The State of Care in Scotland

Over the next few days our newspapers and magazines will be full of reviews of 2018 and the expression of hopes and resolutions for 2019. It would seem churlish not to add to that volume. So here are some social care hopes and reflections for Scotland. Worker pay and conditions: ‘A fair days wage for a fair day’s work’. The adage is very familiar and describes the desire to pay staff according to the skills they evidence. The nature of social care has changed dramatically over the years. Social care is a major part of the Scottish economy with 1 in 13 Scots employed and delivering multi-skilled and professional care and support. Yet we have consistently failed to adequately reward and remunerate them at an appropriate level. Even an initiative such as introducing the Scottish Living Wage for frontline carers has failed to make the step-change that was desired because put simply it has been only partially funded at National Government level and poorly implemented by local authorities. The ongoing effects of underfunding are being seen right across the country as care home and home care organisations struggle to recruit people for the fundamental job of care. If we are serious about care in 2019 we not only need to establish a Pay Commission to set proper targets for worker terms and conditions but we need to stop deluding ourselves into thinking that paying the minimum is enough and start attempting to pay with respect for a job well done. Workforce retention and recruitment The survey published today by Scottish Care is the last in a long line of research we have produced in 2018 and illustrates that we are way beyond the point of crisis in terms of recruitment and retention in Scotland’s social care sector. It’s all too easy to read figures which state for instance that we have 9 out of 10 organisations who simply can’t find staff, that we have a nursing vacancy rate of 20% equivalent to having no NHS nurses at all in the whole of the Western Isles, Shetland and Orkney put together, that we are losing nearly 2/3rds of care staff within the first six months of their employment. These are the statistics but behind them is a story of staff struggling to cover shifts, working far too many hours to fill in the gaps, and being quite frankly exhausted by their care. Behind them is a story of younger staff deciding enough is enough and walking away with their skills and abilities. Behind them is the truth that unless we start to sort out the crisis of the social care workforce in 2019 then we will begin to see closed signs over care homes up and down the country and more people stuck in hospital because there are no social care staff to care for them in the community. The statistics are easy to read but the stories of people at risk should challenge us all to do something urgently. Brexit and migration It is impossible to reflect on the year that has passed or the year to come without mentioning Brexit. The social care sector in Scotland is significantly dependent upon and grateful for the skilled and dedicated staff – some 12% in care homes – who have come to care for Scotland over the last few years. Brexit is not going to happen in March because it is already happening up and down Scotland today as individuals and families are making hard decisions on whether or not to stay and contribute or to leave. Employers are already reporting to us the loss of dozens of staff in the last few weeks who feel that their future lies elsewhere. The depth of uncertainty, the lack of political will and what sometimes appears to us as a failure to appreciate that decisions being made or not being made are for many a matter of life and death is having a profound impact on the social care sector in Scotland. We urgently need a sense of certainty. What we are getting however is a set of proposals around immigration that shamefully describe social care staff as low-skilled and set levels of pay expectation that will make it impossible for us to plug the gaps in our already critical workforce shortage. How dare politicians and policy makers describe the intensive skills of palliative care, neurological support, behaviour management and compassionate care which is being delivered in our care homes and home care organisations as being ‘low-skilled’.  2018 has already seen a massive drop in recruitment from Europe. 2019 has to see the development of a model of immigration that really takes people seriously rather than playing to the crowd. Scottish Budget The Finance Secretary is busily trying to build a political consensus around his initial budget proposals. Our colleagues in Cosla and elsewhere have expressed alarm about the extent to which the current offer will fail to meet the needs of local government. This is the primary route for funding social care in Scotland. Scottish Care has called and continues to call for an investment in social care  in 2019 of £200million. It is not our role to say where that resource has to come from or how we pay for it. It is absolutely our task to flag up the insufficiency of funding which is frankly putting lives at risk. Yes we need to reform how we are doing things and we are working robustly with others to achieve this. Yes we need to ensure that individuals are able to better self-manage and remain independent for as long as possible. Yes we need to ensure that we have services which are adequately resourced from cradle to grave … but. We cannot continue to collude in a system which purchases care on the cheap and sets levels of eligibility so high that you have to be in some instances at death’s door before you get social care support. We cannot continue to collude with a system that purchases care by the minute and considers that care is about tasks rather than being with people .Let’s stop expecting social care to pick up the fiscal crumbs leftover on the plate – let us together change the size of the cake!   Commission for Social Care Scottish Care has called for the creation of a Commission on the Funding of Social Care in Scotland.  England and Wales are shortly to be presented with a White Paper on how they will fund social care., There are lots of ideas floating around – in Scotland we have not even started to have these debates. There is a real urgency faced with the increasing demands on social care, faced with workforce challenges, and the reality of financial uncertai8nty for us all to plan for our personal future. We are expected to do that at a personal level so it is incumbent upon those who call themselves our political leadership to work together in order to arrive at proposals for how we are going to as a society pay for our care in the years to come. Care is too important to be used as a political football. We need to get around the table and start talking.   Integration In the last few weeks of the year we have seen published a report on the Integration of Health and Social Care from Audit Scotland. It made uncomfortable reading and has highlighted clear points for improvement. What we need to do in 2019 is to build on what is working and to once and for all make it clear that integrating health and social care is first and foremost about making life better for our fellow citizens. Integration is not about health and social care professionals learning to work together and talk to each other, though it is in part, it is trying to create a system where the individual citizen has greater control and choice, and the ability to direct their care and support. That is an aspiration which we should surely all work towards achieving.   A future that cares The mark of any society which might want to describe itself as civilized, rights-based and mature is the degree to which it cares for those who are in greatest need and most vulnerable. There is such an amount of excellent care and support being delivered every minute of every day across Scotland. We are fortunate to have tens of thousands of staff who offer amazing care and astonishing love. There is so much to herald as positive and inspiring. But there are still challenges of resourcing, of workforce and of structure. Scotland has a proud heritage of putting people at the centre, of listening to those who have no voice, of creating space for those who feel threatened so they can feel secure, of giving welcome to those who are strangers. We have the capacity to direct our future into one that cares. But this future will not just happen rather it has to be moulded and built, nurtured and nourished, resourced and struggled for. As we finish a year and stand at the door of another we have the prospect of creating a nation that truly cares or one that walks by. Dr Donald Macaskill @DrDMacaskill