Crisis in Social Care

Kathy Jenkins - 17th November 2022

At the same time that the Scottish Parliament is beginning to debate and scrutinize the National Care Service Bill, with representations being made from all sides arguing for major changes and amendments, many who work in social care and are in need of care are aware that this debate is being overtaken by what is happening within Scottish social care services right now.   

Voices from across different players in social care are now raising major concerns about the content of the NCS Bill, and perhaps more crucially about its lack of content.   In its present form it does not lay down a blueprint for a National Care Service (NCS) which will bring about the transformation in social care which is desperately needed.   These concerns are well described elsewhere.

However, parallel to this, social care is facing a current crisis which cannot wait for whatever NCS is eventually created. Some are even saying if action isn’t taken now there may not be a care service to reform, and equally concerning is that discussion and decisions about tackling this crisis are being made without public knowledge or consultation.    

An illustration of all of this is being played out in Edinburgh right now.   The Edinburgh Integration Joint Board (EIJB) at its last meeting (18 October 2022) considered two papers:   Systems Pressure Update and Edinburgh Assistance Programme Update.  The first of these was considered by the Board in open session (open to the public, although few attended, and live streamed) but the second was considered in private session even though by that time it was in the public domain including the press.  The content of these papers is alarming.  Deputations from Edinburgh TUC and Unison raised major concerns about them, but crucially were not allowed to even refer to the contents of the ‘private’ paper in their representations to Board members.  The reason given for this was ‘commercial sensitivity’, undoubtedly in relation to proposals to increase the purchase of beds from the private sector.   The changes, some of which are detailed below, will create ‘facts on the ground’ which will preempt both the NCS Bill debate and a promised EIJB public consultation on the future of care in Edinburgh.

What does the crisis in social care look like?

- There is huge unmet need for care.   For example, in Edinburgh there are 7500 hours of unmet need. And this figure only includes those assessed as having substantial or critical needs.  It does not include those with moderate needs which are offered no care at all.   

-There is a major staffing crisis in public, third sector and private sector care provision.  In Edinburgh this amounts to a 20% staffing shortage. This is putting the health, safety and welfare of care users, their families and care workers at risk.   

-There are large inequalities in the quality and cost of care being provided, whether in care homes or in people’s homes.  

-Workers providing this crucial service are low paid, feel undervalued and not respected and are often given little autonomy to care for people as they assess would be best.  Many are on precarious contracts, lacking job security and work long hours (sometimes unpaid) without adequate support. All this results in high turnover, a major cause of understaffing across the sector.

In the face of all this, funding for social care is being cut.  Social care in Scotland is funded through Integration Joint Boards made up of local authority and health board members.   Throughout Scotland there are reports of cuts in services being made by these Boards resulting in changes being made to care provision which will harm both care workers and those in need of care. 

What do the EIJB papers say?

One of the recommendations in the private paper, produced by “experts” working on behalf of the Scottish Government – a sign of things to come if care is centralised - is to ‘work with private partners to put in place a package of provision of beds over the autumn/winter period’.  In response to local and national consultations on social care, there is strong support for social care provision to be ‘not for profit’, in the same way that NHS Care is and that the Government pledges foster and childcare will be.  This EIJB recommendation moves care in Edinburgh in directly the opposite direction which will result in an increase in the dominance of ‘for profit’ private sector provision (already 40% across the sector).   A recent academic study commissioned by the Scottish Trade Union Congress found that large private providers hold a large part of the for-profit market with the 10 largest providers holding a third or more of available places.  The research found that these ‘large private providers are associated with lower wages, more complaints about care quality and higher levels of rent extraction than public and third sector care providers’.    The private sector also has 20% worse staffing than the not for profit one.   

Other issues of concern in both papers include:

• The Scottish Government's “assistance programme” recommendations will force the EIJB to move away from its long-term Innovation and Sustainability Programme designed to overhaul and improve the whole system in coming years.  This is being held back or changed in order to fund short term solutions which may undermine it.  
• The reports clearly state that home care packages in Edinburgh are overly generous.   They contain proposals to reduce ‘overprescribing of care’, ‘peer review of care at home packages’, ‘over reporting’ ‘cleansing waiting lists’ and a new ‘triage team’ looking in part at whether the request for care (made by social workers following assessment of need) is ‘appropriate’   This is all entirely contrary to the experience of those on the ground, both care users and care workers, who struggle continuously to access adequate levels of care hours. 
• The papers report that pay rates in Edinburgh for social workers, mental health officers and occupational therapists are among the lowest in Scotland.  It recommends that these pay grades be reviewed to make them more attractive (something I have no quarrel with). However, there Is no proposal to pay the lowest paid and poorest staff - social care workers – anymore than their current £10.50 per hour or to increase fuel allowances even though the reports note workers can no longer afford to use their cars for work. 
• Recruitment of new social care workers will be done offering them more flexible and attractive shift work patterns, but there is no reference to their need for training, support and supervision or higher pay.   Neither is there any mention of the shift work patterns of existing care workers.  

It is important to say that there are some recommendations in the papers which appear to be welcome, eg those  regarding reablement, step down facilities and interim beds, although we haven’t seen details of these.  However, they are all being discussed within a context of cuts as explicitly stated in the  Systems Pressures paper which concludes by reporting a Scottish Government review of all funding allocation and states that the Integration Joint Board is facing ‘ competing challenges of improving performance at the same time that financial resources are increasingly constrained.’   Not the sort of NCS Scotland needs!