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November 9, 2021

Eggs and omelettes

They say you can’t make an omelette without cracking a few eggs and from the early signs, the Scottish Government has clearly signalled its intent to serve up a very big National Care Service omelette. From COSLA claiming it is an attack on local democracy to professional care bodies and trade unions expressing alarm and calling for caution -most recently over the amount of the design and development work which is to be outsourced to the private sector. The consultation closed last week. SCA found the 200+ page document impossible to engage with and offered this short submission instead.



Submission to National Care Service consultation

By Scottish Community Alliance


The Scottish Community Alliance is a coalition of Scotland’s leading community led networks. There are currently 24 networks that comprise SCA’s membership and they extend their reach into communities the length and breadth of the country. They are involved in a vast array of activities which touch on virtually every aspect of community life – for example planning matters, social housing, health, horticulture, land management, arts and culture, and renewable energy. While many of these networks have specific areas of interest and offer highly specialised support to their members, what they all have in common is a shared commitment to enhanced levels of empowerment and greater levels of resilience for Scotland’s communities. This is the overarching theme which defines the work of the Scottish Community Alliance and which draws its membership together.


The scale of ambition set out in this consultation – to create a comprehensive community health and social care service that serves the needs of the whole population regardless of life stage or circumstances – is one that will undoubtedly find support, in principle, right across the spectrum of its multiple stakeholders. 

However it is also clear that there is considerably less consensus in terms of how this ambition should be delivered or indeed even whether a consultation as wide ranging and comprehensive as this, should have been launched in the way that it has been. 

That said, due to constraints of time and capacity, SCA does not propose to comment on any of the detail as set out in the consultation other than to offer three simple observations based on experience.

Scotland’s community sector is a significant national asset, the potential of which continues to be underestimated by both national and local government in the pursuit of national outcomes laid out in the National Performance Framework. 

The sector is, by its nature, heterogeneous, reflects local conditions and functions at many different levels of formality. At one end of the spectrum, the sector is the myriad voluntary, informal associations of citizens who self-organise around a common interest or need – the value of which was widely acknowledged during the pandemic. At the other end, there are the more formally constituted, highly organised and professional providers of a wide range of public services (development trusts, social enterprises etc). The key feature that all these organisations share is that they are run by local people and accountable in a variety of ways, to their wider communities.

Specifically, many specialist providers of community led health and social care services have evolved in recent years in response to increasing gaps in statutory provision. However these community led health providers have remained in the ‘shadows’ and tend to operate in the cracks that have opened up as the NHS and the care system has increasingly struggled in the face of rising demand. 

Observation 1. The community sector sits closest to the point of delivery of health and social care services and yet continues to be overlooked and ignored as a full partner in the national provision of community based health and care services. 

Observation 2. At a local level, the lines between the social care needs and the health needs of a community become blurred and it is not useful in the context of trying to develop a new service to see them as separate. The more holistic approach to community wellbeing that the community sector intuitively adopts across the range of its activities, is one that should be reflected in the foundational principles of the new Community Health and Care Service. 

Observation 3. The health, social care and wellbeing needs of the nation are inextricably bound up in one another and the root cause of the current problem is that this is not reflected in the design thinking of the existing services. Therefore this reorganisation should not aim for a National Care Service to sit alongside (even with assumed parity) a distinct National Health Service. It should be as one. Arguments will rage long and hard as to the new name, but a Scottish Community Health and Care Service would at least make it clear that the new service is both community focused and inclusive of both the social care and health needs of the nation.