair of the Centre for Scottish Public Policy. He was the lead author of a provocation paper by the Centre: Is there a National Health Service for Scotland – or do we have an empty umbrella? and of the Routledge Handbook of International Local Government.

 

Read more: Care workers swayed by NHS recruitment campaign;   Yousaf: NCS blueprint not ‘fait accompli’; Rhetoric-reality’ gap on National Care Service;

 

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