THE Scottish government is legislating for a scheme that will fundamentally undermine the idea of direct public delivery of services. 

That it is calling it a “national care service” should fool no-one. That it is undermining fundamental NHS principles in doing so should worry everyone.    

It’s often assumed that the plans embodied in the National Care Service (Scotland) Bill concern only residential care, or perhaps care in the community. Not so. 

The scope and ambition of the legislation is huge, as Kevin Stewart the then-minister for in charge, was fond of saying: “The national care service as proposed in the Bill will bring together social work, social care and community health.”

The proposed NCS will take responsibilities and functions from the NHS, giving them to new quangoes called care boards. 

The care boards won’t deliver services themselves, but instead contract and procure services from public, private and third-sector providers. 

In doing so they can exclude health boards from even bidding for contracts to deliver services which are currently NHS responsibilities. 

Section 41 of the Bill deals with procurement. Care boards, remember, will have no delivery capacity of their own, and will be contracting for and procuring all of the services they are responsible for. 

This is a key part of the Bill, and it specifies that boards can — not must but can — reserve contracts for what are called “qualifying organisations.”

The definition of “qualifying organisation” includes bodies with a variety of structures and ownership types which can be broadly described as being “not for profit.” 

The Scottish government however has made very clear that it will not consider either health boards or local councils as “qualifying organisations.” 

The scope of services that the NHS can be excluded from even trying to provide is enormous. An earlier clause in the Bill (section 28) gives ministers sweeping powers to transfer functions out of the NHS and into the NCS. Section 41, though, provides a guide to areas that will be in scope. 

Services are listed not by name but by Common Procurement Vocabulary (CPV) codes. CPV codes are part of a European-wide scheme which is aimed to make markets in public services work more smoothly. 

Once functions go from being publicly delivered public services to commodities in a marketplace, there then becomes a need for them to be rigidly defined for parcelling into contracts.

So instead of obviously stating that supply services of nursing can be taken out of the NHS personnel — that might scare the parliamentary horses — the Bill instead uses the much less obvious designation 79624000-4. Similar with supply of medical personnel 79625000-1 and much else besides. In fact the Bill includes “a code in the range beginning with 85000000-9 and ending with 85323000-9.” 

That is a list that starts with “Health and social work services” ends with “Community health services” and takes in just about every medical function you can think of in between.

The NCS Bill, if passed, will institute a new service based on contracting and procurement. This aim of the SNP/Green government is that this will spend around a third of the budget currently going to councils, and a smaller but significant chunk of the budget currently going to the NHS.  

This is a massive expansion of markets in public service provision. Community health won’t something that the NHS does — it’s something that the NHS needs to beat competition to be allowed to do, with an official view that having a “mixed economy” of providers will improve things.

For the NHS staff concerned this will mean insecurity forever. This structure is based on the idea that there are no in-house services. The care boards will deliver services via time limited contracts. Tupe will hang over everyone forever. 

More insidious it marks a step back to a purchaser-provider split in health services abolished in Scotland a quarter century ago. 

The Thatcher and Major governments’ principle innovation in the NHS was that the way to run the NHS efficiently was to make a separation between the bodies that commission the services and those that deliver the services. 

Abolishing that was one of the first things that was done under devolution — in fact the first steps were taken by Donald Dewar before the Scottish Parliament was set up. 

Yet it is the very foundation of what we are being asked to accept as a national care service — and if that is deemed the best way to run all of community health. Why should it stop there and not involve other areas? 

Having delayed a vote on the Bill three times even elements within the Scottish government are aware this Bill is a shambles on stilts. 

That the Bill attacks our NHS is merely the latest of many good reasons to call for its withdrawal.