Scottish Care has consistently highlighted the growing crisis facing social care across Scotland because of chronic underfunding. We are therefore not surprised but nevertheless disappointed to read the latest Annual Report from the Audit Commission on the performance of local government in Scotland.
Most social care in Scotland is funded by local authorities and voluntary and independent providers deliver most of the care and support which is needed. The fact that there has been a substantial reduction in funding for local authorities has immediate consequence for some of our older citizens.
Scottish Care members seek to deliver high quality, rights-based care and support to enable people to live as full a life as possible in both a homely setting and in their own home. This is becoming increasingly impossible to achieve because of the current financial restrictions.
The Accounts Commission report indicates that local authority budgets have seen a real-terms cut of 9.6% over the last eight years. Their warnings that Scotland’s aging population and demographic changes are increasing the strain on services is something which social care providers know every day to be happening already.
We agree with the Accounts Commission that there are many factors impacting on local government and their ability to adequately fund social care services, not least the concerns around the uncertainty which Brexit is causing.
But alongside the reductions in public spending we are witnessing a sharp rise in demand for social care, coupled with the presumption that families can bear more and more of the burden. If we are going to preserve an already fragile system then we need to think seriously about how we are going to fund care into the future.
The Accounts Commission has warned that without changes that some councils could be spending 80% of their budgets on education and social work alone by 2025-26.
Scottish Care CEO, Dr Donald Macaskill commented:
“Every week we seem to have yet another report highlighting the critical state of our social care system in Scotland. Yet no one seems to be listening or taking any action.
Four months ago in the Scottish Parliament I called for substantial investment into social care of several £100 millions and this was met as if I was asking for the impossible. What we got in the Budget was a £66million increase to partly fund an extensive range of commitments.
We have to stop using social care as a political football and we have to start getting real. Because the reality is that more and more of our vulnerable citizens are not getting the care they deserve. The reality is that hundreds of people are leaving jobs in social care every month because they don’t feel valued and suitably rewarded. The reality is that we are trying to care for more people on less resources.
I want to stop reading reports which describe a real crisis in care and start to see intentions and investment which speak of a society which wants to care, protect and support the most vulnerable. For that to happen we need urgent political action rather than empty rhetoric. We need cross political party working rather than factionalism. It is easy to find someone to blame – it is much harder to work together to address a crisis. ”
Prevention is the best care: the potential of prevention
In almost every strategy on health and social care in Scotland which you come across these days the two concepts of ‘prevention’ and ‘self-management’ are likely to appear somewhere. They are the aspirational essence of the modern health and care economy. Yet in reality for all the talk there has been little substance added to their mention.
In public health the mantra of prevention has been assiduously articulated. We know the success of preventative approaches in terms of smoking and the significant decline in diseases of the lung as a consequence. We also consciously recognise the benefits of anti-obesity campaigns and attempts to limit sugar intake even if we don’t always follow them. But in the realm of social care ‘prevention’ is often a political and policy mantra which carries little meaning and certainly not one which is currently deserving of resource commitment.
Last year Becca Gatherum in her report for Scottish Care, Bringing Home Care,articulated a vision of care at home which was firmly grounded in the principle of preventative approaches, was rooted in robust research including that of the LifeCurve and which evidenced real individual and societal benefit.
So what do we mean by prevention in social care? Put simply they are those models and approaches which prevent an individual from either early or unnecessary access to enhanced care, hospitalisation or sharper personal physical decline and deterioration. They are approaches which enable independent living for a longer period of time and are focussed on maintaining a higher quality of life and wellbeing. They are about maximising autonomy and control. And yes, significantly they are not only about personal benefit but providing an economic and societal benefit through the avoidance of expensive clinical and especially surgical intervention. Falls prevention is perhaps the best exemplar of the promise and potential of preventative social care.
Yet nearly a year on from the Scottish Care report I see no evidence of any Integrated Joint Board robustly taking up the vision of preventative care. Well strictly speaking that might not be true. There is ‘talk’ of prevention and there are some attempts to use technology enabled care to initiate some developments. Such approaches which use technology to map and monitor decline and physical change in a person have real benefit but without being part of a bigger prevention strategy they can only go part of the way.
In fact it might even be that we are causing damage to truly effective preventative models by some of our proposals and plans. I have seen in recent weeks some horrendous proposals appearing before IJBs which predicate savings based on reducing care home provision on the basis of using technology and assuming a non-existent robust and coherent homecare system which is enabled to undertake even more advanced clinical support in the community. This is dangerous thinking not deserving even of the mirage of planning and threatens not only individual harm but also any serious attempt to systematically reform the health and social care system.
A holistic model of preventative social care maximises the benefits of technology rather than uses it to replace human presence, professional judgement and instinctive experience.
Yet maybe it is not surprising that we have failed to see the adequate resourcing of preventative approaches – because they are initially costly and because you cannot remove advanced homecare at the same time.
Surely the time has come for us to not only to talk the talk around prevention but to be brave and start to walk the talk? It is time for someone somewhere to invest substantially in a model of preventative homecare AT THE SAME TIME as maintaining and building enhanced homecare. They are reciprocal and inter-dependent processes. The one cannot exist without the other. Prevention cannot be used as a replacement for person-led, rights-based, dignified care. You cannot achieve the beneficial outcomes of preventative approaches without initial investment – just ask any public health specialist!
Social care in Scotland urgently needs a sense of political vision which goes beyond bandaging the present system and dares to heed its own mantras and invests in real preventative social care.
Dr Donald Macaskill
@DrDMacskill
In January Scottish Care published research which highlighted the crisis which is facing Scotland’s home care services. We warned then and re-iterate the message again today that the survival and sustainability of homecare in Scotland is under serious threat because of the lack of sufficient investment. See
Our January survey showed that:
• Nearly 40% of care at home services handed work back to Local Authorities in 2017 on the basis of sustainability and capacity
• Half of home care services did not apply for contracts offered by their Local Authority in 2017 on the same grounds
• 86% of home care services are concerned about their sustainability and survival in 2018, with nearly a quarter extremely concerned
• 9 in 10 home care services are struggling to recruit staff for essential posts.
Scottish Care’s Chief Executive, Dr Donald Macaskill commented:
“The data released by Scottish Labour is concerning. Behind every statistic there is a story, for every day spent unnecessarily in hospital there is a lost opportunity for some of our most vulnerable citizens to be spending time at home with their family and friends. Often these are individuals in palliative care and end of life. Sadly, these statistics come as little surprise to Scottish Care.
There is a real crisis in homecare. Assessments are being delayed, care packages are not being offered, in part because many care providers in both the charitable and private sectors simply cannot deliver quality care on the rates they are being offered. I recently visited someone in hospital and 5 out of the 6 patients in the ward were ready to go home but they could not. That is a shameful waste.
For a long time Scottish Care has been calling for additional investment in social care. We all know the data about delayed discharge but we need to stop talking about statistics. People are stuck in hospital not because care cannot be delivered but because the resource is not being allocated to enable it to be bought. Despite every effort of local authorities to protect social care we have seen year after year a squeeze on the ability of care at home providers to meet the rise in demand and rise in costs.
The home care sector in Scotland is genuinely close to collapse and I am calling on politicians of all parties to work with providers to address these challenges. We will be told that there has been increased investment – well it is simply not enough as any visit to many hospitals will show. I am also deeply concerned that some of the proposed cuts to care home services in some parts of Scotland will see more and more vulnerable people being left unsupported in their own homes without care packages.
We have a huge number of home care services willing and able to provide high quality care in people’s own homes but who are stifled from doing so by a drive to the bottom because of a lack of resources. The inability of services to recruit and retain staff and to pay them a good wage further cripples these essential services. We are faced with a reality where a quarter of services are not sure they will still be operating this time next year.
We can no longer tinker around the edges of social care – the challenge needs to be grasped with both hands and driven forward by a political will to ensure there are a range of high quality, sustainable services available in people’s communities which will allow people to go home.
This holiday weekend when families come together we need to collectively address the underfunding of social care in Scotland which means that for too many often frail and elderly individuals they will be spending the Easter weekend in hospital rather than at home.”
Ends.
The shortlist for the 2018 Scottish Social Services Awards is now available. Congratulations to all the finalists and those who submitted nominations.
The awards are open to all organisations, services and individuals working in Scotland’s social services and social care sector and attracted over 100 applications nationwide, representing a diverse mix of social services that have made a positive difference to people’s lives.
Introduced last year, the Scottish Social Services Awards aim to cut across boundaries, celebrate excellence and bring one of the country’s largest sectors, with almost 200,000 workers, together.
Scottish Care would particularly like to congratulate our members who have been chosen as finalists in the 2018 awards. These are:
The winners will be announced at an Awards ceremony on 6 June in Edinburgh.
For more information about the Awards and finalists, click here.
Today (Tuesday 27th March), Dr Donald Macaskill will give evidence to the Economy, Jobs and Fair Work Committee on social care’s contribution to Scotland’s economy.
To read Scottish Care’s written response to the Committee, please click here
You can watch today’s evidence session here.
Is choice a human right?
I want to reflect on two remarks within speeches I heard yesterday to celebrate World Social Work Day and the 50th anniversary of the Social Work Scotland Act. They both had to do with choice.
The first speech was making a comparison between different approaches and philosophies around social care and social work, evidencing the change from the spirit of the 1968 Kilbrandon Report which assumed that social work would be delivered by local authorities, much in the vein as some politicians have recently articulated a desire to return to. But then with the passage of the 1970s and 1980s the speaker commented that consumerism and choice within a mixed economy of care had replaced what had happened previously.
The second remark was within an inspiring speech by a young man, Thomas Timlin, who told his own personal story from living in a neglectful environment, being taken into care, experiencing abuse at the hands of foster parents, through the separation from siblings and his natural mother, being told at 16 that the State had fulfilled its duties of care, to enduring periods of homelessness and eventually becoming a children and families social worker. He commented that no-one had asked his views at any time, no-one had given him choice, had asked him what he wanted at any stage whether during fostering or adoption. The lack of choice had denied him a voice.
Two very different comments about choice but they are at the centre of the current debate about social care in Scotland. They are for me at the heart of what a human rights based, person led approach to care and support is all about.
Choice is after all at the core of our primary social care legislation in Scotland. The Self-directed Support (SDS) Act states in its Principles that an individual shall be enabled to have choice whether that be in an outcomes assessment or in support planning or indeed in the delivery of their care and support. They shall have a choice of four options over which to decide how their personal indicative budget should be spent. They shall have a choice on which provider of social care they want and is best fit to meet their own individual needs. There is also a duty upon a local authority to promote such diversity within the ‘market’ and ‘local community’ to enabling a real exercising of choice. After all presenting a person with one provider (statutory or not) as a take it or leave it – is not choice its instruction.
The SDS Act is a true democratisation of control, consent, participation and empowerment. Choice is part of the DNA of social care legislation in Scotland. Our new National Health and Care Standards go even further and articulate this human rights emphasis and root good care and support within the principles of autonomy, control and choice.
So, is choice a right? Is choice just another term for consumerism and therefore should it be limited and curtailed? Is there anything wrong with the consumer (the citizen) exercising control rather than being told what to do or having their options limited by the State? Is choice a human right?
These are all important and critical questions because they are likely to shape debate within the social care sector in the months and years to come.
For me, personally, choice is an alienable right. My perspective is influenced by being a member of the Same As You? Implementation Group nearly two decades ago. This was a key and ground-breaking strategic Scottish Executive policy which stated that someone with a learning disability was deserving of the same rights, dignity, treatment and citizenship as any other person in Scotland. I remember one person with a learning disability speaking at a meeting and summing up what it meant to have choice. She said:
“It isn’t just that I should have the right to choose what to eat, to choose what I should wear, to choose who I spend my time with, to choose where I live as far as I can; it is fundamentally that I should have the right to choose who comes into my home, who attends to my personal needs, who supports me to fulfil my life. It is my right to choose who sees me naked.”
Choice for countless thousands who have been denied control and autonomy means absolutely everything. It is the vibrant spirit of freedom that gives purpose to activity and underpins individual contribution.
So be very careful of those who wish to undermine the choice that has been achieved for citizens in Scotland, whether they have a disability, live with a mental health condition, or live their lives in a nursing or residential care home.
Choice is fundamental and that choice critically includes the right to decide what organisation provides care and support to me should I require it. Our politicians need to tread warily on any of the human rights citizens have struggled for, rights for social care choice which have been achieved over the last two decades.
For many the freedom to exercise choice is about the ability to be fully a person. Choice has no sell-by date; choice is not an option, it is intrinsic to being an autonomous human being. Choice is a human right.
Dr Donald Macaskill
@DrDMacaskill
Terms & Conditions
Website Design by Creo Design part of the Solutions On Demand Group 2022. All rights reserved