(Image: Colin Mearns, Newsquest)
Ivan McKee has been warned Scotland’s public service reforms risk failure if social care is sidelined, days after his plans faced scathing criticism at SNP conference.
The proposals, led by the Public Service Reform Secretary, could deliver the biggest shake-up of the public sector in decades.
But the plans have been branded “nonsense”, with unions estimating as many as 20,000 jobs could be lost.
The Scottish Government is considering replacing the current 32-council structure with between six and 10 regional authorities and between 120 and 160 community authorities.
In the NHS, health boards will be cut from 14 to two under the plans, with a three-month consultation now underway.
Mr McKee has already faced a brutal backlash against his plans during the SNP conference, with party councillors accusing the minister of sidelining communities.
Now, a coalition of more than 50 organisations has warned that care has only “limited recognition” in the Scottish Government’s reform strategy, arguing that its absence risks undermining ministers’ ambition to shift public services towards prevention.
Lilian Macer, the Scottish secretary of Unison, told The Herald: “For any public sector reforms, you cannot fix or try and fix health without looking at social care. It cannot be separated.”
She said the reform plans, in their current form, were “just nonsense”.
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The union chief challenged Mr McKee directly at an SNP conference fringe event last week over whether reforms would result in more social care packages being available to help tackle delayed discharge from hospitals.
She said McKee failed to answer the question, adding: “There are so many unanswered questions. We’ve got the First Minister standing giving his Programme for Government with no detail about how we progress.
“We are halfway through the three-month consultation and still have no answer.”
The concerns are echoed in a new briefing from the A Scotland That Cares campaign, which represents more than 50 organisations.
Campaigners warn the current reform programme appears to be heavily focused on improving efficiency, arguing that restructuring alone will not deliver the preventative approach ministers have promised.
The report says investment in social care, childcare and support for unpaid carers must sit alongside changes to the structures of public services if the reforms are to succeed.
Read more: If the SNP can't be convinced on public sector reform, we've got a problem
The warning poses a direct challenge to Mr McKee’s approach, with the minister arguing that stripping duplication and bureaucracy out of public services will free up money to be spent on the frontline.
At SNP conference, Mr McKee said Scotland did not need 14 chief executives, 14 IT directors or 14 HR directors, adding: “That’s where the savings come from, and that’s the money that should go to the front line.”
But Ms Macer accused ministers of ignoring workers and providers who had been calling for changes to social care for years.
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She said: “Members and providers have been asking for these reforms for a long, long time. We have given them solutions, we have given them a process to hear the voices of those workers and they’ve completely ignored us.”
Ms Macer described the reforms as a “race to the bottom”, warning that the lowest-paid workers, many of them in social care, could be “squeezed even further”.
She added: “If the Scottish Government proposals for public sector reform are to tinker the edges or make structural changes that look good but do nothing in reality, then it would be unbelievably bad. They are missing a fantastic opportunity and shame on them.”
The report from A Scotland That Cares points to particular pressures in adult social care, where rising provider costs, workforce shortages and fragile services are already limiting the availability, consistency and quality of support.
Katherine May, head of Oxfam Scotland, said: “The Scottish Government has put prevention and public service reform at the centre of its agenda. But those plans will fail unless care is at the heart of them.
“You can’t stop problems from spiralling while underinvesting in the care and support that prevents crises in the first place.”
Sara Cowan, director of the Scottish Women’s Budget Group, said care had been “under-recognised and under-invested in”.
She added: “This leaves carers, the majority of whom are women, struggling mentally and financially and unable to keep their heads above water.”
Community care minister Alison Thewliss said: “We all know that our social care system requires reform and improvement to better serve our population in Scotland; we know the current status quo is not good enough. Over many years, Unison themselves have highlighted changes they’d like to see, and I encourage them to engage with the Scottish Government on what reform could look like.
“As we have said from the outset, we cannot reform the NHS without carefully considering how social care is delivered. I agree with Unison that we have a fantastic opportunity to shape how public services are delivered for the better and it is vital that we address the issues we see in people accessing the support they require.
“The Scottish Government have committed to engaging in intensive consultation with local government over the next three months to develop potential solutions and we will of course be engaging with people who use services, disability organisations, the third sector, staff, the NHS, trade unions and the public."