A leading voice for third sector and not-for-profit social care providers in Scotland says she’s worried the reforms to create a National Care Service could turn into a turf war between politicians and professionals and fail to seize the opportunity to place those who are cared for and their families at the heart of decisions.

Annie Gunner Logan, steps down this week as Chief Executive of CCPS, the Coalition of Care and Support Providers in Scotland. In the second of two articles from healthandcare.scot’s interview with her, Annie says it’s vital Scotland does not lose sight of the reforms of adult social care envisaged in the Feeley report.

“Covid-19 exposed all the flaws in the delivery of social care that we’d been trying to alert people to for years – the use of competitive tendering to draw funding out of the system and people’s salaries, the role of councils and their choice to pay consistently higher rates to their own staff, the link between high standards and listening to people receiving care.

When the Feeley report following the independent review was published we thought at last someone gets it. At last, things will change.

So, when the government consultation on a national care service came out last August, which we’d understood to be a response to the independent review, to be honest, we felt a bit deflated.

The Scottish government response to Feeley is just a bit weak compared to what was in the review. There wasn’t the same vision. It didn’t have the same radical edge.

It was much more about incremental change and tinkering with things. If you take commissioning and procurement, it talks about carrying on doing competitive tendering – just doing it ethically – whereas, I think, what Feeley understood was competitive tendering is in itself unethical and you have to do something else.

We are told this is a model of change. But we don't know what model of change is being proposed here other than to enforce standards more rigorously and to control things more from the centre. I'm not sure that that is a model of change.

We need to see something more coherent with more substance.

Then there is the whole issue of balancing national and local accountability.

I’m concerned that short term considerations and in particular, proprietorial tendencies on the part of institutions are dominating the debate.

Everyone seems to be claiming their right to control social care – ministers, councils, clinicians – but they’ve lost sight of the central thrust of the independent review, which is that it’s the people who rely on social care who should control it.

I dearly wish we could all get back to that, otherwise the promised legislation will just turn into a bunfight about the relative power and status of the vested interests, and the opportunity – perhaps our very last opportunity – to create a system that puts the people who use it first, and not the people who provide it or pay for it or regulate it or commission it, will be lost.

In the meantime, we are still waiting to see how the promise of co-production plays out.

It’s great to see the Social Covenant Group and all of the user involvement, it is long overdue. And at every stakeholder meeting I go to on the National Care Service more than half the people there are there from user groups and unpaid care groups.

And yet, we don't know what it is we're co-producing, because there's been no announcement. Are children's services in or are they out? What about justice services? Which raises the questions: do we actually understand the scale of what is being proposed here – and do we have the capacity and the capability to deliver it?

You ask me about my hopes for the future and they centre on a phrase we use a lot in the third sector: ‘parity of esteem’.

God knows the last few years have shown us very, very clearly that there is a hierarchy in the social care system and, despite all the warm words from politicians, the third sector is not at the top of it. In fact, it's very much the poor relation.

We are either seen as suppliers to be managed through some kind of market dynamic that treats us primarily as contract chasers, treats the people we support as commodities; or we're lumped in with the private sector, seen as greedy, growth-oriented businesses, determined to get our hands on public money – and the job of commissioners is to make it as hard as possible for us to do that.

I'm not talking about individual commissioners locally, but rather the way we are positioned strategically by the system, so a bit of parity of esteem here would help.

But there's something underneath that, for me, that's more important. And it's not about parity for organisations, it's about equity for citizens.

If my family member is supported by a local authority service and yours is supported by a third sector service then, in all probability, the person supporting your family member will be paid less, they'll have a comparatively poorer pension and conditions of service, they will be working more hours, they will be supervised by a manager who has to manage more things, they will be propelled on to their next client by an electronic call monitoring app that limits the time that they can spend, and they may disappear overnight and be replaced by a total stranger if the employing organisation’s contract changes hands. And, on top of that, your family member is highly unlikely to be offered any kind of opportunity or choice in what happens next because self directed support is still largely mythical for a lot of people.

I don't think that's right, and I don't think that's ethical. But that is the system that Scotland's decision makers have created over the years, and they have sustained it, they've supported it, they've maintained it, they've stood by it, and they've tolerated it.

What's in front of those decision makers now is the opportunity to create something else and to create something different.

It's not just about our sector having parity of esteem. It's about the citizens that our sector supports having equity within the system.

That is what I would like to see change.”

 

CCPS represents the interests of more than 80 Scottish third sector care and support providers who, between them, support over 200,000 people and their families and employ around 43,000 staff.

This is the second of Annie’s articles. In her first, Annie looks back on the evolution of community care and how the third sector’s refusal often to cut its prices to win work has meant it never grew its share of social care provision in Scotland.