Scottish Care Calls for Urgent Action Following IJB Finance Report

Scottish Care Calls for Urgent Action on Social Care Funding Following IJB Finance Report

Scotland’s Integration Joint Boards (IJBs) are facing significant financial strain, with a new Audit Scotland report highlighting rising service costs, budget deficits, and a 40% drop in reserves. Nine IJBs now have no contingency funds, raising concerns over long-term sustainability. While most planned savings were achieved in 2023/24, many were one-off measures, meaning further budget adjustments will be needed.

Looking ahead, IJBs face a £457 million funding gap for 2024/25, underscoring the urgent need for realistic financial planning and collaboration. High turnover in leadership roles adds further uncertainty, while the report stresses the importance of transforming services through prevention and early intervention to manage growing demand.

Today’s report on the financial state of Scotland’s Integration Joint Boards (IJBs) makes for disturbing reading. It articulates a position of financial constraint and growing pressures which will be familiar to those who provide social care as well as those who access this support.

Scottish Care has long advocated for a fairer redistribution of health and social care funding, ensuring that the priorities of prevention and early intervention are actually achieved.

We welcome Audit Scotland’s clear assessment and support its call for a whole-system approach to prioritising preventative care and support.

Dr Donald Macaskill, Chief Executive of Scottish Care, said:

“In a situation of limited financial resources, we must allocate funding wisely to truly strengthen social care, primary care, and general practice. We simply cannot continue pouring yet more money into acute and secondary NHS care while at the same time bleeding and stripping out the care and support from social care organisations.

We need to stop people getting into hospital and then being delayed from getting back home – the way we do that is to invest in social care.

Whole-system reform, which includes all parts of the health and social care sector, is now time critical.”

You can read the report here: Integration Joint Boards’ Finance Bulletin 2023/24 | Audit Scotland

 

 

Hearing the unheard: supporting older people with hearing loss in Scotland’s care sector.

World Hearing Day is held on 3 March each year to raise awareness on how to prevent deafness and hearing loss and promote ear and hearing care across the world.

This year’s theme, “Changing mindsets: empower yourself to make ear and hearing care a reality for all!” emphasises how by encouraging individuals to recognise the importance of ear and hearing health, people can be inspired to change behaviour to protect their hearing from loud sounds and prevent hearing loss, check their hearing regularly, use hearing devices if needed, and support those living with hearing loss. Empowered individuals can drive change within themselves and in society at large. Part of the outputs this year is a new WHO global standard for safe listening in video game play and sports.

Anyone working in the care home or home care sector in Scotland will know just how significant the issues of hearing loss are for so many individuals who receive care and support. Indeed, according to Scottish Government data, around 850,000 people in Scotland have hearing loss, which is roughly one in six of the population; with estimates suggesting that 70% of those with hearing loss are over 70 years old. This number is projected to increase significantly in the coming years.

The very hiddenness of hearing loss is one of the many reasons why there is less societal focus on the necessary adjustments and changes which can be made to ensure that individuals are more included and involved and to ensure that those living with hearing issues are able to play their full part as citizens in their communities.

Hearing loss is not just a health condition; it is an issue which affects virtually everything about an individual’s life and how they relate to others and their sense of belonging whether in residential care or their own community. It shapes how people experience the world, how they connect, how they express themselves, and how they are included – or excluded – from society.

For too many older people, hearing impairment is a slow erosion of connection, a gradual retreat into isolation. And in a sector that prides itself on person-led, relationship-based care, this presents a fundamental challenge and one – if I am being completely honest – in the midst of other competing priorities does not receive sufficient attention.

A recent study by the British Irish Hearing Instrument Manufacturers Association (BIHIMA) found that while many older people benefit from hearing aids, 40% of those who need them do not use them effectively. Batteries go flat. Devices get lost. Staff may lack training in how to support residents with hearing aids, leading to frustration and a loss of confidence in the very technology that should empower them.

And then there are those for whom hearing aids are not the answer – people who have been Deaf since birth or who have profound hearing loss requiring British Sign Language (BSL) or other communication support. In truth the care sector across the UK has been slow to adapt to their needs, with BSL provision remaining patchy at best and little resource allocated by commissioners and funders to release staff for training and development.

Imagine living in a care home where every conversation around you is muffled, distorted, or completely inaudible. Where announcements about mealtimes or activities do not reach you. Where staff – however well-intentioned – speak too fast, do not face you, or assume you can hear because you have a hearing aid.

The result? Many older people with hearing loss become socially withdrawn. They stop participating in group activities. They disengage from conversations. They are mislabelled as confused or unresponsive, when in reality, they simply cannot hear what is being said.

And let us be very clear: hearing impairment is a risk factor for cognitive decline, depression, and even increased mortality. This is not a marginal issue – it is central to dignity, quality of life, and fundamental rights.

So, what can we do? The answer is not complicated, but it does require cultural and systemic change. It also requires yet again a targeted resource and finance that allows people to address the discrimination that happens when resources are absent.

As a society we should develop a Charter for Inclusion – and for me the primary action for deafness is staff training and awareness raising. Every care home and homecare provider should ensure staff receive training on hearing loss awareness. This includes understanding hearing aids, learning basic communication strategies (such as speaking slowly, facing the person, and reducing background noise), and being aware of the signs of undiagnosed hearing loss.

Routine hearing checks should be part of life plans for those who receive care and support services, just as vision and oral health assessments are. Care homes should have direct referral pathways to audiology services, ensuring that hearing aids are maintained and adjusted as needed.

Not all hearing loss is the same. Some people need written communication, others benefit from visual cues, and some require BSL or lip-reading support. Care providers should be proactive in tailoring communication to each individual.

We live in an era of smart hearing technology and assistive devices. From amplified telephones to captioned video calling, there are many tools that can enhance communication – if only they are made available and integrated into care and support and fiscal resource prioritised to make their purchase and use possible.

One of the greatest failings in this space is the lack of robust data on hearing loss in Scotland’s care sector. Most of the data we have is years out of date and there has been little focus to address this.

We simply do not know how many care home residents are experiencing undiagnosed hearing loss; or how many are not using their hearing aids correctly and how many care staff have had training in communication with Deaf and hard-of-hearing individuals.

This data gap is a real system and clinical, social care failure. Without accurate information, we cannot plan services, allocate resources, or advocate for the change that is so desperately needed.

If we are serious about person-led care, then hearing loss must be on the agenda. We must listen to the unheard. We must identify adequate resource and funding to ensure real inclusion.

Despite all the undoubted challenges facing it I believe it is possible for Scotland’s care sector to lead by example. To embed hearing care into the heart of what we do. To ensure that no one in a care home or receiving homecare is left in silence.

Because in the end, this is not just about hearing – it is about being heard.

The American poet Camisha L Jones reflects on the transformative impact of hearing aids, celebrating the newfound access to sounds and the emotional resonance they bring. Being heard changes your life.

 

Ode to My Hearing Aids.

 

Then God said

let there be sound

and divided the silence

wide enough for music

to be let in and it was a good groove

 

And God said

let there be overflow

sent sound in all directions

pin drops & children’s laughter

phones ringing & plates clattering

and it was kind of good but too much at times

 

So God said

let there be volume control

let there be choice how loud life should be

and there came the power to fade

the voices, the annoyances, the noise

and that was mighty good for all the unnecessary drama

 

Then God said let there be surprise, startle even

at the bird’s chirp, the ice maker,

the cabinet slammed shut

let there be delight

at the first calls in months

to father & best friend

and these were such good reasons for choking back tears

that God saw

the dark & the light

dangling brilliantly from each ear

and God whispered amen

then smiled when it was heard.

 

From Flare (Finishing Line Press, 2017). Copyright © 2017 by Camisha L. Jones. Used with the permission of the author.

 

https://poets.org/poem/ode-my-hearing-aids/print

A betrayal of dignity: the failure across the UK political leadership to prioritise social care.

Tuesday next (the 25th) sees the Scottish Parliament debate and vote on the Scottish Government’s Budget. It is something of a fait accompli with the votes of the Scottish Liberal Democrats and the Green Party in the bag, and Scottish Labour sitting on its hands. Any sense of self-congratulation, however, should be short lived because not for the first time this administration has seriously let down the social care sector and the tens of thousands of women and men who rely on social care services and supports.

Yet again I find myself writing about the lack of real prioritisation being given to social care by the Scottish Government – in that, however, they are not alone – the UK Government in its new Labour iteration is doing exactly the same. In Scotland there will be defence statements made that the current administration has never given as much as it is now allocating to social care – and indeed it would be churlish not to congratulate them for continuing to finance the Scottish Living Wage which comprises the largest proportion of the additional revenue that has been given to the system this coming year. But such positivity rings hollow when the perilous reality of disintegration becomes apparent.

Social care is not a luxury. It is not an optional extra or a line item to be trimmed when budgets are tight. Social care is the foundation upon which the dignity, independence, and wellbeing of thousands of older people and individuals with disabilities rest. It is the means by which we affirm the intrinsic worth of every individual, ensuring that no one is left behind, no one is forgotten, and no one is stripped of their humanity.

Yet, the 2025 Budget tells a different story. It tells a story of missed opportunities and misplaced priorities. It tells a story of a government that has chosen to turn away from those who are most valuable, those who have contributed to society throughout their lives, and those who now depend on us to uphold their rights and dignity.

The failure to prioritise social care funding is not just an economic decision – it is a moral failing. It is a failure to recognise that the right to live with dignity, to access essential care, and to participate fully in society are not privileges to be rationed, but fundamental human rights. The United Nations Principles for Older Persons and the Convention on the Rights of Persons with Disabilities are clear: states have an obligation to ensure that older people and those with disabilities can live independently, with access to the support they need. By underfunding social care, the Scottish Government is failing to meet these obligations.

I fully recognise that government is about choices and one of the most damaging choices made by the UK Government is its decisions not to exempt social care providers (and hospices I might add) from the forthcoming increases in National Insurance rates. This is a tax on jobs and a tax on care and will drive many care organisations to the wall. It is a political madness entered into with an ignorance of consequence and a lack of compassion. Despite there being a debate on the issue again on the 25th of February in the House of Lords the Chancellor remains deaf to the desperate pleas of those who care and support tens of thousands of people and those individuals themselves.

The consequences of this political failure in both London and Edinburgh are stark. Care providers, already stretched to breaking point, are being asked to do more with less. Staff, who are the lifeblood of social care, are undervalued and underpaid, leading to chronic shortages and burnout. Older people and those who use social care services are left waiting for essential support, their lives diminished by delays and inadequacies. Families are forced to pick up the pieces, often at great personal cost.

We cannot accept this. We must demand better. We must demand a budget that reflects our values, that invests in social care as a cornerstone of a fair and just society. We must demand that the Scottish Government recognises the urgency of this crisis and takes immediate action to address it.  It might not be able to do much about a deaf Westminster, but it must do more to invest the limited resources it has available to it in social care provision. Yes, it will be hard, and decisions taken will not go down well in other sectors – but a society that does not care is not one worthy to be governed. It might even mean, heaven forfend that we invest less in the NHS and take some of the resources we have to prioritise social care over acute and secondary NHS services. Budgets are all about hard decisions – I together with thousands of others cannot accept the fiscal choice that continues to marginalise social care.

Ultimately though this is not just about money. It is about who we are as a society. It is about whether we are willing to stand up for the rights and dignity of every individual, regardless of their age or ability. It is about whether we are willing to say, with one voice, that social care matters.

The time for empty promises and half-measures is over. The time for action is now. Let us not fail those who depend on us. Let us not fail ourselves.  Let us see investment and resource reallocated and let us spend on the lives of those who remain the heart of our communities. To do otherwise is a betrayal of dignity.

Donald Macaskill

 

Photo by Christopher Bill on Unsplash

 

 

Deadline Extension: Care at Home & Housing Support Awards 2025

Deadline Extension: Care at Home & Housing Support Awards 2025 – Enter by 10 March!

We are delighted to announce that the Care at Home & Housing Support Awards 2025 entry deadline has been extended to Monday 10 March 2025, at 9:00 am.

With our annual Care at Home & Housing Support Conference and Awards taking place on Friday 16 May 2025, at the Radisson Blu Hotel in Glasgow, this is the perfect opportunity to celebrate the dedication, innovation, and excellence across the sector.

At a time when the role of social care is more critical than ever, these awards provide a platform to honour outstanding individuals, teams, and services who make a difference every day.

Don’t miss this final chance to recognise and celebrate excellence in homecare – submit your nominations today!

Submit your entry here: https://scottishcare.org/care-at-home-and-housing-support-awards-2025/

Final Deadline: Monday 10 March 2025, at 9:00 am

We look forward to celebrating the achievements of those who make social care exceptional. Get your entries in before the final deadline!

Media Statement – “I worry about the Future” – 49% of Care Homes Report a Decrease in Placements

In January 2025, Scottish Care drew attention to the stark impact of ongoing funding pressures for the independent care at home and housing support sector, the untold stress on the sustainability of vital care providers across Scotland, and diminished access to an adequate level of person-led care. We now turn our attention to the #SocialCareCrisis facing the independent care home sector, through the significant decrease in Local Authority or Health Board placements across the country.

Scottish Care received 146 responses from our membership, overseeing the delivery of residential and/or nursing care across 403 homes in Scotland. We found:

  • A total of 1,463 placement vacancies. 
    • 4 vacancies for every home our respondents oversee.
    • 68% of these vacancies are accessible through Local Authority or Health Board placement and the subsequent National Care Home Contract (NCHC) funding model, providing an essential public service.
  • A significant decrease in the numbers of individuals placed by the Local Authority or Health Board in care homes across Scotland compared to the same period in 2022:  
    • 20.0% of respondents stated that the number of placements had decreased significantly.
    • 29.0% of respondents stated that the number of placements had decreased.
    • 45.5% of respondents stated that placements have stayed the same.
    • 6.2% of respondents stated that the number of placements had increased.

A practice of particular concern is the increased prevalence of ‘2:1’ placement policies in various localities, that Local Authority or Health Boards must recoup the equivalent money of two placements before funding the place of a new individual. Communities across Scotland should not have to wait for fellow citizens to pass away before being able to receive the care home they desire:

“Since before Christmas, there has been a big reduction in social workers seeking rooms for local authority clients. Sometimes, despite the family feeling care home is more appropriate, only homecare funding is offered”. 

Such stark results highlight the unsustainability of the independent care home sector in Scotland. There has been a 18% decrease in the number of care homes for adults in Scotland over the previous decade, and without the sufficient delivery of placements by Local Authorities or Health Boards, this trend will continue. Which each closure, an individual’s choice of and control over their care and support diminishes.

Without a robust and sustainable social care sector, able to promptly place individuals requiring and choosing residential or nursing care, delayed discharge will continue to exert immense pressure on the NHS and other services. More than five million bed days have been lost to delayed discharge since March 2015, at a cost of approximately £1.5 billion.

Never has ring-fenced funding for the social care sector, to meet service demand and support efficiencies across the NHS, been more required. Such funding is notably absent from a Scottish Government budget “that kills”, a very real risk that is summarises by one survey respondent:

“Historically, we had a system aiming to do the right thing but operating poorly, taking too much time to assess and place people appropriately. Now, whether by design or just acceptance, we have a system prepared to let people deteriorate or die without the correct care to save money”. 

We must address the #SocialCareCrisis in Scotland. This begins with the urgent delivery of ring-fenced funding for the adult social care sector to sustain the commissioning of placements within care homes. This is critical to safeguarding a care system that prioritises dignity and delivers high-quality, person-led care. One that looks forward to a future where those delivering or receiving care and support no longer worry about the future.

Dr Donald Macaskill, Chief Executive of Scottish Care, said: 

“Scottish Care’s research demonstrates the profound social injustice of how our crises-driven care home sector operates. People are desperate to move into care homes across Scotland, not least those stuck in our hospitals, and yet local authorities are choosing or simply do not have the money to pay for their care and support. Because of this underfunding, care homes across Scotland are in crisis, and empty beds will lead to care home closures. 

We need a long-term strategy which sustains the care home sector in Scotland rather than what we have at the moment, a reactive, damaging short termism. It is an indignity that we are waiting for two people to die in order for there to be money to pay for one resident.”

 

-Ends-

Social care is social justice.

Next Thursday is the United Nation’s annual World Social Justice Day 2025. A quick look at official calendars shows that there will be lots of events around the country and across the UK on issues of gender, migration, poverty and inclusion.  But at least for me the day asks some uncomfortable questions. In Scotland we often pride ourselves on being a nation built on fairness, dignity, and equality – the very bread and butter of social justice. We are after all the nation of ‘A Man’s a man for all that.’ Yet, when it comes to social care the sector that should be at the very heart of our social justice efforts – we continue to neglect, undervalue, and overlook it.

Social care is not just about helping people live their lives with dignity; it is a profound expression of our shared humanity. It embodies the very principles of social justice: equity, human rights, and the belief that everyone, regardless of age, ability, or background, deserves to participate fully in society. Indeed, as I have said on more than one occasion the distinctive nature of social care as understood by Scottish legislation makes explicit the social justice dimension of social care. And yet, despite all the fine words and policy commitments, social care in Scotland remains on the margins, rather than at the centre, of our social justice agenda.

For me it could not be more plain social care IS social justice and social justice without social care is empty and vacuous.

Too often, social justice is discussed in abstract terms – poverty, inequality, exclusion – without recognising that social care is where these issues play out most starkly. Social care supports older people, individuals with disability, and those living with mental health conditions. It ensures that people are not trapped in their homes, isolated from their communities, or living in fear of not having their most basic needs met. It is the safety net that allows people to thrive, not just survive.

Good social care is the difference between an individual being able to choose how they live their life and having that choice stripped away. It ensures that human rights are not just a theoretical construct but a lived reality. A society that fails to invest in social care is a society that perpetuates inequality, particularly for women, disabled people, and those in poverty, who are disproportionately affected by the gaps in the system.

So why, I ask myself, despite its fundamental role in achieving social justice, does social care continue to be underfunded, undervalued, and underappreciated – at least in Scotland? Why is it that this week we have discovered again that the economic value of adult social care to the Scottish economy is £5.2 billion; that for every £1 spent there are £2 worth of additional socio-economic benefits. Social care is not a drain but a massive driver and contributor to our economy yet it hardly ever appears in any official economic strategy as such.

I suspect the primary reason for this neglect – yet the one that most would not confess to or admit – is the uncomfortable truth that social care is still seen as ‘women’s work,’ as an extension of informal family caregiving rather than a critical professional service. The chronic undervaluation of care work – both paid and unpaid – is a stark reflection of gender inequality in our society. You can also add to this the insidious ageism which pervades attitudes to social care – only this week we have witnessed the casual stereotyping of older age and the dismissal of contribution from the elderly by some political figures including a UK Minister who had been working around adult social care!

It is also not helped by the failure to accept the critical preventative role of social care but instead to continually focus on social care as a reactive response. Instead of recognising social care as a public good, policymakers and political leaders continue to treat it as an emergency response, something to be patched up rather than properly invested in. This short-termism ensures that the system lurches from one crisis to another, rather than addressing the structural inequalities that create the need for care in the first place.

At the heart of social justice is economic justice yet whilst we often speak of fair work, of paying a real living wage, of tackling in-work poverty, we refuse to see that the low pay and poor conditions in social care are an economic justice issue. Until we properly fund social care services, we will continue to condemn thousands of care workers – predominantly women – to pay that does not reflect their professionalism, insecurity, and burnout.

And over all these the classic failure to see social care as an issue of social justice is the fact that social care has become a political football rather than a political priority. Social care in Scotland has been at the centre of political debates, particularly with the proposed National Care Service. But rather than being framed as a fundamental issue of rights and justice, it has too often been reduced to a question of bureaucratic restructuring. We need to ask: will any of these reforms (even the most recent) truly shift power into the hands of those receiving care and those providing it? Or will we continue to have a system where people feel unheard, unseen, and unvalued?

If we are serious about social justice in Scotland, then social care must be our starting point. We cannot claim to be a nation committed to fairness and equality while we continue to fail those who rely on and provide care.

On World Social Justice Day, let us move beyond rhetoric. Let us commit to:

  • Fair pay, conditions, and recognition for care workers rather than self-congratulation about the Living Wage and promises tomorrow.
  • A human rights-based approach to care that prioritises choice, dignity, and participation and has legislative bite with a new Human Rights Act and clear implementation of social care choice not the kind that is limited by budgets.
  • A shift from crisis-driven social care that is there to rescue and patch up the NHS to preventative, community-based support

Social justice is not an abstract ideal. It is something we build through action, through policy, through investment. And it starts with ensuring that no one – whether they are receiving care or providing it – is treated as disposable.

Social care is social justice. It’s time we acted like it.

I leave you with some of the poetry of the contemporary American poet Jane Hirshfield whose works are enthused with a sideways look at the essence of justice. Her poem ‘For What Binds Us’ reflects on the various forces “both physical and emotional” that connect individuals and the resilience that emerges from shared experiences and healing.

For What Binds Us

By Jane Hirshfield

There are names for what binds us:

strong forces, weak forces.

Look around, you can see them:

the skin that forms in a half-empty cup,

nails rusting into the places they join,

joints dovetailed on their own weight.

The way things stay so solidly

wherever they’ve been set down—

and gravity, scientists say, is weak.

And see how the flesh grows back

across a wound, with a great vehemence,

more strong

than the simple, untested surface before.

There’s a name for it on horses,

when it comes back darker and raised: proud flesh,

as all flesh,

is proud of its wounds, wears them

as honors given out after battle,

small triumphs pinned to the chest—

And when two people have loved each other

see how it is like a

scar between their bodies,

stronger, darker, and proud;

how the black cord makes of them a single fabric

that nothing can tear or mend.

Copyright Credit: Jane Hirshfield, “For What Binds Us” from Of Gravity & Angels. Copyright © 1988 by Jane Hirshfield and reprinted by permission of Wesleyan University Press. Source: Of Gravity & Angels (Wesleyan University Press, 1988)

This poem is available on the Poetry Foundation’s website: For What Binds Us | The Poetry Foundation

Donald Macaskill

Photo by Ian Schneider on Unsplash

What does it mean to care at home? A reflection.

There has been a great deal of talk this past week about how important it is that we support and care for individuals as close to their home as possible, including yet again an emphasis on hospital at home – as well as an increased commitment to focussing on prevention and healthcare at home from the First Minister. Yet what is often missed in the political rhetoric and proclamation is a proper understanding of what it means to support and care for someone in their own home or in a homely setting.

Some of that reality was portrayed in research which was undertaken by Scottish Care, Care Forum Wales and the Homecare Association in conjunction with Sky News and which was published this past week. It made for distressing and worrying reading and made me personally question whether we have become blinded to the need for humanity in our national response to the current social care crisis.

Entitled ‘It feels like we don’t exist’ the Sky News item explored the human cost of the social care cuts happening across the country and not least in Scotland. I’ve mentioned these cuts to care more than a few times over the last few months, but they have – unless you receive care and support or work in the sector – gone largely unnoticed and under the radar of the mainstream media. What they mean is that effectively most Health and Social Care Partnerships – the bodies who oversee and pay for the majority of care home and homecare delivery in Scotland – are having to make savage cuts of tens of millions of pounds in order to make their books balance this year and certainly into the next fiscal year. What that means – is not that there are queues outside our hospitals for our politicians and media to see – but that there are invisible impacts which mean thousands of people are having their care and support cut, or are not being assessed at all and that less and less is being spent on the support and care of some of our most valuable citizens. This is a process of cuts to life which is going largely unseen.

The Scottish Care research painted a sad and depressing insight into the reality of the current social care crisis in Scotland. Specific results from Scottish Care membership said that:

  • Over 80% of respondents stated that councils have reduced the number of care packages that would previously have been awarded.
  • 90% stated that councils have reduced the overall number of hours commissioned within care packages.
  • Over 90% stated that councils have asked providers’ to complete care tasks that are unrealistic within the commissioned time.

Such reductions place untold stress on the sustainability of vital care providers across Scotland and diminish access to an adequate level of person-led care. As commissioning and procurement bodies cut packages beyond the true cost of adequate care for our communities, care providers are struggling to stay afloat.

A provider told me of the increasing pressure to do tick box care. One spoke of the request from a Council to support someone up out of their bed, to help them to have breakfast, to make sure they had a wash for the day and to do all this in 15 minutes! This is obscene and inhumane. Another provider spoke of the fact that their care organisation had been fined on numerous occasions because the carer had made a cup of tea or had taken out the rubbish for a supported person – all because it wasn’t in the ‘care plan’. All of this smacks of a system where money talks and compassion walks, where we have turned care and support into a functional set of tasks rather than what it should be – a relationship of dignified humanity which enables a person to flourish and thrive. Behind the rhetoric of more and more money being given to social care is the perverse truth and reality of a system of social care that should shame every Scottish citizen.

I am writing all this being very aware that when care is cut this impacts on not only the person themselves, on the workers but also the wider family who depend so much on a functioning social care system.

Tuesday next, 4th February, is the annual World Cancer Day when we are asked to focus on the lives of those living with cancer and how we can improve health, and social care supports to enable people to live better with cancer. So often in these discussions the experience of older Scots living with cancer, and in large part supported in their own homes, goes missing from our focus.

With our ageing population more and more of those who live into older age are being diagnosed with cancer as well as the reality that positively those diagnosed younger are living longer with cancer. We often ignore the fact that older patients often present unique concerns, such as decreased tolerance to certain treatments, multiple co-existing medical conditions, and the functional challenges in daily activities which often come with age. These factors all necessitate a tailored approach to cancer care for the older citizen but in a system where we are struggling to do the basics humanely such focus and personalisation seems impossible. But it is urgent that we develop such cancer specific supports.

We know from recent research on cancer care that the role of homecare and social care is absolutely vital. Studies have shown that the benefits of home-based supportive care for advanced cancer patients is enormous. We need to resource social care to deliver more effective high quality cancer care.

What we have instead is the comments I hear from so many living with cancer, which is about rushed workers, staff constantly having to look at their watches, always on the move, and yet despite the care by the clock they are requested to make they still continue to show compassion, professionalism and care.

All our citizens, regardless of age deserve the best possible care and support in their own home or in a homely setting. This will not be achieved by ignoring the disintegration of social care across Scotland. We have to wake up to that reality and ignore the saccharine statements of assurance of a system that is working. We have to really accept that to care for someone in their own home, whether they are living with cancer or not, in a manner which affirms their rights and dignity – cannot and should never be done with a stopwatch in your hands.

Donald Macaskill

Photo by Pinakeen Bhatt on Unsplash

 

Blog – The Great ‘Doughnut Fallacy’ of social care in Scotland 

The Great ‘Doughnut Fallacy’ of social care in Scotland 

Minister for Social Care Marie Todd last week announced changes to the proposed National Care Service (NCS) Bill. The most significant of which is the removal of Part 1 of the bill, which focused on the structural reform of integrated social care and community health. This means the bill will now proceed with only Parts 2 and 3. I can’t help but note the passing of the ‘Welfare of Dogs’ Act in the same week and reflect upon what that means for how we value our citizens. What is crucial now is that we do not wait for the Bill to reform social care. A briefing was sent to all Scottish Care members with more detail, but here’s what we know: 

First, it’s important to acknowledge that the plan for a complete overhaul of the social care system, through the structural reforms in Part 1 of the National Care Service (NCS) Bill, has been dropped. This is where the system arguing with itself about who should run things got in the way of making a difference for people. It’s the great doughnut fallacy of social care. 

During the pandemic we experienced a health takeover of social care. They brought with them outdated ideals of person-centred social care. Whilst this was a positive initiative of its time, over 2 decades ago social care switched to person-led care and support. Person-centred was a way of reinforcing the need of the system to connect with itself with the individual citizen at the centre. However all too often what would happen is that the individual in the centre would find themselves in a vacuum surrounded by a system determining their needs, often to the detriment of the individual. This regression to person-centred caused a culture change which ripped a hole in the heart of the independent review of adult social care and delayed the implementation of meaningful change.  

With the structural reform proving too difficult, I am however reassured by the clear language shift to person-led in the Ministers speech reinforcing the need to remember why we are doing this. Put simply, for people not power. 

So what remains in the bill? 

  • It includes “Anne’s Law”, which appears to strengthen visiting rights in care homes although in practice the role of Public Health still has a power to overrule any decisions, making this legislation have no greater impact that what already exists. 
  • It aims to improve information sharing between health and social care services. Many of you will know data is one of the pedestals I like to climb upon, but that is because it is a real area of opportunity. Especially with the adoption of ethical AI. However, it will only work if it meets a vision to reduce bureaucracy and improve the user experience. I wrote about this with Dr Tara French some years ago now in Seeing the Diamond in Social Care Data, but the principles remain the same. Alongside this, there is a need to embrace digital to augment the care experience, offering people more autonomy and freeing up care workers to get back to delivering care. 
  • There’s also a plan to establish a national care service advisory board. This is meant to be an independent body, including people with lived experience, that will help to improve the quality of care across the country. It will provide advice on national programs to support improvements and will monitor and report on local frameworks. However, it’s not statutory, so it may not be as powerful as it could be. What is important here is how the board can ensure transparency and influence over poor practice in all parts of the system. This will be supported by work on  
  • Ethical commissioning and procurement which remains in the bill. This is where real change towards person-led sustainable and quality care can be made, but only if it is enforceable. Financial constraints and the persistent underfunding of social care and support for a decade has led to a time and task takeover meaning that providers are not commissioned to deliver the care and support that people really need to live well. In addition, delays in payments to care providers are putting them at further risk of collapse because they cannot meet cash flow demands. Providers are closing. Staff are exhausted and undermined. There is additional pressure on families, and worst of all, people are being failed. In response to the statement that Scottish Government has increased funding for social care by 25%, two years earlier than planned. I wonder how much of this has been used to meet public sector pay increases or simply to meet inflationary rises. Funding remains a concern and transparency, and good governance is still needed for system change to embed. 

So there we have a list of what should perhaps be the items for the agenda of the first National Care Service Advisory Board. Whatever happens next, it is critical that changes are person-led and focus on the needs of individuals, ensure care workers are properly supported, care providers experience full economic cost recovery, and that the system is accountable, flexible and efficient. Without these critical foundations, the changes to the NCS bill will not deliver the required improvements of the Independent Review of Adult Social Care and the doughnut fallacy will remain strong. However, if we collaborate with intent, we can have our cake and eat it. 

 

Karen Hedge
Deputy CEO, Scottish Care

Media Statement: “It Feels Like We Don’t Exist’ – Scottish Care Calls for Urgent Action

“It Feels Like We Don’t Exist”: Scottish Care Reiterates Call for Urgent Action Following Sky News Report  

Scottish Care is deeply concerned with the findings of Sky News’ recent report into the experiences of homecare and housing support providers delivering commissioned care packages, summarised within our Briefing Report.

Specific results from Scottish Care membership are as follows:

  • Over 80% stated that councils have reduced the number of care packages that would previously have been awarded.
  • 90% stated that councils have reduced the overall number of hours commissioned within care packages.
  • Over 90% stated that councils have asked providers’ to complete care tasks that are unrealistic within the commissioned time.

Such reductions place untold stress on the sustainability of vital care providers across Scotland and diminishes access to an adequate level of person-led care. As commissioning and procurement bodies cut packages beyond the true cost of adequate care for our communities, care providers are struggling to stay afloat amongst increasing operational costs:

“For the first time in 27 years I am genuinely scared for our future.” 

Reversing this reduction in service availability is vital, with funding for care providers that is commensurate to the true cost and value of the vital work they do.

Sky News’ report reaffirms the inadequacy of time and task models of commissioning homecare and housing support, typified by 15-minute visits and the lack of person-led care on offer:

“How are carers supposed to provide high quality care if they only have 5 minutes! This is not enough time to take off your jacket let alone assess the persons wellbeing.” 

As opposed to tailored packages that meet the individual needs of service users, carers must complete multiple complex tasks within this narrow timeframe (personal care, medication administration and meal preparation). Increasingly, basic needs cannot be met. Moreover, by removing the vital human element of care, individual citizens feel rushed and undignified.

The results also highlight a breakdown in partnership working between commissioning bodies, providers and service users when making significant decisions regarding the future of a care package:

“We seem to be in a situation where there is no transparency or honesty”. 

The whole adult social care sector must commit to greater communication with providers on any decisions that affect service delivery.

Scottish Care’s recent response to the Scottish Budget describes a “budget that kills”. Sky News report exemplifies this very real risk without sufficient support at all levels of government.

We must address the #SocialCareCrisis in Scotland. This begins with a truly ethical approach to commissioning and procurement that respects the true cost of care, communicates openly with service users and their care providers, and works collaboratively to advance the much needed change away from time and task models of care. These steps are vital to safeguarding a care system that prioritises dignity and delivers high-quality, person-led care.

-Ends-

Time to tell the story of social care

One of the joys of living in Ayrshire is the continual presence of the poetry of Robert Burns. I have to confess that I have not always loved the works of the Bard but the more I have got to know his poetry and his life the greater my appreciation.

So tonight, with others I will be partaking of that Scottish ‘tradition’ of haggis, neeps and tatties and no doubt will attempt – probably badly – to recite a few Burns’ words in the presence of friends and family. I am also well aware that today and tonight across not just Scotland but across the globe there will be gatherings bringing together families and friends to eat, drink and recite Burns on this his birthday. Despite the tides of modernity and social media influences Rabbie seems not to be going out of fashion – quite the reverse!

In one of those literary happenstance moments today also marks the beginning of National Storytelling Week. Story is as I have often written in this blog a powerful vehicle to communicate truth, to inspire, to challenge and to change. There is something almost timeless about the power of stories to change our world – the energy of tales to shape our understanding of our lives and connect us to one another.

Burns epitomises for many the ability to communicate truth, to tell a story, in verse and in poetry. The ploughman poet understood the enduring truth of storytelling. His verses captured the humanity of his time: the struggles, the joys, the resilience of ordinary folk. Through his words, the voiceless were given voice, and their stories, their truths, became immortal. He was able to speak uncomfortable truth to power and to seek to change and redirect the society in which he found himself – all through the power of story and words.

And that I believe is the urgent necessity and challenge for those of us who work and live in the world of social care. Rather than remaining silent, whispering to the interested few, the stories of social care – the unsung experiences of carers, the resilience and passion of those who receive care and support, the lives that are turned upside down and changed for the better, and the challenges faced by care organisations – all need to be told, shared, and celebrated. And the best way of influencing and changing minds is through the power of story.

I’ve said before that social care exists in the background of society, quietly supporting lives, enabling independence, and nurturing community. It is the thriving energy of our community. But that constancy of presence often means that people do not properly value, notice or understand the importance of the sector. For lots of reasons it is a sector too often overlooked, undervalued, and misunderstood. Stories can change that.

The challenge is that those of us who seek to advocate for social care and its importance to society as a whole have to get better at getting our message across – less about numbers and trends, data and detail, more about heart and humanness, passion and the poetry of care. Through storytelling, we can humanise statistics, breathe life into policies, and remind the public, the media, and policymakers of the essential humanity at the heart of care.

I know at the present time there are very real challenges facing social care as a sector but I feel we too often miss the point if all we do (and it is important to do this) is to continually complain and paint a negative picture; to talk about numbers and statistics, to describe crisis and disintegration, to talk about organisations and structures (even about new plans for a National Care Service!) – to do all that and not to tell the truth of the human lives that are touched by social care and which at its best can be changed, renewed and revitalised by good quality care and support.

These are the stories of so many people I have met over the years. The young man who defied diagnosis and retreated into an inner world of silence yet learned to communicate and verbalise his emotions and thoughts because of the professionalism and care and support he was given by one single dedicated carer. The story of the woman whose whole life had been in her own words always ‘lived in the corner’, the victim of an abusive marriage and a neglectful family and yet who when she entered a care facility discovered her voice, her purpose and learned to live out her dreaming – all because she felt safe for the first time, was made to feel at home, and sensed a community of compassion cradling her in hope and kindness. The story of the carer who literally at the end of her shift goes the extra mile to bring comfort to a dying individual in their own home, of a person rediscovering their independence through compassionate support that helps them to take risks and find courage, or of a care home that becomes a true community where children and adults live as one community with shared hopes, dreams, distress and tears.

These are the narratives that can inspire change, challenge ignorance and the casual stereotype which suggests that social care is there just for the ‘vulnerable’ and those ‘whose lives are over.’ Social care has stories about children, adults, older people that are today, this moment, changing not only their own individual worlds but changing the communities and society around them. Social care is a place of revolutionary and relational change and disruption – if only we had ears to hear, and eyes to see.

Just as Burns captured the universal truths of his time, so too must we capture the truths of social care in ours. We must hear the voices of those receiving care, whose lived experiences too often go untold. We must amplify the stories of the care workforce, whose quiet dedication deserves loud recognition. And we must share the challenges faced by care providers, whose work is made harder by outdated perceptions and inadequate support.

By telling these stories, we can create a tapestry of care that reflects the dignity, complexity, and richness of human life. We can challenge ignorance, foster empathy, and inspire collective action.

So as we raise our glasses to Burns tonight, let us commit to listening to the stories of social care and sharing them with the world. Stories, like Burns’ verses, which have the power to move hearts, challenge minds, and spark change.

I leave you with a poem that captures the spirit of storytelling and its enduring power, words that remind us that stories are not just told but that they are lived, felt, and carried forward.

It is ‘The Storyteller’ by Mark Strand (1934–2014) who was an acclaimed Canadian-American poet, whose spare, elegant words should challenge us to tell the story of social care. Because these stories matter. They always have, and they always will.

“The Storyteller”

 

We are all caught in a story,

each one of us a narrative thread

interwoven into a vast, endless tapestry.

Our voices blend with the hum of the loom,

spinning dreams, fears, truths, and lies.

 

The storyteller knows this

and so shapes the tales,

crafting bridges with words,

turning time back upon itself,

making strangers kin.

 

For in the heart of a story

is the secret we all crave:

to be heard, to be seen,

to belong to the human chorus

of what has been and will be.

 

Donald Macaskill

 

Photo by Etienne Girardet on Unsplash