National Care Service: How much will it cost and why is it so controversial? Could the NCS be delayed?

The National Care Service Bill, which is making its way through the Scottish Parliament, would transfer social care responsibility from local authorities to a new, national service, overseen by ministers – but the plans are not without critics.

An independent review into adult social care in February 2021 recommended the creation of the National Care Service (NCS), followed by the SNP Government introducing the National Care Service (Scotland) Bill to Parliament on June 20, 2022.

The Scottish Government said at the time the NCS formed part of its plans to make Scotland “a fairer and more equal place to live”. So why has the NCS proven controversial?

How is social care faring at the moment?

Finance Secretary Kate Forbes, 32, has been on maternity leave since the birth of her daughter Naomi in August, so the contest is not ideal timing for her. But she was named by Nicola Sturgeon as a potential future leader and is seen as one of the frontrunners. MSP for Skye, Lochaber and Badenoch since 2016, she was thrown in at the deep end as Finance Secretary, being appointed just hours before the 2020 budget after her predecessor Derek Mackay was forced to resign over a sex scandal. She put in a confident performance and is seen as extremely capable. Some have suggested her conservative views on issues such as abortion and gender reform, stemming from her religious convictions, could be a problem.

Scottish Care has warned “social care as a whole is experiencing its greatest workforce challenges in recent years”. The organisation said poor pay for care staff and low government funding is contributing to this.

“The proposed pay uplift to £10.90 in no way covers the impact of the cost of living,” a Scottish Care spokesperson said. “And worse [it] sends a message to those working in social care that they are worthy only of an uplift that is around half of what their counterparts working in the NHS are due to receive (3.8 per cent and 7.5 per cent respectively).

“We are seeing difficulties in recruitment and retention, rising sickness absence and high vacancy levels. We need sufficient nursing and care staff to resource interim care beds, to allow individuals to receive the support or care package they need to rehabilitate, otherwise, they may be at risk of readmission.”

Scottish Care has taken issue with Scottish Government funding for care homes, which it says equates to around £5 an hour for each person who lives there, including “room and board, as well as any complex care needs that individual may have”.

The National Care Service Bill is currently making its way through the Scottish Parliament

“Without assistance and funding, the rising costs will lead to many more care providers shutting down and ceasing the delivery of care,” warned the Scottish Care spokesperson.

“A rise in care home closures will lead to even more real pressure on the NHS. Hospitals are already overburdened. This will have a negative and dramatic impact on those who need NHS treatment and care. If social care collapses, then the NHS will follow soon after.”

What’s controversial about the National Care Service?

Most criticism boils down to a) the cost, and b) the design process.

On the latter point, unions, think-tanks and charities have called for a pause on the Bill, which would set up a framework for the NCS, saying more time is needed to design it.

In particular, there is little detail regarding what the NCS will entail, despite its billion pound price tag. That’s because the NCS Bill is “a framework Bill, leaving much detail to secondary legislation, and that this detail of the NCS will be ‘co-designed’ with the users of services and evolve over time”, according to Scottish Parliament researchers.

However, the Unite union has already withdrawn from the co-design process, saying it feared 75,000 workers employed by local authorities across the country could be transferred into "unspecified, unaccountable ministerial quangos" as a result of the reforms.

The cost of the proposed NCS has also proven controversial. The Scottish Government initially said it could cost up to £500 million to deliver. But in October, Scottish Parliament researchers estimated the bill over five years to be £664m to £1.261 billion.

Then in November, Audit Scotland said the price tag for the NCS is likely to be significantly understated, highlighting issues with pensions, VAT changes, capital investment and health board transition costs, which could see the final total increase further.

The watchdog said "a number of costs associated with the measures ... have yet to be assessed" and "the potential for additional cost is significant".

What now for the NCS?

Now that First Minister Nicola Sturgeon has announced her resignation, it falls to her successor to pick up the NCS flag. But so far the two SNP leadership frontrunners, Humza Yousaf and Kate Forbes, have appeared lukewarm about the future of the NCS Bill.

Mr Yousaf, who played a central role in the plan as health secretary, previously claimed it was the most ambitious healthcare reform since the creation of the NHS. But the health secretary recently told Holyrood Magazine the plans for the NCS could be redrawn. "I’m willing to work with those who oppose the current plan to see if the there are some areas where we could compromise,” he said

Ms Forbes, on the other hand, has gone further, saying she would rethink the SNP’s flagship plans to create the NCS if she wins the race to become the next first minister.

She said she is “hugely supportive” of her party’s proposals, but pledged to decentralise the approach to support local services.

"For it to work, it needs to be a Scotland-wide initiative,” she said. “By that I mean, it needs to have the confidence of workers – ie trade unions; local government, who will be implementing much of it; and the Scottish Parliament, and I understand that about four committees have raised different points around it.”

During a visit to Highland Home Carers in Inverness on Wednesday, which includes a national care training academy, Ms Forbes pledged to put carers at the heart of the strategy.

Her plans would see the minimum wage for carers increased to £15 an hour and includes training pathways for carers to expand their careers.

Ms Forbes’s plans could be scuppered by the financial problems faced by the Scottish Government, with Mr Yousaf telling a Holyrood committee in January that a rise to £15 an hour for care staff would cost “well over £1bn”.