Renew social care (2026 Manifesto)

Deliver social care reform

• Develop national oversight and scrutiny of social care to end the postcode lottery and improve standards, access, quality and accountability.
• Reform commissioning and procurement to take a collaborative and human rights based approach.
• Abolish non-residential care charges.
• Substantially increase financial investment in social care, to ensure demand is met and third sector providers are adequately funded.

In 2021, just before the last Scottish Parliament election, the Independent Review of Adult Social Care in Scotland was published, setting out a clear vision for reform, centred on a National Care Service (NCS). Despite the urgent need for reform, a consensus that change was needed, and exhaustive input from disabled people, people with long term conditions, unpaid carers and the third sector, the review remains largely unimplemented.

What should have been a transformational NCS Bill became the less ambitious Care Reform Act. Although containing some positive steps, this reduction in ambition was deeply disappointing, and it cannot and must not be the final word on social care reform. The ALLIANCE and partners have shared key thinking and priorities for what further transformation in social care should involve.

Scotland needs more accountability for and consistency in social care. There remains an unacceptable level in the variation of availability and quality of social care in different parts of Scotland, which is incompatible with a human rights based approach. The next Scottish Government, alongside local government, must develop an effective system for national oversight and scrutiny of social care. This should include binding national standards and improvements in access, quality and accountability of social care services.

At the same time there is a need to reform the current approach to social care commissioning and procurement, which has entrenched a cost-cutting, time and task based approach. This has negative impacts on the people both accessing and providing care and drives a competitive rather than collaborative approach amongst providers. The ALLIANCE welcome the work underway on ethical commissioning, though questions remain about the definition and scope. The next Scottish Government must reform commissioning and procurement to take a collaborative and human rights based approach that helps to improve experiences of accessing and providing social care.

The ALLIANCE have also repeatedly called on the Scottish Government to abolish non-residential care charges, as it pledged to do during the 2021-2026 parliamentary term. These charges have increased substantially in several council areas and contribute to deepening financial hardship and poverty amongst people accessing social care. Social care is a fundamental necessity to fully realise people’s human rights, including the right to independent living, which charging risks seriously infringing. The next Scottish Government must make abolishing non-residential care charging an immediate priority, fulfilling the pledge unmet in this term.

Overall, there is a clear need to increase the financial investment in social care. Work remains to be done to first identify the prevalence of, and address, unmet need. At the same time, third sector providers face extreme financial hardship. The next Scottish Government must substantially increase financial investment in social care, ensuring that demand is fully met, and that third sector providers receive fair, sustainable and adequate funding.

Build a valued service where everyone has a voice

• Provide equal rights and support for all Integration Joint Board (IJB) members, ensuring that voting rights for lived experience, unpaid carer and third sector representatives translate into meaningful input and influence.
• Actively involve people with lived experience and the third sector in the health and social care reform process.
• Improve pay and conditions for social care staff and address institutionalised gender bias.

The scrapping of most legislative aspects of the NCS from the Care Reform Act did not just represent the loss of proposals for structural change. It also meant that much of the time, expertise and effort that disabled people, people with long term conditions, unpaid carers and the workforce invested in the process were left with very little to show for it. This has jeopardised trust in the system as well as the process, called into question how meaningful the co-design approach was, and failed to deliver promised reforms that would strengthen people’s voices.

Amongst the many proposals dropped from the final Care Reform Act were plans to give all members of Integration Joint Boards (IJBs) voting rights. This was promised to lived experience and unpaid carer representatives as part of ensuring their expertise was properly valued and listened to, alongside strengthened support to help them carry out that role. The next Scottish Government must urgently progress equal voting rights for lived experience, unpaid carer and third sector representatives on IJBs and ensure that adequate time and resource is available to enable their equal and effective participation.

As wider health and social care reform continues to progress, people with lived experience and the third sector must have a seat at the table. If the diverse perspectives they can bring to the process are not heard and given equal weight, then that risks taking forward actions and entrenching systems which do not fully meet everybody’s needs. The next Scottish Government must ensure that there is fair and equal representation for lived experience and third sector representatives throughout all aspects of the health and social care reform programme.

Recruitment and retention are serious challenges for the social care sector, particularly for third sector providers. Despite recent pay increases and the skilled nature of the role, care work remains low paid with limited potential for meaningful career advancement. It is no coincidence that 80% of the adult social care workforce are women, reflecting a longstanding and structural undervaluing of women’s work. The next Scottish Government must continue to address this gendered bias, ensuring that pay and conditions for social care workers fully reflect the value of that work, support people to enter and remain in the workforce, and offer rewarding career progression.