When a plan prepares for failure: the crisis of social care.
We are all of us used to the art of planning. Whilst there are occasions and moments in our lives which happen ‘out of the blue’ and by ‘happenstance’ most of the major events of our life involve a degree of planning. Be it the birth of a child, getting married or moving into a new house, planning is part and parcel of an event’s positive outcome and success.
It wasn’t for nothing then that planning was considered to be intrinsic to the art of successful political leadership. Benjamin Franklin (one of the greatest US Presidents) once wrote: “By failing to plan, you are preparing to fail” and another great strategist Winston Churchill stated: “He who fails to plan is planning to fail”.
An examination of both their writings shows the extent to which careful, meticulous, and methodical planning was intrinsic to the successes of their leadership whether militarily or on the political and domestic front.
The importance of planning has been to the fore of my mind this past week, and it has indeed been a busy one in terms both of politics and the world of social care but we are probably in these last days of October and given its 24 hours before the clocks go forward, at a key stage in both the meteorological season and in terms of the state of our social care system in Scotland.
We are also at that time of the political and parliamentary season when the gears go up a level or at least change. The party conference season is all but over (though the Scottish Greens meet today) and the curtains are being drawn on the political conference theatricalities with their usual mixture of aspirational optimism and depressive pessimism dependent on which party you belong to, which polls you are reading or which pundit you speak to. And of course, the party conference always grants the opportunity for those in government to pull rabbits out of unexpected hats in order to leave loyal followers feeling a bit more positive as they walk, drive or train into the approaching winter. In Scotland that has seen the bizarre and for me misplaced decision to freeze the Council Tax at a time when thousands are going without social care because of a lack of funding.
In the last week Parliament started to stir itself from its post-conference slumber.
For those of us in the world of health and social care, the annual joy which is the publication of the Scottish Government’s Winter Preparedness Plan took place on Tuesday last. Presented by the Cabinet Secretary for NHS Recovery (we now know why ‘social care recovery’ was not in the portfolio title) this work of seasonal solicitude comes this year with an empty budget and no additional resource – that is if you come from the social care world. But like all Halloween seasonal offerings it had its own mixture of fantasy and reality – the fantasy was that it pretended to be for the whole health and social care system, the reality was some extremely worrying failures to really understand the social care world and the very real crisis it is enduring.
But it has not been the only event this week because we also had the publication of the Real Living Wage and the announcement that from next April it would now £12 an hour. This recognition that those who are the lowest paid deserve a significant wage increase is to be welcomed but it poses a problem for the current Scottish Government.
Regular readers of this blog will know that for months – along with others- I have called for our First Minister and the Cabinet Secretary to come true on the promise to pay social care staff £12 an hour. A promise made in April 2023, only to be underlined 20 weeks later when it was announced that workers would have to wait till April 2024 to get that salary increase. And lo – instead of the intervention bringing real positive change, enabling organisations to retain and attract new staff through the summer, autumn, and winter – we are now faced with the reality that come next April there will be no additional benefit, no additional attraction for those thinking of staying or joining a social care organisation. A significant political misstep and own goal and before anyone opines that there was no resource available – let’s just say I am sick to the proverbial of the way in which this administration magics up money from invisible corners when others strike, protest or complain. There is resource – it is all about priorities and what is deemed to be of greater value and what is considered as of lower significance – and the social care world isn’t blind to that political and fiscal truth.
As the seasons change, we are going to be moving into a winter period which will bring about real challenge. We’ve already seen thousands spent by the Government on a campaign to remind people to make sure that they only try to access support from the right source at the right time when they really need it. Nothing wrong ordinarily with such messages but when a system is so fragile and collapsing, they have a ring of preparatory avoidance about them.
Then we have the actual winter plan. It is not a plan worthy of the name because to my mind at least (and dare I say for most people involved in contingency, emergency, and resilience planning) you prepare for an impending challenge by making sure (amongst other things) that you have all the data, all the information, all the facts available to you. This plan is devoid of reality because singularly in its development and political articulation it has failed to fully and realistically involve those who are going to be responsible for delivering the majority of social care provision. Now I have no problem in the public sector saying this is our NHS and public sector winter planning – but I do have an issue with the pretence that this is a plan which is for the whole system and that it has included all. At the risk of repetition nearly 70% of social care provision in Scotland is delivered by the third and independent sectors. A plan which does not include them, speak to their reality, address the challenges of their workforce is not a plan worthy of its name – it is a delusion, deceit and exercise in political spin-doctory.
The third and independent sectors do not have all the answers to the crisis of workforce, lack of integrated working, misplacement of resource, lack of preventative and community-based care and support – but asking us might just have helped. It is not too late – so Scottish Government could start to pay social care staff £13 an hour from now (working up to a Fair Wage); we could invest in community based homecare to ensure people really are able to remain independent at home for longer; remove competition from care and increase collaborative practice; pay the registration fees for all those wanting to enter the social care system (regardless of employer); remove requirements for qualification if you are in the last years of career and so on and so on. We are not short of ideas just a system and political leadership wanting or willing to listen.
I really hope the winter will be one which we get through without long waits at A and E, increasing delayed discharges, a rise in the number of people unable to access urgent social care, and a continued drain of workers from social care organisations. I really do hope the early signs I am seeing of delayed care packages; people being told they do not meet ‘emergency criteria’ and perversely care workers being laid off because of a lack of ‘work’! are not harbingers of what is to come. But the failure to include, involve, listen to, and learn from the social care sector does not give me much confidence.
Apparently another political leader, Dwight Eisenhower, this time said ‘”a bad plan is better than no plan”. That may be true philosophically but the quality, naivety and lack of whole system thinking of the Scottish Government and COSLA’s Winter Preparedness Plan 2023-2024 is leaving most of us in social care extremely anxious about the weeks and months ahead.