It’s been a busy General Election period, where Scotland has seen many of its frontline Holyrood politicians campaigning on behalf of their Westminster colleagues during the past month. With social care being a devolved matter, the needs of those accessing care and support in Scotland have taken a back seat in public discourse. With the commotion over, Scottish Care remains firm in its contention of the pressing need to return closer to home in order to achieve sustainability across the adult social care sector. This must be top of the Scottish Government’s agenda.
Scottish Care’s recent myth-busting report detailed the current sustainability crisis facing the independent sector, with insufficient funding borne from unfit-for-purpose funding models.
Independent care homes are suffering the greatest level of closure across all sectors, bearing the largest decrease in publicly funded care. Rising running expenses, agency staff costs, and the continued impact of high inflation have highlighted the insufficiency of the National Care Home Contract, and its inability to meet the unique requirements of varying models of care, and in varying (often rural) locations across Scotland. Funding for publicly funded residents (particularly those requiring nursing care) is below the level of sustainability, and burdens care homes with the intolerable choice of increasing fees to residents or risking closure. Compounding this is a growing restriction on purchasing care beds in several local authority areas, thwarting any opportunity to offset losses for existing care with new service users.
Compared to other devolved administrations and English Government regions, rates for homecare services in Scotland have failed to increase to the level required to sustain service provision. In all too many cases, rates have either stagnated or decreased. Given an inability to sustainably deliver services, care at home packages are being returned to local authorities at an increasing rate.
Given this trying financial climate, the relationships on which commissioning is based are also fraying. Scottish Care has become aware of cases throughout the country, of the ongoing pressure on care at home and housing support providers to reduce package costs for providers currently delivering services. The possibility of package withdrawal, or the denial of further opportunities to tender, looms large.
Mutual respect and trust is imperative across the commissioning process, and urgent reform to funding models is required as a means to support both providers and commissioners, and to halt the deterioration of the relationships between them.
Ultimately, those who require care and support are impacted, with a postcode lottery reducing choice to larger services that can manage economies of scale and funding shortfalls. In accordance with the Social Care (Self-directed Support) (Scotland) Act 2013, every person who requires social care and support has the right to choose a provider for their care. The current dearth of sustainable independent services and subsequent choice for individuals has seen the continued denial of this legal right. A sustainable mixed market model is the essential prerequisite to choice and control, realising of the rights of those accessing care and support.
These issues occur in the shadow of the ongoing development of the National Care Service (NCS). On Monday 24 June, the Minister for Social Care, Mental Wellbeing and Sport, Maree Todd released draft Stage 2 amendments of the NCS Bill. The Health, Social Care and Sport Committee will consider these amendments, alongside responses to the public consultation, over the course of the coming months.
The NCS represents an opportunity to cement a fit for purpose funding model as part of long-term systemic reform to the adult social care sector. Scottish Care remains committed to a vision of a shared national framework as part of the upcoming NCS, with flexibility for local funding solutions to unique care demands, and non-negotiable conditions for commissioning agencies to meet the true cost of care. Such a framework is key to cementing reform that supports the independent sector’s sustainability and commercial viability, and the importance of their care to communities across Scotland.
A central part of this reform, and Scottish Care’s subsequent advocacy, is the continued drive towards ethical commissioning. Scottish Care recognises the potential of ethical commissioning across Scotland as a means to address this crisis in sustainability. This is through an end to the emphasis on price and competition which has led to this crisis in sustainability.
There are no quick fixes to these systemic problems, and direct engagement with the independent sector should be the first step in achieving proper understanding of the vital role the independent sector plays in the delivery of social care and support, and how the sector’s current plight jeopardises such delivery.
It therefore must be back to the day job for our elected representatives in Scotland, to achieve the sustainable adult social care sector that communities across Scotland deserve.
By Fraser Smith
Policy Lead (Ethical Commissioning), Scottish Care
