With thousands of beds blocked this winter by patients healthy enough to return home, it's time for politicians to put as much focus on social care as they are on NHS Scotland.
Thanks to data obtained by BBC Scotland we know that over a four-week period, an average of 1,216 beds per day were unavailable to incoming patients in hospitals across the country. NHS England is also struggling with this problem and 139k patients were stuck in beds, unable to leave, in December. Scotland's comparative numbers are more than double, with 31,610 reported in Scotland for a population 10 times less.
Health Secretary Shona Robison said the figures "aren't good enough" but blamed the position the government inherited. Possibly the lamest excuse a minister could give when her party has been in government for nearly 8 years!
Scottish Labour's health spokeswoman Jenny Marra said: "Bed blocking has a real impact on our whole health service and the operation of our hospitals. It is something the government needs to get on top of soon". True, but Labour's policy announcements have been focused on the NHS and not on social care - where the real focus should be at present.
The last edition of Holyrood Magazine has a good analysis on how the NHS in Scotland is being used as an election issue. In fairness to the politicians, they are largely reflecting public perceptions and therefore, as I said in the article, we all need to do more to explain the interaction between health and social care. The ConDem austerity cuts in Scotland are largely being dumped on local government and councils are in no position to respond to the demands placed upon them.
Council social care budgets are to be merged with health budgets. This is aimed at forcing both to work closer together to move patients into the right care setting. The Scottish Government announced £100m in funding which, invested over three years, will be used to help health boards and councils provide support packages for people in their own homes. Welcome though this funding is, it is well short of what is required.
Firstly, we need to fund an increase in capacity. We know from our surveys of the staff involved that assessments are not being delivered in full. That's in addition to patients blocking beds - now the equivalent of the bed capacity in the new Southern General Hospital.
Secondly, it's about recruitment and retention of quality staff. We have a hopelessly fragmented delivery of home care that has been increasingly privatised. Many of the new providers cannot deliver the service because of high staff turnover and recruitment problems. There has been a race to the bottom in pay and conditions, and staff are voting with their feet.
For example, an authoritative new report from the Resolution Foundation revealed that at least 160,000 care workers were being collectively cheated out of £130m a year by virtue of being paid below the National Minimum Wage. How can we claim to be a civilised society when we allow the people entrusted to care for our elderly and disabled people to be treated so outrageously? The Save Care Now web site has a petition on this issue that I would urge everyone to sign.
In Scotland, this is reflected in UNISON Scotland's Time to Care report that highlighted some appalling working practices. The growth in zero and nominal hour contracts is another abuse that needs to end because it directly impacts on the quality of care. Workers on these contracts are simply unwilling to report even care abuse, because of the threat to their precarious jobs.
Under the provisions of s52 of the Local Government in Scotland Act, councils should not be using procurement to create a two tier workforce, but they are. The recent local government benchmarking report says that the 8% shift to outsourced providers has, "contributed to reduced costs through lower salary and pension costs". Progress on extending the living wage through procurement has also been painfully slow.
Getting patients out of hospital is essential for the NHS and the quality of life for people stuck in an inappropriate care setting. It requires greater home care capacity as well as a revitalised workforce using the plan in UNISON's Ethical Care Charter. That is where political parties ought to be focusing their attention.