The social care crisis in Scotland is not given the priority it deserves, but there is a growing consensus about what needs to be done.
I was speaking at the Care Scotland, care at home conference on Friday. The panel was asked to set out what’s wrong with home care and how we would fix it.
On a national and local level we need to fix the crazy commissioning system that isn’t working for anyone. It isn’t working for providers who are struggling to maintain a viable business model. It isn’t working for staff; either social workers that are trying to put packages of care together, or home care staff that are the real victims of the race to the bottom in pay and conditions. Most importantly, it isn’t working for service users, who suffer from the high turnover of staff with little continuity of care, or are stuck in a hospital bed because there are no staff to care for them at home.
The solution primarily needs proper funding. It’s easy to blame politicians for obsessing about the NHS, but they are often just following public opinion that rarely understands that social and NHS care are interlinked. Personally, I am coming to the view that we need an agreed national rate for home care, as we have for residential care. This would be a rate that is dependent on providers paying the Scottish Living Wage and maintaining a range of other workforce standards. One of the merits of a national rate as against a local top up is that it wouldn’t just reward the bad employers in the sector.
That leads me to the second issue, employment standards. Any funding agreement has to include the key elements of UNISON’s Ethical Care Charter. The new procurement guidance rightly recognises that paying the Scottish Living Wage alone is not enough because some providers will simply cut other conditions. There needs to be action on zero and nominal hour contracts, sick pay and travel time. In addition, what comes through strongly in all our surveys is the importance of giving staff time to care and proper training linked to career progression. A recent UNISON survey highlights frighteningly low levels of training. Caring should be a great job and many staff I meet recognise that. But the household bills have to be paid and so many end up stacking shelves in supermarkets instead.
I am pleased to say that there was a broad consensus amongst the panel at yesterday’s conference on what needs to be done. Scottish Care also launched their latest research report on this issue, which is well worth a read.
The media headline was all about freezing heath spending, but the key finding is that investment in better social care for older people would improve their lives and help to cut emergency hospital admissions. In 2012-13, the average emergency hospital admission for over-65s lasted for 11.8 days, at an average cost of £4,846. That amount could fund either care at home for a week for 27.7 older people or 9.28 weeks in a residential care home for one pensioner.
Ranald Mair, chief executive of Scottish Care, said: "If we're going to manage to keep more people out of hospital, to maintain them in their own homes and also to prevent them going into long term care at an early stage, then we actually have to invest in home care. The danger at the moment is that we're continuing to invest in hospitals and as you know, all politicians want to be the defenders of the NHS. This isn't an attack on the NHS, let me be clear. If people need to go to hospital that's where they should be. But what we know is that over 20% of admissions of older people to hospital are 'unnecessary' admissions. They're not going in because of their clinical needs, they're going in because of their circumstances and because of the lack of alternatives."
It’s hard to disagree with that. Investment in social care and in particular the staff who deliver care, needs to be one of our highest priorities.
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