Nick Kempe, 23rd December 2021
Care at Christmas and the role of unpaid care in Scotland
Set aside the consumerism and Christianity, Christmas Day is a day when we re-affirm our most important caring relationships. We do this in a myriad of ways, by sharing time, meals and presents or by talking to family and friends in far-flung places. The Christmas break in Scotland gives a care boost to people from all faiths and none, taking advantage of the enforced idleness. While personal caring tasks and domestic labour don’t suddenly go away, it’s a time when people can celebrate their relationships with those closest to them. Covid-19 played havoc with that last year and the Omicron variant is doing so again for the most vulnerable.
Christmas Day is also a very difficult time for some: the people who don’t have anybody, whether living on the street or alone at home; the people who have to work; the people who may be torn between two sets of caring relationships, including the health and care workforce; or the people living in a care home where visits may not be allowed because of an outbreak of Covid-19. And just as Christmas re-affirms caring relationships, it can end others, with some people realising they don’t want to spend time together and others that they no longer wish to care.
The complexities of care at Christmas reinforce the work that Common Weal has done on the meaning of care and which we believe needs to drive the development of a new National Care Service.
Christmas is a particularly significant time for informal or unpaid carers and the people who are dependant on them for care. It would be a shame, therefore, if the findings of the carers census for the last two years, which were published on Tuesday, were buried in the Christmas glitter.
The report contains some striking figures that should be central to the design of a new National Care Service. The number of informal carers in Scotland is estimated to have increased as a result of Covid-19 (no mention is made of the collapse in social care and preventive services) from somewhere between 700-800,000 to about a million. At the same time the number of individual carers being supported by local services dropped from 32,690 in 2019-20, i.e. before Covid had really struck, to 31,760 in 2020-21. Those changes should surprise no-one. But what the figures also tell us is that only c3.5% of informal carers in Scotland receive any support to do so.
In theory the Carers (Scotland) Act 2016 gave all carers the right to a written plan from 2018. But out of these c32,000 carers receiving support, only 21,000 had records with sufficient information to tell whether a carers plan was in place. Of these the census found just 41% of adults and 47% of children had such a plan. Three years after the Act came into force the right has been delivered for less than 10,000 or 1% of Scotland’s carers.
Without a plan, carers are likely to receive advice rather than services like respite. The figures in the census show that without radical reform the right to a short break as proposed in the National Care Service consultation will be a right for the very few and not the many. Additionally the resource issues, too few services and not enough support workers, will not be solved by changing management structures or quicker form filling.
The census strongly suggests that what support is provided at present is targeted at those carers providing the most care. Based on 17,150 records where it was possible to tell how much care was being provided, 54% of carers spent an average of over 50 hours a week providing care, more than a full-time job. Only 17% of these carers provided less than 19 hours care a week and many of these were young people who have less time to care because they are supposed to be at school.
The impact of providing this care is covered by two contradictory findings. Both censuses found that caring adversely affected the emotional well-being of c80% carers. On the other hand, based on 6,240 records for which information was available, the census suggests that 99% of carers were willing to provide care and that 97% were able to do so in 2020-21. The two are hard to reconcile but maybe this proves that if you cut services to the bone it is remarkable what people will do for others, whatever the personal cost.
The census figures indicate that care isn’t fundamentally about rights, but about people reaching out to one another. This, rather than the rights approach the Scottish Government is advocating, needs to be the starting point for how we design a new care system. How do we best support this natural propensity of people to care?
The answer lies in making carers central to the creation of the new National Care Service. This is about far more than how we extend short-break services for the 1% of informal carers most in need. It’s about how we ensure every informal carer has a reasonable income, lives in housing fit for the purpose, has a range of supports available locally and has power over the way services are delivered. Common Weal’s Care Reform Group will explain how we think this could be done next year.
Take care over Christmas!