The following is based on a speech given at the Scottish Care Homecare Conference on the 16th May.
Well since I picked the title of this brief talk, I’ve been told that I shouldn’t be using the word ‘crisis’ because the constant talk about social care being in a state of ‘crisis’ is a real off putter for the general public – they don’t like it – even if it might be true.
So, I could just drop the word like any good follower of research on public opinion or just go for it.
I’ll do the latter if you don’t mind and I’ll explain why.
The first reason is that anyone – never mind someone like me standing here in front of several hundred experts in homecare and housing support – who didn’t own up to the painful raw reality of a sector facing innumerable challenges would be rightly accused of naive escapism if not delusion.
The second reason for calling our current state a moment of ‘crisis’ is that I also want to suggest that because of not despite the challenges- that this moment has the potential to be like a turning point.
Dragging memory into the now I’m reminded from my old school lessons of the fact that the word crisis comes from the Greek krisis, meaning decision, turning point, or judgement.
A crisis is not the end.
A crisis is a crossroads.
It is where choices are made, values are revealed, and futures are forged.
And in that spirit, I want to speak not only of the pressures that homecare faces – but of the possibility that lives within it.
Because homecare and housing support – for all its complexity, its fatigue, and yes, its fragility, remains one of the greatest expressions of love and solidarity we have as a society and its potential as a moulder of the moment, as a shaper of society and as an economic driver for Scotland is – I believe – huge!!
But to begin with let us speak plainly:
Yes – we are operating in a climate where public finances are constrained if not drained and exhausted. Scottish Care published research earlier in the year which has shown the savage cuts which are resulting in a sharp drop of packages of care and support being purchased – a loss of essential services or at least the reduction of critical services for thousands of those who urgently require care and support – we know the fractious failures resulting in work being reduced – we know and it’s now well publicised the huge level of debt being carried by HSCPs – around £500 million – which is simply meaning that services are not being bought
Yes – there is continued uncertainty around reform, regulation, and the shape of the future National Care Service if we are even allowed to use that word – and with others Scottish Care has recently been involved in publishing a report which gives some indication of what we consider to be essential steps ahead – at the heart of which has to be an assurance that not just invited guests but all stakeholders will be around the table to make decisions and enable reform to happen ..
Yes – recruitment and retention remain critical challenges. The increase in NI together with the absurdity of thoughtless and callous recent announcements by UK Government to the care worker visa seem both designed to make it harder for businesses to be sustainable and for us to attract a workforce skilled and capable in doing the job.
Yes – too many workers are underpaid, undervalued, and overburdened – it is not enough to say the NLW is the level of our aspiration any more – fair work – employee demands – all show that we need and can do better – with terms and conditions that speak to a skilled, qualified, and professional group of women and men – that address decades of low esteem, low value and low pay – and terms and conditions that are urgently needing to change.
But despite these truths, something remarkable persists.
Care continues.
In homes across Scotland – behind tenement doors, in croft houses and city flats – human connection is happening. Dignity is being protected. Meals are prepared. Medications administered. Hands are held. Laughter echoes down hallways, and tears are shared in silence.
Despite the growing obscenity of 5 or 15-minute visits – a truth remains – care is being delivered and quality care almost against the odds and certainly not because of the system and unethical contracts and commissioning practices.
The fact of faithfulness – the truth of the dignified routine of relationships protected and compassion delivered is a light we need to hold on to.
This is not failure. This is resilience. This is the hope of homecare to transform not just individuals but communities, not just lives but society.
When we talk about homecare, we are not just describing a service – we are not talking about a set of functions, or tasks or actions – we are describing a philosophy of life.
One that says:
- People should be supported in the places they love,
- That independence is not the absence of support, but the presence of the right kind,
- That relationship matters as much as task,
- And that a home is more than bricks and mortar – it is where identity, memory, and selfhood live.
So, in this so-called crisis, what new beginnings might we choose?
Let me offer some:
- Revaluing the workforce as the heart of homecare
Not as deliverers of minutes, but as enablers of life. Let us raise their pay, yes – but also raise their status. Let us offer them careers, not contracts. Let us listen to their wisdom and build reform around their insight.
- Refusing the false economy of underinvestment
A stitch in time doesn’t just save nine – in homecare, it saves hospital admissions, mental health deterioration, loneliness, and loss of independence. Every hour of care at home is an investment in human flourishing. It literally saves and shapes lives with purpose and meaning. This is what prevention is all about – and aren’t we supposed to be focussing on that?
- Create an economy which values care.
I want to quote the Prime Minister – no not that one – but Mark Carney who in his quite excellent book ‘Value(s)’ argues that shared values – such as solidarity, fairness, responsibility – should underpin economic systems AND that we need to see a clear distinction between ‘market value’ and ‘human value’ and must not assume the former should be dominant.
He has written:
“The pandemic has reminded us of the true value of essential services and those who provide them.”
But as he also highlighted a crisis like the pandemic exposes who bears risk and who benefits from value.
Those of us in the world of social care have long argued that our economic foundations are misguided – that as the fourth economic contributor to the Scottish economy – why is social care not even mentioned in our economic strategies? Why do we not see the care and support of others as an economic contributor and driver in our society, rather than continually to use the language and character of cost, drain and deficit.
There is a real danger in straitened economic times that we lose sight of this contribution and engage in a perverse drive for market results. Homecare services should be rooted in wellbeing, autonomy, and human rights, not just contracts or outputs. Carney’s push for “mission-oriented capitalism” backs models of care delivery that prioritise social value and ethical leadership.
“Purpose is not a slogan; it must be embedded in governance, strategy, and culture.”
If this is a crisis then it is also an opportunity to re-shape, renew and re-orientate – to utilise the innovation, the insight and imagination which is so abundant in the independent care sector to point to a new way of being community.
This is our hope. It is the seed of revolution and change.
It does not march through streets or always make headlines, but it changes lives every single day. It lets people remain rooted in their stories, surrounded by their familiar things, free to live – and not just survive.
So let us see in this crisis – a chance to decide again who we are, what we value, and what kind of Scotland we wish to build.