Scottish Care has issued the following Media Statement following recent negotiations with COSLA and the Integrated Joint Boards.

Care home providers have been forced to accept a marginal uplift of 2.8 % to the funding of care home placements made by Local Authorities.

The 2.8% offer from COSLA includes delivering the new Scottish Living Wage of £8.45 to adult social care workers in care homes from May 1st 2017, which means in effect, providers have been presented with a net 1% uplift in funding for care homes at a time when they are faced with significant cost pressures which have increased by approximately 8.5%.

Providers were faced with an immensely hard and challenging decision, either to accept this unreasonable offer or abandon the National Care Home Contract entirely, therefore potentially jeopardising the stability of the care they provide for older people. An overwhelming majority of those who voted to accept did so under considerable protest, feeling caught between a rock and a hard place. However, they felt that the preservation of the National Care Home Contract was their main priority in order that the people they support were best protected against further cuts to the funding of their care.

Dr Donald Macaskill, CEO of Scottish Care who negotiate the Contract on behalf of care home providers, said:

“We believe that this level of funding endangers not only the survival of the National Care Home Contract but risks huge instability within the whole Health and Social Care environment in Scotland.

“Many providers have expressed not only their disappointment with this funding but their sense of dismay and hurt. As they see it, the contribution of the care home sector to wider health and social care provision, is clearly viewed with such low esteem that the viability concerns for the sector have been so easily dismissed.

“We are profoundly concerned about the survival of some of our care homes and will want to work vigorously with COSLA and Integrated Joint Boards to ensure that quality provision is not lost to the sector as a result of accepting this offer. We are immensely disappointed in the level of this uplift and what we consider to be the grossly inadequate funding of social care by Scottish Government.

“COSLA have indicated that the limited finances available mean they are unable to further improve this funding package. Therefore we can only conclude that it is the failure of Scottish Government to adequately fund the settlement that risks a significantly detrimental impact on provision for older people in Scotland.

“The unwillingness to invest directly into the care home is resonant of a failure to grasp the significance of the issue and a wholehearted lack of valuing of the sector and thus older people’s care and support.

“This is not only about money. It is about the rights, dignity and choice of older people. Scottish Care and its members believe this deal is completely unacceptable, and will work hard to ensure that older people’s human rights and care services cannot be jeopardised in this way again.”

 

Statement from Scottish Care:

The Scottish Government launched its much awaited Mental Health Strategy on the 30th March.

It has a great deal which is positive within its 40 action points including increasing the mental health workforce in A&E, GP practices, police stations and prisons and reviewing counselling and guidance services in schools. In particular we welcome the planned reform of the adults with incapacity legislation so that it complies with the best international human rights standards.

However as an organisation with the rights and dignity of older persons at our core Scottish Care regrets the lack of focus in the Strategy on the mental health needs of our older population.

When the Mental Health Framework was published last year, Scottish Care with others welcomed its particular focus on the lifespan especially its recognition of the needs of older persons. We see little of this reflected in the Strategy.

Our ageing population will and its increase by 86% by 2037 will inevitably mean a higher proportion of those with mental health needs being over the age of 65 and also a higher proportion of these individuals requiring the support of elderly care services. It is therefore crucial that we ensure high quality mental health care and support is built into the provision of these services, which nearly 100,000 people across Scotland access. To fail to adequately recognise, plan for and seek to improve the mental health needs and supports for this population through the Strategy would amount to a serious human rights and equalities issue. We are not convinced the published strategy achieves this.

Scottish Care regrets the complete lack of a dedicated focus on the mental health needs of older Scots in the new Strategy. We are calling for more focussed work to identify the current gaps in support for older people with mental health conditions including social care gaps,
and prioritised support and training of staff in care services to deliver positive outcomes for individuals with mental health conditions.

Scottish Care has identified four areas where we believe more specific attention needs to be paid to mental health priorities for both older people and individuals receiving and working in social care services:

1.
Recognising mental health conditions in older people as wider than dementia.

Whilst dementia is an undoubtedly crucial element of mental health which the Strategy rightly recognises, it is important to recognise that the spectrum of mental health conditions that an older person may be living with is much wider and these conditions may even be undiagnosed. By narrowing our lens to dementia support only, we risk failing to improve the availability, appropriateness and quality of support for older people living with other conditions, including but not limited to depression, anxiety, eating disorders, bipolar disorder, schizophrenia. The fact that people are living longer does not diminish the range of conditions they may be living with nor the requirement for tailored, effective support to be available to those over 65.

2.

Ensuring appropriate support for those living with enduring mental health conditions who access social care services

One of the current shortcomings of mental health care and support which the new Strategy does little to acknowledge is the way in which both formal and informal support is available to individuals when they start receiving social care services, particularly within a care home setting. The current infrastructure and professional relationships between care services, GP services, pharmacy services, Allied Health Professionals and primary care mean, at best, multi-disciplinary support to individuals in care homes settings is a postcode lottery.
Additionally, more effective planning needs to be in place to ensure those who have moved into a care home setting can have continuation of community support available to them before they entered the care home. Finally, care home staff do a fantastic job in promoting personalised care to deliver positive outcomes for residents, but there may be additional support and training they need to ensure they fully understand how best to support individuals living with different mental health conditions. The integration of health and social care certainly presents opportunities to improve shared learning, multi-disciplinary and cross-sector working, better professional dialogue and person-centred rather than location-centred care, but this will require culture change which could be progressed more effectively by recognising it through the Strategy.

3.

Awareness of the risk of developing mental health conditions in periods of transition, change and trauma, particularly in older age

As well as the current challenges around effectively supporting older people with enduring mental health conditions, it is important to recognise the particular factors relating to older people and social care which may prompt or exacerbate mental health conditions. For instance, older people are more likely to experience bereavement through the loss of friends, spouses and relations which can require mental health support. Additionally, individuals who go through transitions such as moving into a care home or another care setting may experience difficulties in adjusting to a loss of home or a perceived loss of identity. It is therefore crucial that we recognise the risk factors and pressure points for older people, where they may require additional expert support in order to maintain or restore positive mental health.

4.

Transitions between adult services and older peoples services

The new Strategy recognises the particular risks faced by young people moving into adulthood – it does not do the same for the move from adult to older persons services.
As articulated in the above two points, there are risks to positive mental health associated with transitional phases and it is recognised that transition phases can lead to a breakdown in communication and quality of care and support, leading to further uncertainty and anxiety for individuals at the centre of that support.

Scottish Care believes that, as a society, we still have an inherent inequity in older people’s care and support compared to other types of care and support and unfortunately, discriminatory practice can still prevail. Whilst positive progress is being made around outcomes and personalisation, and human rights-based approaches can support this, there remain challenges for how we support older people with mental health needs to live well and what resources (including funding) are available within older people’s services to do this effectively. Attention must therefore be paid to how we support people with mental health needs through care transitions effectively so that they do not experience a diminishing of quality support based on their age or location.

Whilst the new Strategy is a clear step in the right direction it is nevertheless still falling short.
Scottish Care would want to see more explicit actions relating to older people and social care to ensure that real progress is made through the strategy in addressing their mental health care and support provision challenges.

Scottish Care will be commencing a piece of work in autumn 2017 exploring the unmet mental health needs of older people in receipt of social care services. This work will explore both what these unmet needs are and what needs to be in place to address these gaps, whether they relate to awareness and understanding, care and support availability and appropriateness, or staff capacity, skill mix and training.

Pilotlight was a five year programme funded by the Scottish Government as part of the implementation of self-directed support.

Pilotlight co-designed seven pathways to self-directed support focusing on mental health, risk, self-employment, young people in transition, older people in transition, people with younger onset dementia and people in recovery from substance misuse.

The project tested and refined a model for successful power sharing, produced tools and resources, and developed solutions for the implementation of self-directed support. Each pathway included people who access support, local authorities and support providers.

On the homepage of the project website, we’ve published a short, animated video entitled, ‘Are you in the dark about self-directed support?‘ It provides a summary of project. Please watch, enjoy and share.

Thanks to partners and those who have supported and/or been involved in the Pilotlight project since its inception.

The SSSC are considering increasing supervisory and management qualification requirements for registration for all supervisors and managers in adult services.

The proposal is to change the minimum requirement for qualifications for supervisors and managers from 15 SCQF credits to 30 SCQF for new registrants (and possibly existing staff).

Although Scottish Care will be submitting a response, it is very important that our members recognise what these proposed changes mean in reality and engage with this consultation process.

The consultation closes on 16th April.

The SSSC also wants this consultation to inform the wider support provided to managers and supervisors. The questionnaire can be found through the link below:

http://www.sssc.uk.com/consultations/consultations/current-consultations/consultation-on-the- supervisory-and- management-qualification- requirements-for- adult-services

For further information please contact Robert Kelman – Learning and Development Advisor at the SSSC on 01382 346469 or [email protected]

If you would like to discuss this with a member of the Scottish Care Workforce Matters Team please contact Katharine – [email protected] or Paul –[email protected]

 

The next Scottish Care Workforce Development Strategy Group event will take place on Wednesday 3rd May.

If you would like to attend please email Katharine Ross directly
– [email protected] by Friday 14 April.

We expect this to be a popular event so we would appreciate you confirming as soon as possible.

Please also let Katharine know if you have any dietary requirements.

If you would like further information please contact Katharine by email or telephone – 07427 615880.

The full programme can be found here.

The following is the text of an address Katharine Ross, Scottish Care’s National Project Lead on Workforce, gave this evening to the Scottish Parliament’s Cross Party Group on Palliative Care. The theme was ‘Realistic Medicine.’

I would like to thank the Scottish Partnership for Palliative Care for inviting me to speak this evening.

I’d like to discuss the principles and ethos behind Realistic Medicine, and how it relates to the people who delivers the greatest volume of palliative and end of life care in Scotland – front line social care support workers.

The principles of Realistic Medicine as we all know are:

time, open conversations, honesty – putting the person receiving health and care at the centre of decision making and creating a personalised approach to their care.

In the context of this evening’s discussion, I’d like to explore how good we are in Scotland at putting our older citizens who are dying at the centre of decisions being made which enable a personalised approach to their death.

At the end of 2016, Scottish Care undertook a significant piece of research which sought to explore and describe the experiences of front line support workers employed in care homes and care at home organisations who were involved in the delivery of palliative and end of life care.

At four locations across the country I, along with my Scottish Care colleagues, were privileged – and often moved to tears – listening to examples of compassionate end of life care. We heard extraordinary stories of physical, practical, social, emotional and spiritual support being given to older people.

All of which was being delivered by front line support workers.

We captured stories such as the care home staff who formed a guard of honour as a resident left their home for the last time.

We heard of the importance of time and honesty. One participant said quietly:

“I want to be able to explain to somebody exactly what’s going to happen (when they die). I want to be able to stop someone being afraid”

We also heard the challenges involved in having open conversations about dying. As another support worker said:

“I don’t know what to say….it can be overwhelming. We try and say what we think is right. It just comes out.

 …You feel like you’re apologising all the time”

I suppose what we really captured was the human impact of delivering care at the end of someone’s life, and of doing this in challenging conditions on a regular basis – for multiple people.

Indeed a focus group participant was the inspiration for the title of our publication. “We are the trees that bend in the wind” is how this person described a workforce which adapts, changes and flexes to the journey of palliative and end of life care, and experiences it with the supported person.

But this phrase also relates to a workforce under sometimes intolerable pressure and strain, at risk of breaking, or at least of losing part of oneself in the process of providing end of life care.

Delivering palliative and end of life care to older people requires highly skilled, technical and practical interventions. It also involves providing emotional support, a familiar face, a hand to hold, family liaison and so many more forms of care and support that cannot be captured in any job title, not least ‘a support worker’.

In our report, Scottish Care have made 12 recommendations. Some relate to the individual who is dying – for example the development of work which embeds a human rights-based approach to the exercising of choice and control at the end of life, especially relating to the rights of older people. Dying of frailty or dementia, for example, should have a specific pathway in the same manner as those which have been successfully developed for cancer and other conditions.

Other recommendations relate to the workforce, and to the policy conditions which ultimately dictate practice.

There has to be a greater emphasis on honest & open conversations about how we pay for and commission palliative and end of life care. Can we honestly say that we adequately resource the social care sector to train its staff to an appropriate palliative level? Do we ensure sufficient time is given for a care at home support worker, to listen, to have open conversations, hold somebody’s hand, to comfort, provide love, to wipe a tear of fear away?

The answer is no.

The ethos of Realistic Medicine – time, open conversations, honesty – are critically important for all of us in this room to have, to ensure that all older people in Scotland experience a person centred death.