This week I gave evidence at the Health and Sport Committee on the proposed Health and Care Staffing Bill, specifically in relation to Part 3 of the Bill relating to social care. Last week, colleagues from the NHS presented their perspective. Whilst the intention of the Bill may be well-founded, the unintended consequences of introducing it could have significant limiting effects for the sector. Social Care in Scotland has come a long way to begin to create the conditions required for improvement and innovation; you can see this in our policy such as the Health and Social Care Standards introduced earlier this year, our legislation such as the Self Directed Support (Scotland) Act, and in our practice such as the new methods of inspection implemented by the Care Inspectorate. I am proud to represent an ever-evolving sector which retains at its heart an asset-based individualised approach to providing care that is grounded in Human Rights. As human beings, and as a society, our wants, needs and wishes change, and this means that to be able to meet the needs of our older citizens, and others who access care and support, we must be flexible to those demands. On top of this, the market itself is ever-changing as we are living longer and in times of austerity, we need to be able to think differently about how care and support is delivered. The biggest concern that I have is that the purpose of legislation is to freeze its components and the proposal to enshrine the use of a tool in statute puts at risk several things:

• It does not allow for professional flexibility, or for a multi-disciplinary approach, or the development of the new models of care and workforce development that the sector so desperately needs to be sustainable.
• It does not consider significant parties to the process such as commissioners who would need to respond to the potential increased demand in resource, or, social workers, who would need to be available to assess those who access care and support in order to provide the data for the staffing tool.
• There is a real risk of the legislation directing resource, meaning that limited funding may be directed towards meeting staffing requirements, or towards meeting the potential additional administrative burden upon a sector who already have to report both to the Care Inspectorate and to their commissioners.
• Most significantly however is the potentially devastating impact upon the recruitment and retention crisis that the sector currently faces. The SSSC workforce data report published last month shows a Stability index of 77.1% that means almost a quarter of staff are changing roles or leaving. Our own data shows that more people leave than enter the sector within their first 6 months of employment, and that the nursing vacancy rate is currently at 32%. This cannot continue, as evidenced by last weeks headline news that 19 care homes closed because they cannot recruit nurses. We must too bear in mind that last year some of our providers were paying £1200 per night for an agency nurse, and that whilst the number of nursing agencies has increased by 18% in the last year, there is no greater pool to draw from. Creating legislation does not in itself create nurses.

The whole issue that the Bill has been created to address needs a solution that is co-produced from across the health and social care landscape, offering opportunity and flexibility to free up systems and allow the optimisation of the workforce through a multi-disciplinary approach, with career pathways which value our staff and enable them to progress, and to allow for the use of technology and other solutions which the National Workforce Planning Group may already be exploring or which may not even exist yet. A care home is not a clinical setting, it its by its very definition, a home. People who live there are surrounded by their own possessions and sometimes their furniture and décor. And as is also the case for our care at home workforce, they build relationships with those who both live and work there. We need to enable our skilled workforce across the sector to exercise their expertise and professional judgement and allow them time to just ‘Be’ with the people they support. Fundamentally, the Bill in its current format puts that at risk. Our evidence is in, next week the regulatory bodies will be presenting, and thereafter the committee will make their decision on how to proceed. Every single vote will count. #careaboutcare You can watch live or pre-recorded on SPTV  and you can see our submission here Karen Hedge National Director, Scottish Care

#Every3seconds – the Third Dementia Strategy One Year On

September 2018 marks the seventh World Alzheimer’s Month, an international campaign to raise awareness of dementia and to challenge stigma. This year’s campaign promotes the important message that every 3 seconds someone in the world develops dementia. That is a startling and arresting figure highlighting the extent of dementia as a worldwide health challenge. It has also forced me to reflect on what has happened since the launch of the Scottish Government’s Third Dementia Strategy which was published just over a year ago on the 27th June 2017. The Strategy states boldly in it’s Executive Summary that: ‘Our shared vision is of a Scotland where people with dementia and those who care for them have access to timely, skilled and well-coordinated support from diagnosis to end of life which helps achieve the outcomes that matter to them.’ It has numerous action points and recommendations. A blog isn’t the place to reflect on each of these in depth but I do wonder how much closer are we to achieving the vision of the Strategy? So … here are three brief thoughts… Workforce: a core part of the Strategy is the recognition that equipping and skilling up the workforce is essential for the delivery of effective dementia support and care. In some parts of the system – and I’ll be frank – in the NHS we are getting there with a good degree of resource improving excellence and championing the cause. But I lament the inadequacy of resource being allocated to the social care workforce which delivers the vast majority of support to folks living with dementia in Scotland. We’ve got the courses and the programmes, the talent and the willingness – what we lack is the capacity of organisations to free up their staff to do the training and develop their practice. In particular care at home organisations are struggling in the face of rising costs and reductions in fees to be able to survive never mind equip their staff to achieve dementia excellence. I hear from so many sources that because of their own financial pressures that local authorities are cutting training and learning budgets to the bone. Put simply we can never achieve a skilled dementia-confident workforce in social care unless we pay for it. Palliative care and end of life. Most palliative care and end of life support is delivered by social care staff. It is they who are present to reassure and offer comfort, to chasten fear and grant solace as people struggle with dementia and with what that means. Yet we support them so poorly. Countless workers are leaving their jobs because of the emotional fatigue which is the real cost of delivering human centred palliative care and yet something simple like attempts to create bereavement support for this group of staff are continually frustrated. Add to that the existence of effectively electronically tagging our workers and the obscenity of 15 minute visits which treat people with dementia with such indignity and it’s little wonder we have an increasingly burnt out workforce. Thirdly, the Strategy recognises the invaluable and fundamental role of informal carers in providing dementia care in Scotland. We now have a Carers Act. The aspiration of that Act is to support family carers and to enable them to continue to support their relative who might be living with dementia. Even though it’s still early days the comments I am hearing suggest to me that this is yet another good Government policy and legislative intervention which is well intentioned but poorly implemented because of inadequate funding. Care providers and their staff daily work alongside informal carers and I know that in exactly the same way that paid staff are emotionally drained then so too are countless hundreds of our army of thousands of family carers. This has been compounded by the dramatic loss over the last year or so of local day services and opportunities to offer respite and rest to families. So the vision and aspiration of the Third Strategy seem a distance away from the reality of many lives being lived with dementia across Scotland. The Strategy also states: ‘At the heart of this strategy is a recognition of the need to ensure a person-centred and flexible approach to providing support at all stages of the care journey.’ The 21 commitments might be being partially achieved but I find it hard to be persuasive of that to the person who spoke to me recently and who told me the story that because her local authority had needed to save some money on its budget that it had changed the supplier of continence pads – she has had to use the savings she had put away for a holiday to buy extra supplies which work for her husband with late stage dementia. I can’t really face her and say we are now one year into our Third Dementia Strategy and are doing as well as we could or should. Dr Donald Macaskill @DrDMacaskill