Blog: Disrupting stigma means disrupting commissioning and procurement

Every single day I hear people discussing the sustainability of the care sector.

I hear it from providers, I hear it from commissioners, I hear it in the news, I hear it from our Politicians. But the quietest of all in this are those who are most affected. I almost never ever hear it from those who access care and support or indeed their loved ones who are also impacted by social care experience.

This voice is missing for many reasons, but mostly because it comprises of our most vulnerable. Those who may need support to articulate their desires clearly, or perhaps those who do not wish to rock the boat because they may have fought for what they receive, or even those who come to social care at a point of crisis. At best, it may find itself contained within a report presented to an Integrated Joint Board or kept in a silo perhaps because it is considered to pertain only to carers and not the holistic setting that a family is.

There is a stigma in accessing care and support. Those media headline grabbers and others on that bandwagon should put themselves in the shoes of those who may be in the demographic of the ‘ticking time bomb’ they write about. My own loved one describes a pervasive guilt about accessing something in case it prevents another, “perhaps younger person”, from accessing it. The guilt is so deep that I cannot even name them here.

And so we find ourselves (for a variety of reasons) in a place where people are coming to care much later than previously, which means they have more complex needs, are requiring a more intrusive intervention and face potentially life-limiting circumstances as they often first enter ‘the system’ because of an unplanned hospital admission.

This position then creates a ‘double whammy’, in both the here and now, and in the future, as without accurate data, we cannot accurately plan. For instance, how do we know how many care staff or nurses we might need, or need to train, if we do not have a true picture of those who may actually need care and support? And perhaps more importantly, how do we adapt for the future? For instance, by utilising and embedding preventative disruptors such as technology developed and applied with human rights in mind (guided perhaps by Scottish Care’s Human Rights Charter and Guidance for Technology).

Amidst this there remain Health and Social Care Partnerships who continue to dis-invest from social care in order to meet targets, without realising the wider impact upstream. Or worse still, to test out that impact in order to prove a point. And in doing so, completely missing the point. Health and Social care is about people’s lives and lifestyles, not about which funding body holds the pot of money.

The chronic and long-term under-funding of the care sector is undermining the human rights of the citizens of Scotland. It has created the conditions for marketplace competition – a drive for the lowest price rather than the high-quality care and support that the people of Scotland deserve, but which care providers continue to strive for. You don’t come into care if you don’t care.

An Ipsos Mori/Centre for Ageing Better survey conducted earlier this year explored user views on the worst things about getting old: 30% are concerned they won’t have enough money to live on, 26% losing mobility, 24% losing memory; 22% unable to do things they once could, 19% being lonely[1]

Quite frankly, we can do better. If people knew about the opportunities which lie in social care, this could be vastly reduced.

However, I write this blog in the week that the process for application to the National Procurement Framework for Care and Support is due to close. Scottish Care is eager to play our part in ensuring that the current model of commissioning and procurement is changed to ensure that it better reflects a rights-based, trust focused and relational approach to the care and support of older people. I personally have a history in disrupting commissioning practices from when I worked for a Local Authority in England (incidentally, joint funded by the NHS) leading to a model devised by working with families and providers, and resulting in 110% more people having access to care and support than previously at no additional cost.

Collaboration and co-production is where we work together to make the most out of what we have, and the bringing together of minds around a common vision and focus leads to realistic innovation, choice and control. Not incidentally a characteristic required of the market by the Self-Directed Support (Scotland) Act.

Scottish Care saw the initial development of the National Procurement Framework as offering the potential of reducing complexity, fostering relationships and addressing some of the sustainability issues. Yet the process has resulted in a Framework which is far from proportionate, requiring only the accountability of providers, it leads merely to a duplication of regulation and negotiation. An action in opposition of the trust-based relationships being nurtured and in effective community-based planning, and which led to the inherently more cost effective and equitable service provision which I describe above in my previous work.

There are of course other challenges with the framework, but that unwillingness to engage and work with the whole sector as equals is what mostly holds us back. In one recent review of a Health and Social Care partnership, their only comment on the contribution of the independent sector, was to list the number of care home beds and home care hours that they provide. This undermining of resource and opportunity and resistance is clearly articulated in the Audit Scotland report into integration which describes the challenges of culture change and the role of leadership in achieving and embedding best practice. After all, it is best practice which offers opportunity.

Whilst a solution is complicated, it is not unachievable.

In May I launched a paper on ‘Putting Human Rights into the Commissioning Cycle’ at the Scottish Care National Conference for Care at Home and Housing support in an attempt to put the person into planning. All too often Strategic Planning happens behind closed doors and based purely upon a set of statistics, or upon the results of community engagement which is tokenistic or piecemeal and therefore not representative. A shared vision grounded in human rights can support a whole community, including the significant contribution of independent care providers, to come together for good.

Above all however, that shared vision must be a positive one. A vision which recognises the value of our older people and the contribution that they and their families make, a vision which recognises the wider value of social in employing 1 in 10 Scots, and in contributing £3.4 billion to the economy, a vision which values the varied mix of care and support which offers real choice and control to those who may wish to access it.

At the recent Business in Parliament Conference, the First Minister said that “ … any country will only achieve it’s potential if it enables the people within it to achieve their own potential”.

Well, that time has come, who’s with me?

Karen Hedge

National Director, Scottish Care


[1] IpsosMori/Centre for Ageing Better/Feb 2019

Last Updated on 14th November 2019 by Scottish Care