The Care Reform (Scotland) Bill started life as the National Care Service (Scotland) Bill in 2022.
This blog will provide some background to the passage of the Bill ahead of the Stage 3 debate on 10 June 2025, with a focus on the changes made at Stage 2, and the issues left for further discussion ahead of Stage 3.
For a full narrative and timeline for the Bill up to Stage 2, please see SPICe Spotlight’s ‘The National Care Service (Scotland) Bill – hub for SPICe material’. These blogs cover the period from 2022 – January 2025, just prior to Stage 2 proceedings which commenced in February 2025. The most recent blog provides a timeline of the key dates and scrutiny of the Bill, and highlights the Bill’s slightly unusual passage up to the start of Stage 2.
Pre-stage 2 consideration
Due to the anticipated scale and nature of the Scottish Government’s Stage 2 amendments, Members were given an indication of the Scottish Government’s intentions for the Bill ahead of formal Stage 2 proceedings. The Health, Social Care and Sport Committee had published its Stage 1 Report a year earlier on 22 February 2024. Recommendation 108 of that report called for:
- “the full text of any amendments it intends to lodge at Stage 2;
- a marked-up version of the Bill as introduced incorporating these amendments in a highlighted format; and
- an updated Policy Memorandum and Explanatory Notes”
This led to further scrutiny by the lead Committee following the completion of Stage 1. The proposed Government amendments were published at the end of June 2024. The Committee issued a further call for views over the summer and undertook further evidence sessions through the autumn of 2024 on the draft amendments. (See ‘Stage 2: changes to the Bill’ on the website for official reports of these meetings and the second call for views). The Committee did not publish a further report.
The main proposal in the marked-up version of the Bill published in June 2024 was the removal of most of the structural elements – the creation of a national and local care boards – and removing proposals about moving accountability for social care to the Scottish Ministers. Resistance to these proposals, as they were presented in the Bill as introduced, was considerable from the outset.
Early in the autumn of 2024, COSLA and the trade unions announced their withdrawal of support for the Bill, regardless of the proposed amendments. By the conclusion of this additional scrutiny phase, all opposition parties had withdrawn their support for the Bill.
Stage 2 consideration and debate
Official Report for Stage 2 meeting on 25 February 2025.
Official Report for Stage 2 meeting on 4 March 2025
Once the Scottish Government (and others’) amendments were published, there was little left of the original Bill at the start of Stage 2 proceedings. Brian Whittle MSP sought to remove all the remaining sections, which would have put an end to the Bill altogether.
The Minister had announced that the Scottish Government would remove Part 1 of the Bill. This contained all the substantive sections on structural reform and accountability. What would remain would be Parts 2 and 3 of the Bill, Sections 36 – 43, and these were the focus for amendments. These sections cover care records, digital approaches to information and information sharing across health and social care, rights to breaks for carers and Anne’s Law.
The name changed as a result of Stage 2 amendments because it could no longer be argued that the Bill was establishing a national care service.
The remaining sections were debated, including on:
Independent advocacy
There was general agreement that independent advocacy to support users of social care services was important, alongside the provision of independent advice and information. The Minister asked that Labour, Conservative and Green Members agreed to work with her on the provisions ahead of Stage 3.
Complaints
Consideration of complaints had raised issues during Stage 1, with a number of national bodies, as well as local authorities covering and addressing social care complaints. The Minister argued that the current complaints process should operate to allow via a number of routes: with service providers, local authorities, the Care Inspectorate and the Scottish Public Services Ombudsman, but that it could be further developed and strengthened (amendment 99 relating to regulations on complaints handling).
Fair work, human rights, and ethical procurement in the social care sector
Jackie Baillie MSP opened the Stage 2 debate amendments in this group. She argued that there was an opportunity to set out the founding principles for fair work, equality and human rights in the social care sector
She sought a code of practice on ethical commissioning, and to strengthen requirements on services and commissioners to ensure ethical procurement, based on the fair work founding principles. She also argued that reference to the introduction of sectoral and collective bargaining should be on the face of the Bill. Carol Mochan MSP spoke to detailed amendments linked to fair work and financial transparency on the part of providers. The Minister, did not support these amendments arguing that they did not focus on users of services, were unimplementable, did not work when responsibility, for commissioning, for example, was local, or would create new, unnecessary statutory duties. However, room was left to discuss strengthening the provisions in this area, ahead of Stage 3.
Strategic planning for social care
Jackie Baillie MSP spoke to these amendments at Stage 2, which proposed a four-year national strategic plan for social care, created with key stakeholders and covering planning and procurement of services. More transparency about funding was sought, alongside improved intelligence and data on social care needs, unmet need and estimated costs.
The Minister again expressed her willingness to work on improving the wording about a national strategy, which built on the integration of health and social care.
Care records
Brian Whittle MSP highlighted the delays in creating an effective means of safely sharing data and information across health and social care. The Minister argued that it was preferable to have a power rather than a duty, and that her amendments would simplify the process, without putting undue pressure on organisations that didn’t have the right infrastructure in place for a mandated digital system. She went on to explain the reasons why allowing an individual full control over certain data, while good in theory, might lead to unintended consequences – when emergency care was required for example. She also highlighted that data protection and control of personal information is a reserved matter. She referred to progress on creating a ‘digital front door’ allowing people to access part of their health information directly, and being piloted in Lanarkshire.
Sandesh Gulhane MSP argued that personal data does belong to an individual, and that it should be possible to create a system where that person can control access, with certain caveats, such as in an emergency. There was a lack of consensus, and some Members expressed frustration that these amendments, for a clearer pathway to information to improve health and social care integration, were not being agreed to.
Scrapping the Bill – leaving out Parts 2 – 4
The Minister highlighted that scrapping the Bill would mean that anything positive – proposals for information sharing, improving access to breaks from caring, Anne’s Law, and extending a reserved contracting process to third sector organisations would also not be implemented.
Opposition Members argued that these things could have been introduced without the Bill, and much sooner. Brian Whittle MSP argued that the reserved contracting process introduced ambiguity in the context of ethical commissioning.
Entitlement to care
The amendments on entitlement to care sought to speed up the access to care assessments and to expedite access to, and improve services for those with a terminal illness. The Minister argued that assessment was a matter for local authorities, and also subject to the Social Care (Self-directed) Support (Scotland) Act 2013. However she expressed a keenness to work with Paul Sweeney MSP on improving care for those with a terminal illness ahead of Stage 3.
Right to breaks for Carers (4 March 2025)
The second meeting covered consideration of the remaining groups of amendments.
The amendments about breaks for carers were concerned with the definition of ‘sufficient’ – what constitutes a sufficient break? Gillian Mackay MSP also spoke for carers who might not want a break from their loved one, just a break from the caring responsibilities, and, for example, wanted to go away with their loved one under the arrangements for breaks.
The Minister was concerned that some of the wording was straying into employment law language and reserved matters in relation to international relations. She was also concerned that over-prescription in the legislation would work against the personalised approach that carers were seeking. The Minister was looking to work with Members on improving the wording ahead of Stage 3.
Gillian Mackay MSP also raised the fact that there were no timescales for carers for the preparation of carer support plans in the Carers (Scotland) Act 2016. This effectively means that carers can wait for long periods for an assessment, and then for any support to be put in place.
Section 40 covers visits to or by care home residents (‘Anne’s Law’). The Minister described her desire to balance, in residents’ favour, their dignity, wellbeing and human rights, with the need to suspend visiting and connection in extreme circumstances.
Jackie Baillie MSP’s amendments sought to further strengthen consideration in favour of residents. The Ministers urged the Members to support her amendments but was open to further discussion with Jackie Baillie MSP and Brian Whittle MSP on strengthening the proposals.
Katy Clark MSP put forward two amendments about reporting of tax and ownership status of care services. She did not press them having spoken the Minister, but wanted to highlight the change over the years from mainly publicly provided care services to a situation where most publicly funded services are now privately provided. She also stated that there was ‘significant market concentration in much of Scotland, with the 10 largest for-profit care home providers accounting for more than a third of registered places’. Some of these organisations are registered outside the UK. Her argument appeared to be that the distance created between private, remote and disparate equity and essential care services rendered transparency and accountability impossible through Freedom of Information, and that publicly funded services should all be subject to Freedom of Information legislation. With a high level of market concentration, sustainability within the sector for residents could also be an issue if profitability is not reliable.
Other amendments concerned changes to the procurement rules by extending the reserved contracting process to third sector organisations, with time limits for contracts decided on a case by case basis, and providing new ministerial power to amend the ‘light-touch regime’ threshold for procurement.
A number of relatively uncontroversial amendments were debated about the regulation of social care and adult protection.
An amendment included the establishment of a National Social Work Adviser and National Social Work Agency.
Brian Whittle MSP introduced a series of amendments on reporting on the operation of the legislation, to improve oversight and equity across the country. However, the Minister did not agree that the amendments would achieve the desired purpose and argued that some of the information is already published.
The amended Bill
The Bill as amended at Stage 2 was published on 4 March 2025. The largest part of the Bill, Part 1 was removed, leaving Parts on:
- (Part 2)Care records (to provide for a scheme to allow information sharing to improve efficiency and effectiveness of delivery of services);
- Information standards – how health and social care information is processed, stored etc;
- (Part 3), Reforms connected to the delivery and regulation of care. The amendments incorporated modifications to the Carers (Scotland) Act 2016 – introducing ‘sufficient’ breaks from caring for adult and young carers;
- Visits for care home residents (Anne’s Law) – allowing the identification of an Essential Care Supporter (ECS), and for a duty to be placed on care home providers to facilitate visits to and from care homes except in the most extreme circumstances. The provider must do all it can to mitigate any risk to allow visits; the Scottish Ministers must also produce a code of practice to support the visiting provisions;
- Procurement matters to reserve the right for certain ‘not-for-profit’ organisations to participate in certain competitive (reservable) contract procedures;
- Regulation of social services, adult protection and the introduction of a National Chief Social Work Advisor and a National Social Work Agency These sections are related to strengthening the powers of regulators, Scottish Social Services Council and the Care Inspectorate (SCSWIS) to require information and to make it more straightforward to cancel a care service registration (making it illegal for that service to continue operating). For Adult Protection, the Bill allows health care services to report concerns to a local authority or any of the health professionals listed and/or an Adult Protection Committee. The National Social Work Adviser will report annually to the Scottish Ministers on the state of social work and the social work workforce and advise Scottish Ministers on social work policy. The office and agency will not directly cover the social care workforce.
- Section 13 of the amended Bill makes provision in relation to independent advocacy, advice and information for social care services.
Stage 3 proposed amendments
The Groupings and Marshalled lists are available on the Bill webpages. There are 15 groups of amendments covering:
- Group 1: Health and social care information
- Group 2: Freedom of information
- Group 3: Carers
- Group 4: Care homes: right to visits
- Group 5: Health and social care integration principles
- Group 6: Care commissioning
- Group 7: Care inspectorate powers
- Group 8: Social care workforce
- Group 9: National Chief Social Work Adviser
- Group 10: Care entitlements and assessments
- Group 11: Independent information, advice and advocacy
- Group 12: Projection of care needs
- Group 13: Social care market monitoring
- Group 14: Reports on Bill costs and operations
- Group 15: Short title
These amendments show some progress made since Stage 2, with some of the same themes returning about access to care records, with further detailing around the purposes and circumstances for sharing information.
Katy Clark MSP submitted amendments to include care services into schedule 1 of the Freedom of Information (Scotland) Act 2002. She also submitted amendments on social care market monitoring to increase transparency of profit and tax status.
Section 38, on breaks for carers has amendments to increase the flexibility on how breaks are taken. Jeremy Balfour MSP has lodged amendments that focus on support for carers, including financial support, and including a duty on relevant bodies to promote support take up.
Brian Whittle MSP has lodged an amendment to require reports on spending on carer support by integration joint boards and any other relevant body.
Amendments are lodged to further detail how care home visiting should be considered and arranged and which bodies should be informed. There are also amendments that seek to introduce the opportunity for decisions about suspensions of visits to be reviewed.
Sandesh Gulhane MSP has lodged an amendment to allow for complaints to be made about visits for care home residents, by residents, their carers or their Essential Care Supporter.
In the Bill as amended, Section 40, amending the Public Services Reform (Scotland) Act 2010, Section 78C would introduce a Code of Practice on the right to visits, which must be reviewed.
New sections are proposed to amend the Public Bodies (Joint Working) (Scotland) Act 2014, providing powers to modify integration planning and delivery principles.
Jackie Baillie MSP is also seeking modifications to the 2014 Act on including ethical commissioning guidance.
Sandesh Gulhane MSP has lodged amendments to increase powers of the Care Inspectorate.
There are a series of amendments lodged on the social care workforce: to undertake an audit of the workforce, the publication of a strategy to monitor and promote fair work in the sector, and to report on it. Jackie Baillie MSP has lodged amendments on sectoral bargaining. Note that these could be read in connection with the UK Employment Rights Bill which is going through the UK Parliament currently. There are associated Legislative Consent Memorandums, one of which covers sectoral bargaining in the social care sector, which is supported by the Scottish Government.
Paul Sweeney MSP has lodged amendments that seek to enable continuity of care when a person requiring support moves from one local authority area to another. The difficulties of accessing support when moving home was raised a number of times during Stage 1 scrutiny as an argument for a national care service because it was felt that a truly national service would inhibit variation in access and delivery across local authority areas.
Paul Sweeney MSP also returned with amendments seeking regulations to prescribe a timetable for assessing the needs of someone with a terminal illness.
On independent information, advice and advocacy, a number of amendments were lodged with some detail, while the Minister sought for a power to make regulations about the provision of these.
Anne Jepson, Senior Researcher, SPICe