Labour and the Scottish National Party are locked in a tight battle to win next month’s Scottish elections, but on the subject of adult social care they are almost at one.
Both would retain free personal care for older people and, more radically, merge health and adult social care to reduce delayed hospital discharges, shift care into the community and manage the costs of an ageing population.
But this national political consensus does not extend to social care professionals; quite the contrary.
In part, this opposition reflects a perception that both major parties want to see the NHS take over adult social care. In February, as the governing party, the SNP announced plans for “lead commissioning”, under which a council or health board would take over the commissioning of health and adult care for a given area. However, its press release said this could involve the transfer of 38,000 social care staff from councils to the NHS, suggesting a health takeover.
Labour’s plans for a National Care Service would involve giving control of pooled budgets to community health and care partnerships – existing arrangements that involve councils delegating social care responsibilities to the NHS – though with more council involvement.
It said: “Despite a single management and funding structure, the NHS has not made significant progress in shifting the balance of care from acute hospital-based care to community health care – how would adding social care to that arrangement improve matters?”
Politicians should be looking at the best means to improve outcomes, rather than starting from the premise that structures should change, said
Association of Directors of Social Work president Michelle Miller. “ADSW is concerned that in any restructuring the important contribution of social work is not lost,” she added.
Both associations favour a charter of entitlements for care users that councils – and their NHS partners – would be required to deliver upon. The Scottish Association of Social Work is also opposed to the parties’ approach.
Professional officer Ruth Stark said NHS money should be transferred to local government instead, to invest in preventive services to keep older people out of hospital.
However, the integration plans have their supporters. “It should deliver a higher quality of service for older people and it’s what older people want – an end to the artificial divide between health and social care,” said Callum Chomczuk, senior policy and parliamentary officer at charity Age Scotland.
Under Scotland’s system of proportional representation, neither Labour nor the SNP is expected to win an overall majority, meaning there will be either a minority government or a coalition also involving the Conservatives, Liberal Democrats or Greens.
Child protection ‘invisible’
While the parties are talking about health and social care, children, particularly the vulnerable, have been disappointingly “invisible” in the campaign so far, said Anne Houston, chief executive of charity Children 1st.
“We want to know how parties will address the issues that cause the biggest problems for children and limit their life chances – violence at home, parents drinking to excess, sexual abuse and difficult family relationships,” she added.
Both the SNP and Labour have a strong focus on early years services and have pledged to invest in services such as children’s centres and parenting support, but have said less about child protection. This is despite the strong focus in recent years on the impact of parental substance misuse on children, following the killing of 23-month-old Brandon Muir in 2008 by his mother’s partner, Robert Cunningham.
Labour responded to the case by calling for the law to be changed to make it easier to take children into care, though this was rejected as an “oversimplification of a complex problem” by the SNP.
Labour’s manifesto retains this focus though in less stark terms, calling for “swift and effective action” to protect young people and risk.
In government, the SNP has legislated to streamline Scotland’s hearings system, which handles the cases of vulnerable children, and revised child protection guidance. The guidance means that professionals will no longer have to identify a category of abuse when children are placed on child protection registers, which is designed to ensure children with a wider range of needs are protected.
Stark said any lack of debate on child protection during the campaign reflects progress that has already been made.
“There’s been quite a lot of investment in improving practice in children’s services. It’s not as controversial as it is in England,” she added.
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