A national care service should be established in Scotland on an equal footing with the NHS, a review has found.
A report by the Independent Review of Adult Social Care called for a new national service that reports to Scottish ministers.
It would oversee delivery of social care, aim to improve standards, ensure enhanced pay and conditions for workers and provide better support for carers.
The review also recommends national improvement programmes to raise quality in care homes, and advocates reforming the commissioning and procurement of social care support.
The review has been welcomed by unions and the First Minister.
Speaking in the Scottish Parliament, Nicola Sturgeon said the Scottish Government will respond to the report in “due course”.
She added: “The pandemic has shown us more starkly than ever before just how much our care services matter, so the review report provides us with a basis for significantly improving these services, as a vital first step towards the creation of a national care service.”
The review was led by Derek Feeley, a former Scottish Government director-general for health and social care and chief executive of NHS Scotland.
He said the “story of adult social care support in Scotland is one of unrealised potential”.
He added: “There is a gap, sometimes a chasm, between the intent of that ground-breaking legislation and the lived experience of people who need support.
“We have inherited a system that gets unwarranted local variation, crisis intervention, a focus on inputs, a reliance on the market, and an undervalued workforce.
“If we want a different set of results, we need a different system.”
Among the report’s recommendations is an end to charging for non-residential services, so social care can be free at the point of need for those receiving care in their own homes or community settings.
It also calls for the Independent Living Fund, which enables disabled people who need support to live in their communities, to be reopened.
Carers should be given “better, more consistent support” and the right to respite, with an amendment to the Carers Act if required, the report adds.
The national care service should be supported by reformed integration joint boards, which will take responsibility for planning, commissioning and procurement and should be funded directly by the Scottish Government.
Responding to the report, Inclusion Scotland chief executive Sally Witcher said: “The Covid pandemic did not break the social care support system, it shone a spotlight on just how broken it long had been.
“This report sets out a radical approach to much-needed fundamental change.”
Claire Cairns, network co-ordinator at the Coalition of Carers in Scotland, said that if fully implemented, the recommendations “have the potential to deliver radical change by creating a social care system which is progressive, ambitious and will ultimately improve the lives of supported people and unpaid carers”.
Roz Foyer, STUC general secretary, said: “We fully support the recommendation for the rapid implementation of changes to commissioning practices, sector-wide adoption of Fair Work to improve pay and conditions in the short-term, and, importantly, arrangements to expand collective bargaining to cover all social care staff.”
GMB Scotland’s Rhea Wolfson said: “We are pleased the report acknowledges our campaign for a £15 an hour minimum wage in social care and we would stress to the Government and the industry this is very achievable with collaboration and political will.”
Mike Kirby, Scottish Secretary of Unison, said: “We welcome the support for a national care service, however the challenge now moves to the Scottish Government to deliver.
“For too long the care system has been weighted towards price and profit. A national care service, with the NHS as its inspiration, would make quality of care and Fair Work its focus.”