Insights on Ethical Commissioning – Lynn Laughland MBE, Chief Executive Officer, HRM Homecare
As Scottish Care’s advocacy for the thorough implementation of ethical commissioning and procurement progresses at pace towards upcoming Scottish Government Statutory Guidance, the necessity of such work for the homecare and housing support sector is further evidenced by the latest Homecare Deficit 2025 report.
The Homecare Association’s 2025 analysis calculates that the Minimum Price for Homecare needed to deliver safe, legal and sustainable care is £32.88 per hour. Yet many councils continue to commission at rates well below the real cost of delivery, with funding in recent years failing to keep pace with inflation, workforce pressures or legal employment standards.
Over the last four years, commissioning levels have covered only 87.6% of provider costs on average, leaving providers forced to absorb the remaining deficit or reduce service capacity. This chronic underfunding has been accompanied by widening pay inequality between public-sector-delivered homecare and the independent and voluntary sectors, who provide the majority of Scotland’s care hours. The result is a destabilised market, weakened workforce, and compromised continuity of care for the people of Scotland.
Lynn Laughland MBE, Chief Executive Officer of HRM Homecare and member of the Scottish Care Executive, speaks further on the importance of continuity of care.
Continuity of Care: Why the People Behind the Service Matter
I’ll never forget a conversation I had with an older neighbour a while back. She told me how much she looked forward to seeing her support worker each morning—not just for help with breakfast and medication, but for the chats, the laughter, and the reassurance that someone truly knew her. “She’s like family now,” she said with a smile.
Then, after a spell in hospital, everything changed. When she returned home, she discovered her care package had been reassigned. The familiar face she had come to trust was gone, replaced by a new team of staff. “They’re kind,” she admitted, “but they don’t know me.” There was a sadness in her voice, the sense of having lost more than just a routine—it was the loss of a relationship.
I share this story not to criticise but to reflect. In Falkirk, and in many other areas, councils allocate home care based on availability and cost. I understand the pressures behind this system: resources are tight, demand is high, and fairness matters. But I also see the human side—the person who, just when they are most vulnerable after hospital, has to start over with strangers instead of returning to the carers who know them best.
Continuity of care is about more than convenience. It’s about safety, dignity, and confidence. A support worker who knows someone well can spot when they’re not quite themselves, notice the small changes that signal something bigger, and provide comfort at a time when everything else feels uncertain.
I believe councils do their best within difficult circumstances. But perhaps we can start asking whether continuity could be given greater weight in the way care is allocated. Could there be more flexibility, more room to reconnect people with their previous carers when they come home? Even if it can’t always happen, trying where possible could make a world of difference.
Care is not simply a service to be delivered—it is a relationship to be nurtured. Protecting those relationships means protecting people’s sense of stability, identity, and wellbeing. And in the end, isn’t that what care is really about?
For further insights from Lynn on a range of matters involving ethical commissioning, please see the following columns:
