Workplace dementia

More than 40,000 people under the age of 65 have been diagnosed with dementia in the UK, 3,200 of those in Scotland. It is estimated that 18% of them continue to work after a diagnosis and therefore this is a growing workplace issue that employers and unions should be addressing.


Today, I was speaking at a seminar organised by the STUC, Age Scotland and Alzheimer’s Scotland, aimed at raising the profile of the issue and building alliances to improve awareness and action.


The number of people with dementia is forecast to increase to over 1 million by 2025 and 2 million by 2051. Not least because of the increase in the retirement age and poor UK state and occupational pension provision - a greater number of people are expected to work later in life.


As the lead negotiator for the largest pension scheme in Scotland, the most common question members asked me was, ‘how I can retire early?’ Now, they are just as likely to ask about working on past the normal retirement age.


This driven by many factors in addition to increasing the normal retirement age. In local government many members have short service – the average is ten years. Contrary to the media myth of the 'gold plated pension' the average pension in payment is only £3705 per year. Many women in particular need to work on to build up a decent pension after career breaks and a number of men come into the public service workforce later in their career. We also have an ageing public service workforce with 50 to 59 year olds the biggest growing proportion.


To help us address this issue, we have a very useful guide from the Alzheimer's Society, which UNISON contributed to. This guide sets out practical advice about how to spot the signs and symptoms of the illness. It also explains how to support people with dementia - giving them choice and control of their lives, and allowing them to continue to contribute their skills and experience to the organisation.


This can not only make a difference to affected staff, but bring benefits to the whole organisation. The business case includes improving staff retention and providing a more inclusive service - which itself, evidence suggests, can enhance productivity and performance.


A dementia diagnosis doesn’t necessarily mean a person can no longer do their job. However, dementia is a progressive condition and over time it will increasingly impair a person’s ability to work. By becoming dementia friendly, organisations will further develop a culture that understands and supports all staff and enables them to work in a way that suits them and meets the organisation’s needs.


Union reps should use the guide to make themselves aware of the symptoms of dementia. Only 48% of people with dementia in the UK are diagnosed and people with early onset dementia can face particular delays receiving a diagnosis. There is a perception that only retired older persons suffer from dementia, so this might not be the first thing a steward thinks of when representing a member.


There's also the question of legal compliance. People with a disability are protected under the Equality Act 2010, and generally this will include people living with dementia. This means that employers have a duty to make reasonable adjustments for staff with dementia so that they are not disadvantaged at work. Adjustments could include clear signage and labelling, creating quiet spaces, and installing soundproofing or putting up visual barriers to minimise distractions. They might also entail a review of current job specification, reallocation of duties, a change of working hours, or redeployment to another role.


An older workforce will bring a number of challenges and opportunities and dementia is one of those. Unions and employers need to address these issues urgently. Organisational culture takes a long time to shift, so raising awareness and then training for managers and union reps should be an early priority.

Let's have a proper reform of the council tax - not another sticking plaster

We understand that the Council Tax is a difficult issue for politicians, but this latest sticking plaster isn't the solution.

I was giving evidence to the Scottish Parliament’s Local Government Committee this morning on the secondary legislation implementing the Scottish Government’s latest tweak to the Council Tax. These involve increasing the higher bands, ending the freeze and changes to the reduction scheme. More details in my briefing.

Increasing the multipliers for the top bands is a modest progressive move. However, it still leaves those in a £212,001 home paying the same bill as those in a million pound one. The Commission on Local Tax Reform indicated that the tax on highest value homes would need to be 15 times that of the lowest value homes in order to achieve proportionality. The current system means a £400K house pays three times as much as a £40K house - not ten times. This means that like VAT, it takes up a bigger proportion of low income households than high.

This chart compares the impact of the Commission’s proposals with the Scottish Government’s plan.

The government also needs to clarify how it expects water charges to be treated under the new bands.

In addition, there is to be no revaluation, so the new bandings will be based on 1991 property values. That simply isn’t credible when 57% of properties are in the wrong band. No one doubts that revaluation is politically challenging, even if there are likely to be equal numbers of gainers and losers. It could also introduce transitional provisions. The question is, just how long does the government intend to avoid revaluation before biting the bullet?

A bigger problem is that the Scottish government has decided to take the additional revenues, estimated at £100m, to allocate to their priorities – a new form of ring-fencing. Similarly, they have capped increases to the Council Tax at 3%. Both of these measures undermine local democracy.

Any improvements in the council tax reduction scheme will be welcomed by low income households. However, this cost used to be met by central government, not councils, who lose £333.2m through the system. This means the plan appears to impact on the income of councils with the most low income people. These people may well also find that any savings made on their council tax bills will not make up for cuts in the services they use or extra charges for those services. Charges now make up almost 7% of council budgets while council tax revenue has shrunk to around 15%.

All of these changes need to be effectively communicated to the public; otherwise it will be front line staff that take the flak for the confusion.

Setting up a fair property tax and rate that reflects the real values of properties is what will make the system fairer. We also need to design a system for those who struggle to meet their property tax obligations because of low incomes, which doesn’t unfairly impact on the budgets of local authorities with disproportionate numbers of low income citizens and deferment opportunities for the small group of property rich, cash poor pensioners.

While we welcome the end of the council tax freeze and improved bandings - we simply cannot go on with short-term fixes that damage services and undermine local democratic accountability.

Impact of Brexit of Scotland's health and care sector

At this morning’s Holyrood Brexit and Health seminar, I was asked what my immediate response to the Brexit vote was. Well of course I was elated at the thought of the promised £350m extra spending on the NHS. I had quickly calculated the Barnett consequentials and drafted UNISON’s shopping list to the health minister. Then I woke up and realised that this pig had not flown by my window!

In the real world, health is like so many other sectors, avidly awaiting any semblance of a strategy from the UK government. It remains unclear if this is because of civil service unpreparedness or cabinet divisions. However, it shouldn’t stop us in Scotland, identifying the risks and the opportunities and preparing our own position.

An early priority should be the economy. There are some positive signs of recovery except for the currency, and crucially for health, the public finances. We should be concerned that the Autumn Statement does not use Brexit as an excuse for a new round of austerity in order to achieve the ideological goal of reducing the state. In the alternative, if the Chancellor accepts the need to boost the economy, we should be increasing revenue spending as well as capital. NHS Scotland needs revenue funding more than it needs capital.

The big issue that focused most minds at today’s seminar is migration.  A right to stay for EU nationals is crucial to health sector. It may be legally possible to deport people, but there would be huge political and practical difficulties. I suspect the UK government’s unwillingness to make a declaration on this, is more to avoid a pre-Brexit migration surge than as a realistic bargaining chip.

There are various estimates of how many EU nationals work in the health and care sector in Scotland, but none are reliable. Audit Scotland’s report today on the social care sector used a 2008 survey that showed 6.1% of the social care workforce in Scottish care homes for older people were EU – non-UK workers, and a further 7.3% were employed under work permits. Most of those employed from within the EU came from Poland and the Czech Republic and those from outside the EU were from the Philippines, India and China. The NHS staff survey on ethnicity is published annually, but is voluntary and equally unreliable.

What we do know is that staffing levels are already under pressure. NHS Scotland had 2207 nurse vacancies in March of this year and the social care sector is struggling to recruit and retain staff.  If we are struggling with EU nationals, we need to ask how we will recruit the additional 65,000 additional health and care staff the sector will need in Scotland by 2022.

Recruiting more care staff from the indigenous workforce is going to be challenging given the numbers involved. We will need to really value care workers for the great job they do. That means fair pay, training, and time to care. We also need to break down gender segregation in the sector. Unless significant numbers of male staff are attracted to the sector, something like one-third of all female school leavers will need to work in care – and that simply isn’t going to happen.

While these are the immediate concerns, we should start to plan for other issues that will impact on the health sector. These include the common EU standards in professional regulation and employment law, particularly the working time directive. There may also be some opportunities in Brexit to address the limitations European procurement law has had on the sector, in particular, state aid and the posted workers directive.

There are wider public health impacts of EU environment and food regulation. Not to mention the loss of research funding and opportunities for collaboration over research. We should also be concerned about a UK approach to trade deals given the lack of expertise and ideological approaches. If we think the EU has made a mess of TTIP, CETA etc. – imagine what ministers like Liam Fox will do! Private healthcare predators could have a field day in a post-Brexit environment.

In conclusion, Brexit creates a wide range of potential issues for the health and care sector. The threats are obvious, although we shouldn’t lose sight of opportunities. Most people at today’s seminar recognised that we should move on from despair at the outcome and focus on what we need to do to protect these crucial services.

Household income and inequality

As a new Oxfam report has highlighted, the richest 1% of Britain’s population owns almost more than 20 times the total wealth of the poorest 20%. Or put another way, 634,000 of the wealthiest people are worth 20 times as much as the poorest 13 million. This makes Britain one of the most unequal countries in the developed world.

This 'us and them' society is illustrated by a story in today's Guardian. The disgraced former owner of BHS, Dominic Chappell, owes more than £500,000 to the taxman on the profits he made. HMRC has started legal proceedings to recover the money. However, Chappell has put the business that owes the tax, Swiss Rock Limited, into liquidation, meaning he could walk away without paying the bill. Truly, only the 'little people' pay taxes.

We also have some more detailed data on disposable income, helpfully analysed by SPICe in their latest briefing. Disposable income per person in Scotland is currently £17,905. This is just below the UK figure of £17,965. Scotland has the 5th highest GDHI per person of all UK regions. Between 2013 and 2014 Scottish GDHI per person grew by 0.2% in cash terms. This is lower than the increase across the whole of the UK (0.5%).

Taking a longer time frame is interesting. Between 1997 and 2014 Scottish GDHI per person increased by 28% (£3,740) in real terms with the UK seeing a 27% (£3,830) increase over the same period. The gap between Scottish and UK GDHI per person has decreased from a peak of 8.6% in 2000 to 5.1% in 2014. This is one statistic that we can't put down to the oil price crash.

Unsurprisingly, London has the highest disparity between the highest and lowest GDHI per person in the UK. Scotland in comparison is a more equal society, at least in terms of disposable income. However, there are significant inequalities within Scotland. Aberdeen and Aberdeenshire has the highest level in disposable household income at £20,547, followed closely by Edinburgh. Glasgow City is the lowest at £14,757. East and North Ayrshire saw the largest increase in GDHI per person last year while East and West Dunbartonshire saw the largest decrease.

The GDHI figure is broken down into primary income ( wages, assets etc) and secondary (benefits, pensions and gifts). Scotland has the sixth highest level of primary income of the U.K. regions and accounts for 7.8% of all primary income in the UK, but 8.3% of total UK population. Only London, south-east and east of England outperform their population share. Scotland has the highest proportion of income from wages of total income and the second lowest proportion of rental income and self-employment. Since 2008 all types of primary income have decreased in real terms in Scotland, but financial assets have declined the fastest, probably due to low interest rates.

Scotland accounted for 8.4% of the total income from benefits which is almost exactly the same as Scotland’s population share of the UK (8.3%) and are fourth from bottom in this 'dependency' league table. Interestingly it is areas like, Lochaber, Skye and South Ayrshire that have the highest secondary incomes. This is probably due to pension income and reminds us where the bulk of the welfare budget is actually spent.

So, this data shows that income inequality in the UK remains a huge issue for concern. Scotland is a more equal country, but still has big geographical differences. The question for policy makers is how should these disparities be tackled. Unequal countries do worse on almost every count, so we should focus on progressive taxation and stronger public services to bridge the gap.

Scotland's Budget 2016

The Fraser of Allander Institute has published a report; Scotland’s Budget 2016, which analyses the outlook for Scotland’s public finances.

 

Around 50% of the Scottish budget will now be funded directly by the revenues raised in Scotland, rather than simply relying on a block grant from Westminster. This requires new arrangements for managing economic risks that might impact the annual budget. Fiscal devolution on this scale is largely unprecedented internationally and certainly within the UK. Therefore independent analysis of this sort is very welcome.

 

As more revenues are raised in Scotland we need to take a closer look at the economy. The report highlights fragile economic growth that has lagged behind that in the UK as a whole over the past year with growth of just 0.6%, compared to UK growth of 1.7%.

 

The outlook for the Scottish budget to 2020-21 is not encouraging. The Scottish budget has faced unprecedented cuts since 2010. This year, Scotland’s resource budget is around 5% lower in real terms than it was in 2010-11. Capital spending has been hit particularly hard, down 12% in real terms since 2010-11. While we need to await the UK Autumn Statement to see what a ‘reset’ for UK fiscal policy actually means – it is unlikely to mean an end to austerity. The report suggest that the Scottish budget could be cut by between 3% – 4% in real terms by 2020-21 and up to 6% – around £1.6 billion – under a worst case scenario. The Scottish Government has decided to make only a modest use of its new powers, totalling less than 1% of the overall budget.

 

Despite this difficult financial position, the Scottish Government has announced plans to increase health spending by £500m more than inflation by the end of the parliament. It has also committed to maintain real terms spending on policing and has a flagship policy of doubling the provision of free childcare with a £500m price tag. The report says that delivering these commitments will require difficult decisions and a serious re-prioritisation of existing spending. This means that other ‘unprotected’ public services could face an average reduction of 10% to 17% (2.6% to 4.5% annually) in real terms by 2020-21.

 

Local government is likely to yet again face the brunt of the cuts. As an area of ‘unprotected spend’, the report suggests that the grant to local government could be reduced by around £1 billion on a like-for-like basis by 2020-21 – with increases in business rate and council tax income only partially offsetting these cuts.

 

As the report concludes, the scale of the challenges facing the public finances means that bold and radical solutions will be needed. Business-as-usual is not an option.

Valuing the workforce is the key to better social care

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? 

Plenty of vision in government plan, but delivery is more challenging

The Scottish Government's plan for the coming year is light on legislation, but there is more meat in the administrative sections, if it can move from process into action.

I outlined the key elements of the Scottish Government's 'Plan for Scotland 2016/17' in a briefing yesterday. So let's step back and look at the plan overall.

The main purpose of the plan is to set out the government's legislative programme - it's the Scottish version of the Queen's Speech. There are 14 Bills, but most of them are technical or dealing with specific issues like Domestic Abuse. They are also largely uncontroversial and even Bills on big issues like social security and child poverty are about the process of how the government will administer new powers.

The one exception is the Air Passenger Duty Bill. When this tax is devolved, the government wants to halve it with the longer term aim of abolishing it. This plan makes a mockery of the government's climate change commitments by dumping tons of carbon emissions into the atmosphere. It is also unaffordable in the current budget and gives a tax cut to the wealthiest in society - 50% of Scots don't even use air travel.

Other promised legislation that campaign groups will want to build on, like the Climate Change Bill and Good Food Nation Bill, have been pencilled in for later in the parliament. Overall, you wonder if the legislative programme would have been more adventurous if the SNP had secured a parliamentary majority in May. Minority government's tend to push more into administrative action, rather than risking parliamentary votes. I suspect the May draft of this plan looked somewhat different!

There are two big challenges in the administrative sections.

The first is finance. Austerity isn't going away and the next budget will have to set out taxation as well as spending plans. This plan severely limits the government's room for manoeuvre by promising no change in the basic rate of income tax. There are still plenty of opportunities to increase revenue on the fringes, but only the basic rate provides enough income to really challenge austerity and tackle the issues identified in the plan.

The second is public service reform. There is a whole section in the plan devoted to how the government wants to engage communities and decentralise. However, the actual measures are pretty modest, like 1% community budgets. On the other hand, we have centralising measures like the regionalisation of education and the ring fencing of council tax. That's before the review of health boards and councils gets under way.

There are a number of measures in the plan that could be truly transformational. The main one is increasing early years provision. Doubling the provision with 200 new centres and 20,000 extra staff is potentially huge. The problem is that £500m doesn't meet the cost, unless the plan is to do it on the cheap, with low paid staff rather than properly qualified early year's professionals.

Which leads me neatly into social care. It was precisely a race to the bottom in pay and conditions that got us into the mess we are in today. There are new resources to address this, but implementation is a bit of a guddle. Creating a fairly paid, properly trained workforce that has the time to care is absolutely crucial to getting patients out of expensive acute hospital beds. This is an opportunity to put some meat on the worthy Labour Market Strategy by creating sectoral collective bargaining structures for the care sector. This would get all the stakeholders working together to deliver the agreed outcomes.

This is crucial to another big element of the plan - shifting NHS resources into community services. This is absolutely the right policy, but very difficult politically. The slightest hint of a hospital closure or even downsizing creates a local storm. The problem for the government is that they came to power on the back of this very type of political protest. Now their financial plans for NHS Scotland look very challenging unless they can free up acute resources.

Finally, there are some other positives in the plan. The police officer numbers target has been dropped and replaced by the ‘right mix and numbers of officers and staff’. It will take some time to repair the damage and get back to a balanced workforce, but it’s a start.

There is also a commitment to improve value and reduce the cost to the public purse of PPP schemes, including ending contracts ‘where possible and appropriate’. The NHS and some local authorities are starting to get into gear on this after UNISON’s ‘Combating Austerity’ report highlighted potential savings.

Equally, the section on inclusive growth and fair work, demonstrates a clear understanding of how unequal societies damage growth. This section includes measures to mitigate the Trade Union Act and support for learning. You wouldn’t see this infographic in a UK government publication!

So, the limited legislative programme reflects the challenges of minority government. However, government doesn’t always need to legislate to achieve its policy goals. There is plenty of positive vision and process in this plan – delivery is as always more challenging.

Brexit priorities should be the economy and public services

Oh to be a fly on the wall at yesterday's UK cabinet away day on post- Brexit planning. Given that most of the ministers around the table were in favour of Brexit - they will no doubt be outlining how they will spend the extra £350m a week they promised!

In practice they will be considering more prosaic options than the Brexit fantasies. As the Guardian reports, some officials at the Foreign Office are pushing for “as much Europe as possible” while others in the Home Office are reluctant to consider full EEA membership or single market access because their priority is an immigration clampdown.

And there lies the kernel of the problem. The most advantageous trade deal requires the UK to sign up to most of the EU rules, including the free movement of labour. The very thing the Brexiteers around the cabinet table used to stir up the Brexit vote.

Then there is Scotland's lone man around the cabinet table - David Mundell. He will report that the natives are restless, having voted decisively to remain in the EU, and considering options that don't even appear in the hastily cobbled together Whitehall scenario planning.

I can offer him some assistance with the UNISON Scotland submission to the Scottish Parliament European Committee inquiry on this subject. In that submission we suggest that Governments should take immediate actions to support the economy and address the concerns of EU citizens living in Scotland. After that, we believe that the Scottish Government should use all its powers to protect public services and human rights, including employment rights. This also means considering all the constitutional options to minimise the impact Brexit could have on Scotland.

You can see from this that our immediate concern is for UNISON members who are EU nationals. The obvious first question for me was how many public service workers in Scotland are EU nationals. I trawled around the usual statistical sources and discovered that no one appears to collect this data. For example, in NHS Scotland there is a voluntary staff survey, which given the number of staff who declined to answer, is unreliable.

Jonathan Portes at NIESR has been doing some research into this and has published some very interesting initial findings this week. He has discovered that HMRC’s estimate that in 2013-14 there were 2,540,000 individuals who “had a tax record” in the UK and were EEA nationals. In contrast, the Labour Force Survey (LFS) in 2013-14 reported the number of EU nationals in employment fluctuated between 1.45 and 1.62 million. The Annual Population Survey reported 2.15 million, although this includes non-economically active persons. While Jonathan suggests some possible reasons for the difference, it still adds up to a significant discrepancy. More importantly it suggests that we may be more reliant on EU nationals than we think.

In our submission, I set out in some detail the reasons why migration is so important to Scotland's economy and public services and therefore why Theresa May’s priorities are wrong for Scotland. Public opinion polls in Scotland and the UK show strong support for letting EU migrants stay. We do not believe that our colleagues from EU countries should be used as some form of bargaining counter in Brexit negotiations.

The Scottish Government should also be calculating the costs to public services and the wider economy of the different post-Brexit immigration options, being considered at Chequers. For example, if the UK government decides that free movement is too great a political price to pay for EEA membership, then there would be significant additional employment costs. The current rules for non-EEA nationals include sponsorship and immigration skills charges. If the supply of labour was restricted there will also be workforce planning issues, particularly in health and care, and associated training costs. Scotland will need around 65,000 extra health and care workers by 2020.

We don't ignore the various constitutional options and set those out in our submission. However, an early priority should be the very human consequences for EU nationals living in Scotland and Scots living in EU states. This matters for them personally, but it also matters for the Scottish economy and the public services they help deliver.