Care Revolution: Time to Act

This is a personal blog, reflecting on my experiences working in the care at home sector.

When you hear the word “revolution”, what springs to mind?  Is it the image of the storming of the Bastille as part of the French Revolution? Or perhaps the information and telecommunications revolution which started latter years of the 20^th century?

Not surprisingly there are a plethora of definitions of what a revolution is, but the one that struck me as most relevant to a care revolution – and which chimes most with the theme and intention of today’s conference – is:

“Dramatic and wide-reaching change in conditions, attitudes or operations”

Why is a revolution needed across the care at home and housing support sector in Scotland – and why is it time to act now?

I was a director of my family run care at home organisation in Edinburgh for many years, along with my mum and sister. I often reflect on what was undoubtedly one of the most rewarding, fulfilling, fun and life changing experiences of my life thus far, but it was incredibly challenging as well as emotionally and physically exhausting.

Those were the days when meaningful, close relationships existed between providers, social work teams and commissioners; where timely dialogue and true multi-disciplinary team working often generated transformative outcomes for people supported in their own homes – no matter where they lived.  The term ‘postcode lottery’ did not exist (yet).

In other words, that was during what could be described as the ‘halcyon days’ of care at home!

Those were also the days when there was transparent accountability and proportionate legislative and scrutiny measures; when social care organisations and their respective workforce were trusted, empowered, and enabled to deliver care and support in a flexible, person-led way. Social interaction and community activities were considered as important as medication prompts and personal care – and funded accordingly.

It was a time when the commissioning system resulted in fair pay, reflecting the skills, knowledge, and professionalism of the workforce.  As a result, recruitment campaigns were usually highly successful, facilitating provider choice and discretion. Care workers stayed with the same employer for many years – developing skills and gaining professional qualifications during that time.

It was a time when care workers and management teams had the freedom and space to care for others and – just as importantly – care for themselves.

But enough of my reminiscing… what do we need to do now?  Here are some of my thoughts.

Conditions and Operations

I know I am not alone in feeling that we don’t have to wait until the NCS is established to create conditions for meaningful, wide-reaching, revolutionary change.  Indeed – some of the changes we need to make aren’t that dramatic at all.

I would argue that we already have robust legislation, most notably the Self-Directed Support (Scotland) Act 2013, which provides the levers for much of what the NCS purports to achieve. We do however need to be much better raising awareness and increasing knowledge of this Act – because it truly does create the choice and control for individuals eligible for funding, as well as their families who are more often than not, providing significant levels of care and support.

I also believe this legislation is inextricably linked to the establishment of a framework for a much-needed (and much talked about) human rights-based commissioning framework, designed to meet expectations of the National Health and Care standards and be flexible enough to adapt to organisational and individual needs. Only then will we have a real chance of the care sector gaining parity in terms of pay and conditions with NHS colleagues undertaking similar roles.

And this is really important. There are just over 59,000 adults living at home who currently receive a funded care at home package, and latest PHS figures indicated that there are a further 10,000 people who are either waiting for a care package to start, or for a care assessment to take place.   These are sobering statistics when one considers the ‘critical and essential’ commissioning criteria widely adopted across HSCPs as they continue to manage fiscal challenges.

How will this current system enable people to live their best lives and have choice and control?

It’s therefore critical that decision makers view expenditure across the social care sector not as a ‘cost’ – or even worse, as a discretionary expense – but as an investment in the health and wellbeing of all Scotland citizens, and in society more widely.

On so many levels, can we really afford not to?

Attitudes

I am constantly inspired by the innovative and entrepreneurial spirit that exists across the social care workforce; individuals and organisations who exude professionalism, creativity, bravery and who have the appetite to take informed risks and drive forward with original approaches to care delivery.

From using the latest digital care planning software to enhancing people’s lives by using person-led technologies – there is a huge amount of activity taking place across care at home services that can (and should) be scalable across the integrated health and social care sector.

I also continue to be in awe of the kindness, dedication and skills of the care at home workforce. I speak from personal experience, not just as somebody who worked in the sector, but as a daughter. I will never be able to express my gratitude to the care workers who were part of a multi-disciplinary team (led by my incredible mum) that enabled my dad to live his best life at home while living with Alzheimer’s Disease.

Over the past couple of years, alongside dedicated community, and primary care NHS teams, they made it possible for Dad to die at home, with my mum, as he had wanted to do.  I still grieve my dad’s death, and I miss him terribly – but I take solace from the love and care Dad received in his own home, and what we all experienced because of this.

The care revolution I envisage therefore demands an attitudinal change towards care at home services. This change must start from a renewed place of trust, respect and positive regard for providers, the social care workforce more broadly and an understanding of their critical role in the care of people and the co-ordination of that care, and the contribution this makes to the NHS. This will require honest, collaborative, brave and sometimes uncomfortable conversations and actions, and perhaps respectful dismantling of many of the (sometimes unhelpful) hierarchical barriers and attitudes which currently exist across health and social care.

Even with the acknowledgement of enduring financial challenges, there are too many risks in accepting the status quo and naively believing the halcyon days of care at home and housing support will magically reappear.

They won’t.

Like all revolutions, change needs to be intentional.  Let today’s conference therefore be an opportunity to have the brave, bold and honest conversations needed to enable change to happen – and for action to be taken now.

As John F Kennedy said:

“If not us, who?

If not now, when?”

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Katharine Ross has worked in the social care and integrated sector for over 20 years. She is passionate about championing co-production and participation across health and social care systems and services, enabling people to live their best lives through having their choices and human rights upheld, and their voices listened to.   Her care at home organisation won the Scottish Care Company of the Year Award in 2011, an achievement which is still a source of great pride to her and her family.

 

Scottish Care research has uncovered the scale and impact of delayed payment for care packages delivered by independent providers across the country. Public contracts should be paid within twenty-eight days. Yet this is not always the case.

When asked the level of late payment they are working with, 100% of respondents have informed Scottish Care that they operate with payments due over 30 days. With sums in certain cases going into the millions, the average owed amongst the cases provided to Scottish Care is £303,986.

When asked if they had any late payments that are more than 60 days, 62.8% stated they were, with an average sum of £139,990 owed per case. Again, certain providers are owed millions.

Care providers deliver vital support to their communities across the country. If they are not appropriately remunerated for delivering these vital services, their very existence comes under threat. It is again, those in need of care and support in our communities who will suffer. The situation is predicated on the misunderstanding of the current fiscal condition on the independent care sector in Scotland.

Scottish Care members have articulated the impact on their ability to deliver much need care:

“Our tendered care packages are accepted and delivered without issue, yet we wait months for eventual payment. The time we spent chasing these payments, critical to our ongoing survival as a business, could be spent delivering the care our clients need and deserve.” (Care at Home Provider)

“In a time where we, and the rest of the independent sector, need to grow to meet rising demand, this inadequate commissioning of services like ours further burdens our operations and the care our homes provide.” (Care Home Provider)

This undervaluation of social care is in stark contrast to independent services’ foundational importance to Scotland’s economy, and the ability to save significant sums of money through a preventative approach that addresses issues such as delayed discharge.

As a result of this, Scottish Care calls for:

• An urgent short-term investment to ameliorate the funding shortfalls of commissioning and procurement bodies.
• An immediate end of late payments for the delivery of care packages, and the prompt payment of owed monies.
• A systemic change towards a model of ethical commissioning and procurement under a National Care Service (NCS), with statutory provisions to empower providers:
  • A standardised process of recourse to claim owed monies, including interest fees.
  • A transparent method of financial assessment that keeps providers informed throughout the process of admission and assessment.
• A permanent representative of the independent care sector as part of new National Care Boards under an NCS, to routinely advise on issues impacting the financial viability of the sector, such as late payment.

Appreciating the current fiscal challenges local authorities face, Scottish Care is committed to working in partnership to remedy these issues and ensure the ongoing delivery of care and support across Scotland.

-Ends-

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The Delayed Payment Briefing Report is available here.

Next First Minister must ensure Scotland’s ‘globally significant’ commitment to care delivers concrete changes, campaigners say

Campaigners have warmly welcomed Scottish Ministers’ backing for a new world-leading commitment on care, and say that it must not be overshadowed by the political upheaval facing the Scottish Government. Instead, campaigners say ‘to be worth the paper it’s written on’, the next First Minister must fully deliver a meaningful step-change in how both unpaid and paid carers in Scotland are valued and supported.

Following a successful campaign by A Scotland That Cares, a coalition campaign backed by over 70 organisations with Scottish Care as part of the steering group, including leading Scottish charities, think tanks and trade unions, the Scottish Government has proposed a new, dedicated National Outcome on care.

Once finalised it will make Scotland one of the first countries in the world to make such an explicit and comprehensive commitment to driving and transparently measuring progress on how care and, crucially, those who look after someone, are valued.

First introduced in 2007, the Scottish Government’s National Performance Framework (NPF) includes eleven National Outcomes, the goals which it says describe ‘the kind of Scotland’ it wishes to create. However, there is currently no Outcome on care, a glaring omission which A Scotland That Cares sought to change during the Government’s recent review led by the Deputy First Minister, Shona Robison.

The campaign, backed by carers across Scotland, was launched at the height of the Covid-19 pandemic when people and many politicians took to their doorsteps to ‘clap for carers’ and other key workers. Since then, the campaign has shown how the undervaluation of all forms of care is leaving too many people who look after someone, particularly women, to pay a deep financial and personal price, including poverty and burn-out.

The draft new National Outcomes recommended by Scottish Ministers have today been lodged at the Scottish Parliament for scrutiny by MSPs before being finalised, and they include a new National Outcome on Care, which states ‘We are cared for as we need throughout our lives and value all those providing care’.

As well as covering care at all stages of a person’s life, the new National Outcome will cover everyone with caring responsibilities in Scotland; from unpaid carers looking after friends and family, including young carers, to parents looking after children and paid social care and childcare workers.

Becky Duff, Director of Carers Trust Scotland, said: “Carers, whether paid or unpaid, are the backbone of our society, providing essential support and compassion to those in need. For too long, their tireless efforts have gone unseen and unappreciated, resulting in carers often facing burn out and poverty. The Scottish Government’s landmark new commitment to carers is a positive step towards ensuring that carers of all kinds receive the recognition and resources they urgently need and deserve.”

The creation of a new National Outcome on care comes as public support for carers remains high, with polling showing nearly two-thirds (64%) of adults in Scotland back a new National Outcome on care. It has already attracted support from multiple political parties.

A Scotland That Cares says the new Outcome must be underpinned by robust indicators, such as those proposed by academics through the University of the West of Scotland – Oxfam Partnership, to ensure that its delivery translate into practical policies, adequate funding, and meaningful support systems that make a tangible difference to the daily lives of carers.

Donald Macaskill, Chief Executive of Scottish Care, said: “For decades, carers of all kinds have provided an essential service which, despite its Cinderella status, has kept our communities and economy afloat. The new National Outcome on care must be a line in the sand, and given the weight, impetus, and funding it needs to drive the substantial spending and policy changes required to address the myriad of issues facing the care sector, carers and those they care for.”

Campaigners are urging MSPs from across the political spectrum to back the new National Outcome while ensuring that Scotland’s 13 proposed National Outcomes have more weight in driving policy and spending decisions across all levels of government.

Jamie Livingstone, Head of Oxfam Scotland, said: “This hugely welcome, globally significant commitment to carers cannot be overshadowed or undermined by short-term political upheaval. The next First Minister must instead ensure the proposed National Outcome on Care is worth the paper it’s written on by delivering rapid and transformative changes that boost investment in care and give carers the support they need. It’s time that carers, and the contribution they make to our country, are both visible and valued.”

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Find out more about the A Scotland that Cares campaign at ascotlandthatcares.org

Survey Reveals Urgent Concerns Over International Recruitment in Social Care 

Scottish Care, the representative body for independent social care providers in Scotland, has conducted a survey revealing significant challenges faced by care providers in recruiting and retaining internationally recruited staff. The findings shed light on the potential risks to social care service delivery across Scotland due to recent decisions by the Home Office regarding international recruitment pathways.

The survey was initiated in response to Scottish Care member reports regarding increasing difficulties in international recruitment. The Home Office’s decision to request additional documentation and communication issues exacerbated concerns among care providers, particularly around Certificates of Sponsorship.

Data gathered from the survey revealed several key insights:

• Over 66% of Scottish Care members are currently recruiting staff from overseas, indicating a heavy reliance on international recruitment pathways.
• However, 68% of respondents expressed reluctance to consider international recruitment in the future, due to concerns over sustainability and financially viability.
• Respondents from 14 Local Authority areas indicate that care providers employ over 15% of staff from overseas, with 7 areas reporting over 25%.
• Alarmingly, some care providers reported between 95 – 100% of staff being internationally recruited, posing significant risks to service sustainability.

These findings highlight a serious concern over the sustainability of social care delivery in Scotland. The potential loss of internationally recruited staff could intensify the existing vacancy challenges and impact overall service provision.

Scottish Care urges policymakers to address the urgent issues facing social care recruitment. Immediate action is needed to protect social care service provision and support the sector’s workforce.

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Scottish Care has prepared a Briefing Paper for the International Recruitment Survey Findings, which is available here.

The National Care Forum (NCF) in collaboration with the Global Ageing Network, Scottish Care and UKRI has published a report resulting from the Social Care International Workforce Summit held as part of the Global Ageing Conference last year.  

The report’s publication also marks NCF CEO Professor Vic Rayner as the new board chair of the Global Ageing Network, a role she will hold for two years. 

Professor Vic Rayner said: “Co-hosting the Global Ageing Conference with colleagues from the Global Ageing Network and Scottish Care was a huge honour and one which I am thrilled to continue as I take over the leadership of the Global Ageing Network board. I relish the opportunity to nurture the international connections that have been made and set a course, together with members and partners, to tackle the issues affecting the care of older people around the world and ensure their rights are represented.  

“The work we will be doing together reflects the enormous change taking place throughout the world that has a bearing on the daily delivery of care and support to older people, particularly the impacts of mass migration on the global care workforce. Our discussions at the conference included insights from 14 different countries and collectively reached a series of conclusions and recommendations. It is now time for us to communicate these outcomes via this report and demand action and funding from our governments and policymakers to help ensure each territory is empowered to develop a robust care workforce, attract new talent while rewarding the dedication of current care workers, and continue to transform the lives of older people with excellent, professional care.”  

CEO of the Global Ageing Network, Katie Smith-Sloan commented: “Without an adequate, trained and well supported workforce, there is no care. Throughout the world, we are facing enormous challenges in attracting, retaining, training, compensating, and elevating the profession of care workers. A global challenge needs global solutions. To this end, the Global Ageing Network and our members, as a global community dedicated to the well-being of older adults, are committed to raising awareness and driving the public and private sector towards urgently addressing the workforce crisis. There is a way forward if we work together.” 

The report is available to download here.