What could the Scottish Government do to stop social care provision being cut further?
While agreeing to pause the National Care Service bill until after the summer and of the need to engage with the Trade Unions, the new Scottish Government is yet to announce any measures that would address the resource crisis enveloping social care provision and the workforce. Instead, it has remained silent about the implications of this year’s Scottish budget for social care provision and appears to have little or no idea of what to do about issues like the very high levels of staff turnover and vacancies.
The financial implications, however, are now very apparent at the local level in the budgets that have been set by the Health and Care Partnerships which are responsible for adult social care provision.
In March the Care Inspectorate published a damning report of the state of adult care services in the City of Edinburgh https://www.careinspectorate.com/images/documents/6997/City%20of%20Edinburgh%20inspection%20report%20March%202023.pdf
Its conclusions, however stilted and full of management speak, spoke of the lack of resources:
”Staff vacancies, turnover and absences impacted on staff’s capacity to undertaketheir roles and responsibilities as fully and to the quality they desired. There was nota sufficiently available capacity of appropriately qualified staff to deliver the intendedassessment, care planning, service delivery and review outcomes.”
That same month, the Edinburgh Integrated Joint Board which is responsible for managing the partnership, agreed £11 million of cuts and to develop plans for another £35 million of cuts in June. It was arguably a brave decision to delay the cuts that long, as IJBs are under a legal duty to produce a balanced budget, but their meetings for April and May have been cancelled. Edinburgh is an area where demand is steadily increasing due to the rise in the general population (10% in the last ten years) and the population of older people who are most likely to need services. It should now be obvious to the Scottish Government – who commissioned the report by the Care Inspectorate – that they have placed the IJB in an impossible position.
It’s the same in Scotland’s largest local authority by population. In March the Glasgow IJB agreed £21,576k in savings –management speak for cuts – and to use £17,166k from reserves to set a balanced budget. 197 full time equivalent jobs are to be lost. The remaining £3m from the £41,742k shortfall, is to be met “from within budgets”. This means frontline staff will need to restrict further the number of people receiving services, with all the consequences that has including for “delayed discharge” from hospital. The crisis won’t be solved by further integration, as proposed in the NCS Bill, only more resources. On top of these cuts, there has been no inflationary increases for Criminal Justice services, which are directly funded by the Scottish Government and whose funding has been squeezed for years
The budgetary shortfall in the Glasgow HSCP was made worse by Glasgow City Council withholding money awarded to them by the Scottish Government to fund increases in the pay of social work and social care staff, £7.8m in all. An extraordinary turn of affairs but then Glasgow City Council is on the rocks and the only choices left to it are to rob Peter to pay Paul.
Over in Fife, Scotland’s third largest local authority and HSCP, there is a £20,936k funding gap. £12,850k of that is be achieved by efficiency, £3,587k by service redesign and £5m by transformation. Like many other HSCPs, it is now planning for the cuts within the context of a medium-term financial strategy covering several years. In Fife, most of the predicted damage is coming this year, but in other local authorities like West Lothian the worst is planned for the future. Besides £6.589k savings for the current year, which will include loss of 13.5 FTE staff in social work teams for older people, West Lothian are planning to “review” their care home provision with the loss of 82.4 FTE jobs in future.
This is an absolute disaster which can only serve to undercut the pay and conditions of staff in the sector still further. Instead of IJBs levelling up staff and trying to match pay and conditions within the NHS, their actions are serving to strengthen the role of the private sector which sucks profits out of care.
IJBs are so under the control of the Scottish Government, a situation which will only worsen if the proposals in the NCS Bill for Care Boards is allowed to go ahead, that it is very difficult for them to speak out. Nevertheless, sprinkled through the various budgetary reports are carefully phrased comments from staff which shows where ultimate responsibility lies. For example:
“It should be noted that the additional funding provided by the Scottish Government for IJB adult social care functions for 2023/24 is much reduced in comparison to prior years despite the very significant levels of inflation experienced over the last year and ever-increasing demands due to demographic pressures.”
The new Scottish Government is in a very difficult financial position but needs to act now to begin to address the resource issues in care provision or else lose all credibility. A good start would be to look at total budgetary spend and increase the proportion of care monies invested in frontline social work care services. This could be done by devolving resources currently controlled and spent by central government, freeing up social workers to help people and work with local communities and most important of all stopping profits from being extracted out of care provision.