Towards a real national care service

Scotland’s care system is in deep crisis, with exhausted staff, inconsistent services and too much public money leaking into private profit rather than frontline care. The report argues that the Scottish Government’s national care service proposals won’t fix these problems because they leave the private‑market model intact. 

Instead, it calls for a major expansion of publicly owned and operated care – funded through affordable public borrowing, improving pay and conditions, and reducing profit extraction – to create a transparent, integrated system that works like the NHS and delivers better outcomes for workers, service users and communities.

Recommendations:

• Expand publicly owned and operated social care as the core of a real national care service.
• Support councils, NHS Boards and Care Boards to develop business cases for insourcing.
• Provide capital funding to buy or build public care facilities.
• Offer transitional revenue support to help local authorities shift from commissioning to direct provision.
• Improve pay, conditions and pensions by bringing care staff into public‑sector employment.
• Reduce leakage of public money by moving away from private‑equity‑owned providers.
• Use insourcing as part of community wealth building, keeping care funding in local economies.
• Replace expiring private contracts with incremental re-municipalisation of services.
• Develop a national insourcing strategy to coordinate and accelerate the shift to public provision.