As the UK Chancellor prepares to deliver the Budget next Wednesday, Scotland stands at a crossroads. For too long, social care has been treated as an afterthought or as the underling of the NHS, yet it underpins everything we value: dignity in later life, support for unpaid carers, and the ability for people to live independently and participate fully in society.
This is not a marginal issue. It is the infrastructure of compassion that sustains our communities. And right now, that infrastructure is collapsing.
Scotland’s social care system is at breaking point. Workforce shortages, rising costs, and chronic underfunding have created a perfect storm.
In rural areas like the Highlands, geography compounds the crisis: delayed discharges cost millions, care homes close, and families face heartbreak as loved ones are sent hundreds of miles away because there is simply nowhere local to go. This is not dignity rather it is systemic failure.
Audit Scotland has warned repeatedly that urgent action is needed to change how services are delivered. Yet despite record allocations on paper, the reality is stark: councils and health and social care partnerships are in year debt to the region of around £500 million. Providers are closing. Skilled workers are leaving because they cannot afford to stay in a profession they love.
When I think of the two main sectors that my membership comprises both are on their knees in the majority of locations.
Homecare is the backbone of independence, but it is collapsing under financial strain. The latest Minimum Price for Homecare in Scotland, as calculated by the Homecare Association for the financial year 2025–2026, is £32.88 per hour. No Scottish council meets the minimum price. Notice it’s a minimum price not a fair price!
To add insult to injury providers report late payments averaging £300,000 per organisation, threatening viability and continuity of care. And the obscenest occurrence is the explosion in 15-minute visits when we were supposed to be seeing the end of this practice which is an absolute assault on dignity.
Every hour of care at home is an investment in human flourishing. It prevents hospital admissions, reduces loneliness, and sustains wellbeing. Yet this lifeline is fraying if not already broken.
The independent care home sector provides 86% of all registered places in Scotland yet has seen a 34% decrease in residents since 2014. Over the past decade, 476 care homes have closed or changed hands, sometimes forcing families to travel 100 miles or more to visit loved ones. This is not just inconvenient, it is cruel. Any fair analysis shows the £1,027 per resident per week for intensive 24/7 nursing residential care is a good £500-£1000 short of the true price of dignified care and even that ties return or profit to 4%, way below what most economists argue is needed to keep a business, be it charitable, not for profit or private going.
Empty beds today mean closures tomorrow, and every closure strips communities of choice and dignity.
Delayed discharge is the most visible symptom of a whole system paralysis. More than five million bed days have been lost since 2015 at a cost of £1.5 billion. Hospitals are gridlocked because social care is starved of funds.
But the invisible cost is what really matters. It’s the thousands who are waiting up to 18 weeks to be assessed for the care they need; it’s the hundreds who die without the dignified end of life care they deserve; it’s the burnt out and exhausted thousands of family and friend carers who are at their wits end with fatigue and emptiness.
And just in case you think I’m engaging in hyperbole and exaggeration – the avoidance critique of those made uncomfortable by the raw truth of political failure, others are in agreement.
COSLA, the representative body of local government in Scotland, has issued a clear warning: without fair and sustainable funding, we risk the viability of services that people rely on every single day. Their manifesto calls for an additional £750 million investment in social care and an end to 15-minute visits in homecare.
More immediately they have also called for the urgent reconvening of the Financial Viability Response Group of which providers through Scottish Care and CCPS sat on at the start of the year and which in April offered a truthful report with recommendations to the Cabinet Secretary.
Councillor Paul Kelly put it bluntly:
“Local Government cannot do this alone. Demand is increasing, costs are rising, and the workforce is under immense strain.”
Yet we have been faced with silence from the Scottish Government other than a statement to address winter pressures by giving £20 million to NHS Boards to address ‘social care’ needs. An allocation not to local authorities or HSCPs but to the sacrosanct NHS.
Scottish Care has consistently argued for a budget that values social care not one that kills reassurance and forces closures. As I said recently, people are dying because they cannot get the social care they need. This is not hyperbole; it is happening now. Services are closing, staff are being made redundant, and communities are losing lifelines.
The UK Government must also shoulder responsibility. Immigration policy changes such as scrapping social care visas, raising salary thresholds, and increasing sponsorship costs are reckless and inhumane. In rural Scotland, internationally recruited workers make up more than 25% of the workforce. Removing this lifeline will devastate communities and put lives at risk.
Both governments must act decisively. The UK Government needs to reverse damaging immigration changes, exempt social care from National Insurance hikes, and deliver Barnett consequentials that prioritise care. The Scottish Government needs to commit to COSLA’s £750m ask, deliver multi-year funding agreements, and accelerate reform that values workforce and community-led care models.
This is not about party politics – it is about people. Every delay deepens the crisis. Every cut costs lives.
Social care is not a drain on resources; it is an investment in humanity. It is the infrastructure of compassion that sustains our communities. As we await the Budget, let us demand a budget that cares; a budget that restores dignity, strengthens the workforce, and ensures that no one in Scotland is left without the support they need.
I appeal to our political leaders to stop the rhetoric and start the rescue.
To the public I say, raise your voice for those who cannot.
Social care is the foundation of a fair Scotland. If we fail to act now, we will not just lose services but inevitably we will lose lives, communities, and trust in the very idea of care. “Social care is not a cost – it is the currency of compassion.”
We cannot afford another winter of reactive measures. We cannot afford to lose more care homes, more workers, more trust. The UK Budget must deliver for social care. The Scottish Government must match ambition with action.
This is not just about funding. It is about the kind of country we want to be. One that values its elders, supports its carers, and builds communities of care rooted in dignity, belonging, and hope.
This Saturday, before the Budget, let us make one message clear: Scotland demands a budget that cares. Nothing less will do.
Donald Macaskill
