The National Care Service as originally envisioned would have removed responsibility for social care in Scotland from local authorities and moved it to 31 care boards. These care boards would replace integrated joint boards (which integrate health and local authority services), and also take on their responsibility for community health services. Each care board would be directly responsible to Scottish Government ministers [1]. The new structure was supposed to achieve goals set out by the 2021 independent review of adult social care, which argued for national driving of improvement and standardised terms and conditions for staff across Scotland [2]. The process of change was intended to be complete by 2026.
In December 2023, Scottish Government Social Care, Mental Wellbeing and Sport Minister Maree Todd issued letters to the Scottish Parliament committees responsible for health and care and for finance, stating that the planned National Care Service would be substantially delayed, and would no longer include its main structural reform [3].
The December 2023 letter to the health committee stated that the Scottish Government “no longer expect to abolish integration authorities and establish care boards”, and will instead continue to use the existing powers for joint boards. Local government and the NHS will maintain their existing accountabilities as now, and local government will retain responsibility for delivery and ownership of assets in social care.
As per the original proposals, there will still be a national board accountable to ministers overseeing social care, which will distribute funding centrally, and set national direction and standards [4]. The letter to the finance committee stated that the “go-live” date would now be the 2028–29 financial year [5]. Ahead of this, a co-design process for a National Care Service Charter will include social care users and local government.
This announcement follows a series of delays and alterations reflecting concerns from local government and civil society bodies and parliamentary committees. These led in 2023 to a decision to delay passage through the Scottish Parliament and an agreement with local government that they would retain responsibility for delivery and ownership of assets. Common areas of concern included a lack of detail on funding and governance, and challenges to the assumption that removing powers from the local level was necessary to improvement. In Autumn 2023, there had been a National Forum where Scottish Government officials engaged with stakeholders about the Bill, and signals from the Scottish Government that the radicalism of change would be tempered [6].