A Vision for a National Care Service

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2023 National Delegate Conference
7 February 2023
Carried as Amended

Conference recognises the need for change in social care. The current system values neither staff or service users. It creates a low paid workforce and fails to recognise the skills required for the high quality social care that our most vulnerable citizens deserve. The current system across the UK enables and promotes a market approach which has seen for profit companies take over many care services, driving down pay and conditions and directing profits to shareholders, many of whom do not even live in the UK. Often, when they fail, councils have to pick up the services with tax payers’ money.

The cost to the public purse goes even beyond that, with the failure to provide quality social care services delaying hospital discharges.

Conference agrees that things need to change and that a care system is needed that values staff and increases both the pay and status of social care workers. At present morale amongst staff across the UK is very low and there is a serious recruitment and retention crisis. Changes in carers, a lack of staff and an increasing reliance on agency workers does nothing to promote consistency of care for the most vulnerable in our communities.

UNISON has supported the creation of a National Care Service but there needs to be a very clear vision of what we mean by that. In Scotland what is being proposed in the National Care Service (Scotland) Bill is not something that we should recognise as a real National Care Service. Instead it will retain care as a commodity in a market based system, and extend market mechanisms across all of social work and community health.

If passed the Bill will enable services to be taken out of the democratic control of local authorities and placed in the hands of care boards – quangos responsible only to Ministers. It will also enable all social work services to be removed from council control to be the responsibility of care boards which will not deliver services directly but procure them – from public, third sector and private providers. In total, 75,000 workers could be transferred out of councils and an unknown number of NHS staff, potentially taking this workforce out of our service areas and into the civil service.

The moves will devastate local government, removing over a third or the workforce and having knock on effect to services elsewhere in councils that currently support the social care and social work services, such as Human Resources and payroll. UNISON has a policy of protecting local government and the services they provide. The Scottish proposal flies in the face of all we have collectively fought for.

The Bill also offers nothing to our members in social care and fails to take profit out of care provision which holds down terms and conditions, especially in the private sector.

It would be better for the workforce and service users if the money it would cost for this huge restructuring was invested in local government to enable councils and not for profit providers to provide the quality care services we want to see and to reward and value staff.

The Bill leaves massive uncertainly around pay, terms and conditions, and potentially allows a race to the bottom. Currently there is a living wage paid to care workers in Scotland, through their contracts with the integration Joint Care boards. This could be further enhanced without the need for a separate quango. The impact on our members’ pensions has not been addressed, creating massive uncertainty for workers and for local government and other pensions funds. TUPE has been promised but this has its limitations, especially with pensions.

This has highlighted the key importance of starting with a vision for what a care service should look like. We commend the UNISON Cymru Wales’ report conducted by APSE as a starting point towards this.

Its conclusions set out key principles that should be included in a National Care Service including a promise for a fully funded, universal, free at the point of delivery service that works in the interests of all; an end to private companies making profit out of care and a commitment to deliver care services through local government

Conference agrees that UNISON must, as a matter of urgency, set out our vision for a National Care Service in the UK and in each devolved nation to underpin our campaigning and negotiations. Scotland’s situation demonstrates that it is not enough to assume that all stakeholders, including governments, share our principles and values for a National Care Service.

Conference calls on the National Executive Council to:

1)Work with devolved nations, service groups, self organised groups and other like-minded stakeholders to design a vision of the National Care Service we want to see. This should be underpinned by the following principles:

a)Social care should be fully funded, universal and free at the point of delivery;

b)Social care should be delivered by democratically elected councils and there should be proper investment to develop social care to a high standard;

c)There should be sectoral bargaining across social care;

d)For-profit providers should have no place in a National Care Service;

e)Fair work, decent pay and improved status should be the norm for all care workers.

2)Call on Labour Link to promote this vision within the Labour Party in the UK and the devolved nations and seek their support to take it forward in UK Parliaments and to implement it when in power.

3)Support UNISON Scotland in their campaign to have the NCS (Scotland) Bill withdrawn and learn lessons in the other nations from the Scottish experience.