Welcome to the Public Works blog.

Public Works is UNISON Scotland's campaign for jobs, services, fair taxation and the Living Wage. This blog will provide news and analysis on the delivery of public services in Scotland. We welcome comments and if you would like to contribute to this blog, please contact Dave Watson d.watson@unison.co.uk. For other information on what's happening in UNISON Scotland please visit our website.

Thursday, 17 December 2015

Scottish budget ducks tax and shunts austerity to councils

If yesterday’s budget is “a Scottish response to austerity” then we are in very deep trouble. A response to austerity has to be more than simply administering George Osborne’s efforts to wreck our public services.

Let's start by acknowledging that the root cause of the problem is Tory austerity. The Chancellor’s Autumn Statement confirmed that public expenditure in Scotland faces year-on-year real term reductions. By 2020 
it will be 12.5% lower in real terms than when the Conservatives came
 to power in 2010. This is the equivalent of one pound in every eight being cut by 2020. 

There are also further commitments on Scotland’s public services including around £250m in payroll costs due to the UK government increase in National Insurance contributions. At the time he announced these increases he vaguely suggested that the savings to the Treasury would be recycled into public services. I said then that ‘pigs might fly’, and true to form they haven’t.

This leaves John Swinney with some difficult choices on tax and spending. A real response to austerity would have looked at growing the spending envelope by increasing tax revenues. I am not unsympathetic to his argument against using the Calman powers on income tax, because there will be no power to introduce variable rates until the new Scotland Act powers are implemented in 2017. As many of us argued, this was the big flaw in the Calman compromise. There is a welcome new 3% LBTT supplement on second homes, although it is less clear why properties below £40,000 are exempt, or why the supplement isn’t larger. Other Scottish taxes only increase with inflation.

Far from increasing taxes when new powers arrive, they announced a 50% cut in Air Passenger Duty. This is not only bad for the environment, just days after the FM’s Paris climate change rhetoric, but it also amounts to even more middle class welfare. A 50% cut in APD would put an additional 60,000 tons of CO2 into the atmosphere. It's also a social justice issue because half the public doesn’t fly. No prizes for guessing which half.

The big cop out was the Council Tax freeze. Even George Osborne recognised the pressures on social care by promoting an increase in the Council Tax in England that is likely to raise £2bn. An equivalent in Scotland would expand the spending envelope, and together with the money he is routing through health, would start to make an impact on Scotland’s very real social care crisis. The problem with routing £250m of funding through the NHS is that health boards, with some justification, will argue that they need an equivalent to the English NHS increase and therefore will find every way possible to avoid passing all the funds on. The recent Audit Scotland report on integration includes all the warning signs.

While any tax freeze is popular, most people understand that it can’t go on forever. If the Scottish Government want’s to support income, there are more progressive ways of doing this than a tax freeze that helps wealthy households the most. It is the most disadvantaged who pay for this tax freeze through cuts in services and increased charges.

The big loser in yesterday’s budget is local government. The budget is cut by 3.5% or £500m in cash terms. On top of that there are additional commitments like the NI increases that could double that cut. CoSLA calculates this will cost 15,000 jobs or ‘the equivalent of 50 Tata Steelworks’ – but don’t expect a taskforce! 

A cynic might take the view that the Scottish Government is simply outsourcing the most difficult cuts to councils – the ‘not me guv’ strategy. References in the budget document to reform, including shared services, are not going to plug the gap. When will politicians learn that more centralisation simply doesn’t work.

I spotted a related announcement in England yesterday that is worth watching. There is a plan to devolve Attendance Allowance (AA) to English councils. When free care for the elderly was introduced the Scottish Government argued that they should get the savings this policy created for AA. Unsurprisingly, the Treasury said no. However, if they devolve this funding there should be Barnett consequentials of some £500m. Not all of this would be ‘new’ to Scotland, but it could provide a source of some additional funds for social care.

There is little good news for the rest of the public sector in the budget. Food Standards Scotland faces a significant cut, so check your xmas dinner because regulatory and funding cuts means inspection and enforcement are being cut. The Fair work, skills and training budget is cut by £13m in real terms. The Tories and Liberals who like to portray Scottish Water as a burden on the budget, might like to note that it will make a positive contribution to the budget of nearly £100m.

Education and police budgets largely flatline. For education, the Scottish Funding Council faces a small real terms funding cut of £23m. The Scottish Police Authority budget is also cut by £12m in real terms although mostly on capital spending. There is a welcome £4m uplift for community justice services. Fire and Rescue has a somewhat larger cut of nearly £20m in real terms.

Iain Macwhirter makes some valid points on why silence on tax is a ‘counsel of despair’ in today’s Herald. He said: “The Scottish political classes like to boast their progressive credentials and they vie with each other in their hatred of the evil Tories. But they are all for social justice just as long as it doesn't mean increasing taxes.”


A proper Scottish response to austerity would be to have a serious national conversation about tax. Yesterday’s budget ducked the big issues and simply shunted austerity down to councils.   

Wednesday, 9 December 2015

Time to get serious about social care

While sound and fury explodes all around us on NHS spending, spare a thought for the crisis in Scotland's social care system.

Today, I was in parliament for the launch of the Commission for the Provision of Quality Care in Scotland report. The Commission was established by Neil Findlay MSP when he was Shadow Cabinet for Health and Wellbeing with the aim of reviewing how we can improve the way adult social care is delivered. It was Chaired by David Kelly who was a Director of one of the first Community Health and Care Partnerships in Scotland and brought together all the main stakeholders.

The strength of this Commission and the earlier one on health inequalities is two fold. Firstly, they address issues that don't get nearly enough attention in the Scottish health debate, that at times seems obsessed by A&E waiting times to exclusion of all else! Secondly, Neil was very clear in his remit that he didn't just want another analysis of the issues (something we are very good at in Scotland), he wanted solutions. Even if the solutions might be politically difficult.

The report starts with a stark assessment of the current position. We have an ageing population with an increase in multi-morbidity and long term conditions. In disadvantaged areas the most common co-morbidity is mental health and this combination has a strong association with health inequalities and negative outcomes for individuals and families.

These additional demands bring with them associated costs. The report estimates a real term increase of up to £2bn per annum will be required by our health and social care system by 2025. With a small growth in the size of the overall population this is likely to place an increasing tax burden on the working age population. The recent IPPR report reinforces this point.

During the years of Tory austerity the Scottish NHS budget has had a degree of protection at the expense of other public services including social care.This approach has failed to recognise the inextricably linked relationship between acute hospital care and care in the community. The consequences can be seen in the numbers of patients blocking beds in our hospitals and a £5million increase in the amount councils are having to generate from charging income for social care in order to compensate for the financial shortfalls.

The report describes the complex and frankly inadequate ways the quality of care is assessed in Scotland. UNISON Scotland's 'Time to Care' report starkly set out the views of care staff over the quality of care they are forced to deliver. While in the main health and social care services are provided good levels of quality, there are still too many examples of poor quality. The report concludes that general trends about quality cannot be ignored. In particular, the connection between the quality of staffing, working conditions, and quality of care is a matter of primary importance.

The workforce chapter seeks to address a key component of this. The Commission recognises that more than anything else, the payment of the living wage and a general improvement of terms and conditions will be required to deliver a social care workforce consistent with our aspirations for quality care. This view is shared by the evidence submitted to the Commission from both trade unions and employers across the public, private and voluntary sectors. The contracting race to the bottom in care provision has to stop.

Since the report was written the social care crisis has if anything got worse and today councils and providers in England are making similar points. We have residential and homecare providers in in very difficult financial circumstances, drawing on reserves and some are struggling to meet even day to day cash flow. Others have significant vacancy rates and increasing staff turnover. Social workers in care of the elderly teams report that it is becoming increasingly difficult to find a provider to deliver care packages in some parts of the country.

Pay is but one element of fair work. The Commission commends UNISON's Ethical Care Charter that includes the wider considerations that commissioners of home care should account for when contracting. These include training, induction, travel time, ending zero-hours contracts and most importantly ensuring that there is time to care.

The Scottish Government's standard response to concerns about social care is to refer to the new Integrated Joint Board's that aim to provide a seamless care service. While the Commission supports this approach, it recognises that this structural change will not in itself be enough. The recent Audit Scotland report confirms this. Despite the Kerr report and much talk about preventative spending, we have not been able to break the public perception that everyone should have a district general hospital within ten minutes of their house – nor the political pressure to satisfy that thirst.

The Commission argues that a top-down approach to the commissioning of services will fail to deliver responsive care and support. The report places an emphasis on getting locality planning right building on the knowledge and capacity of local people about their own wellbeing. It also recognises that best practice needs to be supported and rewarded. Equally, there is a need to work with poorly performing locality teams to improve outcomes. We need to recognise that not all differences in outcomes are down to differential resources. It can reflect poor leadership, organisation and bad practice.

Housing provision also needs to change if we are to address the needs of an ageing population. All too often, a person will move from their family home into a care home via a period in hospital.This is partly because of the lack of suitable alternatives at local level. We need to build new, affordable and sustainable housing, with a range of house types and sizes that encourages mobility in the housing system and enables downsizing for those that wish it. Housing support services currently play a small, but significant, role in supporting older people to remain living at home and needs to be expanded.

A key recommendation of the Commission is that we fundamentally rearticulate the basic social contract between the citizen and state based on the principle of reciprocity.That people contribute to the wider social good through payment of tax and direct contribution to care and support – and in return people receive high quality care and support when they need it and irrespective of their financial circumstances. This means addressing the current differences between services free at the point of use such as healthcare and some social care, but not for those under the age of 65.

As such, the Commission arrives at a new and more robust social contract: the responsibility of the state is to ensure that citizens with personal care needs receive that care free at the point of use; and that citizens are otherwise responsible for their daily living costs and additional support requirements, funded from personal wealth or income, or for those citizens who are less well off, from welfare support.

Finally, the Commission addresses the question of funding. A properly funded and organised social care system would actually save money. For example, a bed in a District General Hospital costs in the order of £2,500 per week, as compared with £500-£800 per week for a care home and even less for home care. The Commission points to work done elsewhere in the UK on the options for addressing the funding gap, something we have simply ducked in Scotland. A national conversation needs to be informed by a detailed examination of the spending gap and how that might be funded. The Commission makes no claim that its work is sufficiently detailed to be a definitive statement on this issue. However, they do say that it is sufficiently large that it cannot be wished away or ignored.

The value of this Commission report is that it does more than simply analyse the scale of the problem, important though that it is if we as citizens are to grasp the importance of social care. The Commission goes much further in describing what a quality care might look like and how it should be delivered. It also doesn't duck the need for a new social contract and the necessary conversation about funding.

 

Thursday, 3 December 2015

Big challenges face health and care integration

Audit Scotland highlight major challenges for health and care integration in a report published today.

The Public Bodies (Joint Working) (Scotland) Act 2014 aims to ensure health and social care services are well integrated and that people receive the care they need at the right time and in the right setting, with a focus on community-based and preventative care.
The report recognises widespread support for the reforms and all 31 integration authorities (IAs) are expected to be operational by the statutory deadline of 1 April 2016. There are significant differences in which services will be covered by the IAs as this chart shows:
 


Despite this progress, Audit Scotland have identified significant risks which need to be addressed and they argue that IAs will not be in a position to make a major impact during 2016/17. Difficulties in agreeing budgets and uncertainty about longer-term funding mean that they have not yet set out comprehensive strategic plans. Many IAs have still to set out clear targets and timescales showing how they will make a difference to people who use health and social care services.
 
The report also points to the complexity of the proposed governance arrangements, with some uncertainty about how they will work in practice. This will make it difficult for staff and the public to understand who is responsible for the care they receive.
 
There are significant long-term workforce issues identified in the report with IAs inheriting workforces that have been organised in response to budget pressures rather than strategic needs. Other issues include different terms and conditions for NHS and council staff, and difficulties in recruiting and retaining GPs and care staff. They identify three main workforce difficulties:
 
  •  Financial pressures on the NHS and councils. NHS boards and councils continue to face pressures from tightening budgets and rising demand for services. Most councils have responded to these pressures in part by reducing staff numbers and outsourcing some services to the private and voluntary sectors. These changes are less evident in the health sector. As a result, there are concerns that any future changes to the workforce will not affect health and care staff equally.
  •  Difficulties in recruiting and retaining social care staff. Over many years, councils have had difficulties recruiting and retaining care home and home care staff. Organisations in areas such as Edinburgh and Aberdeen, with high living costs, have had particular difficulties. There is a need to develop a valued, stable, skilled and motivated workforce. We found examples of organisations developing new approaches to making careers in caring more attractive. For example in Dumfries and Galloway and Aberdeen City they are considering creating caring roles that are part of a defined career path, to encourage more people into these roles.
  •  The role of the voluntary and private sectors. Voluntary and private organisations play an important role in providing care and support, but there are particular challenges in how IJBs can involve these diverse organisations as part of a coordinated workforce plan. The introduction of the national living wage will have a significant impact on the voluntary sector and their ability to provide the same level of support for health and care services.
 
Overall, this report is a useful description of the current state of play in developing health and care integration. It also highlights a number of concerns over the pace of progress and the financial and other pressures the new arrangements will face.