The key to delivering high quality social care in Scotland is a fairly paid, well-trained workforce that is given the time to care properly.
Today, I was giving evidence to the Scottish Parliament Health Committee on the social care workforce. The committee has been looking at how the new Integrated Joint Boards have been coping with the challenges facing them. Unsurprisingly, new structures take time to settle down and even agreeing budgets has been problematic.
The NHS needs better social care to tackle delayed discharges from hospital beds. Delayed discharge patients occupied a staggering 567,853 bed days last year, that’s one in twelve beds in NHS Scotland, costing around £114m. These figures mask a human tragedy for many elderly people who want to be in their own home, or even a residential setting, rather than in a hospital bed.
The Health Committee’s survey showed that just four of the 31 Integrated Joint Boards have adequate numbers of care staff to get these patients out of hospital. That reflects our own experience; with social workers reporting that it is becoming increasingly difficult to get providers to staff care packages. One senior social worker told me last week that she rang five providers and none could provide staff for an elderly person due to be discharged from hospital on the following Monday. She had to go on bended knee to the much-reduced in-house team to get a temporary solution.
We are seeing some very high staff turnover rates from even the better providers. This matters because it is expensive to keep recruiting and training new staff. Elderly persons want continuity of care - seeing a different carer each week is very poor practice.
The quality of care is starkly reflected in UNISON Scotland’s latest survey of home care staff, ‘We Care, Do You?’ Workers describe some pretty appalling practices that none of us would want for their elderly relatives.
So what’s the solution? In fairness to the Scottish Government they have at last recognised that we have to resource social care properly. Years of council cuts have led to a race to the bottom in pay and conditions for these workers and short cuts in care delivery. Even inadequate 15-minute care visits become 10 minutes because they often don’t take account of travelling time.
Just increasing capacity isn’t enough either. If providers can’t recruit and retain staff, the new care packages will only exist on paper and patients remain in hospital.
£250m was allocated this year to improve social care, although it was routed through the NHS, when it is councils that deliver social care. This may make NHS funding look more impressive cosmetically, but it contributes to ‘the guddle’ as I described it in the Sunday Herald.
There was never any transparency over the constituent elements of this money and in particular how much was allocated to ensure the Scottish Living Wage is paid to care workers from 1 October – an essential element of the policy. Just a few weeks before the policy is supposed to be implemented, councils and providers are struggling to get the procurement policies in place. Providers say there isn’t enough money; councils say that’s all they have received.
We are also concerned that some providers may well pay the correct wage, but will cut back on other terms and conditions. This is contrary to the statutory procurement guidance that refers to all workforce matters – not just pay.
Much of this could be avoided if we adopted a structured national approach to the provision of social care. We should not lose sight of the fact that we will need some 65,000 extra care staff in Scotland by 2020 – so we need to get this right now.
Here is a plan:
A national sectoral bargaining structure with all the stakeholders; government, employers and trade unions, around the same table.
This forum to agree a national hourly rate for home care, similar to that agreed for the residential sector.
Government to commit to early engagement each year with transparent resource allocation.
A commitment to deliver all the elements of UNISON’s Ethical Care Charter, including the Scottish Living Wage, proper training, an end to insecure work and time to care.
In effect this would be a national framework that would allow the Integrated Joint Boards to get on with the task of agreeing local delivery solutions. This would be a sensible balance between the national and the local. Is that really too much to ask for those who deserve a decent standard of care?