Human rights are at stake in Scotland’s social care.

On Thursday last week within the beautiful setting provided by Clydesdale Bank’s Banking Hall in Glasgow Scottish Care held its first Care Lecture. I hope it will become an annual opportunity to hear a guest speaker explore an issue of the day relevant to the care and support of older people.

We were honoured to have Judith Robertson, Chair of the Scottish Human Rights Commission as our lecturer. She spoke to the theme of “Human rights in social care.’ The full text of her address with added analysis will be available in our second Care Cameo to be published in a few weeks time.  Needless to say it was both challenging and thought provoking and centred upon a strong critique of both the UK and Scottish Governments failures to properly embed human rights in social policy.

I will leave further comment on Ms Robertson’s analysis for another time but what I want to focus on today is a wider issue of the prevalence of human rights in contemporary public and policy discourse. This is a markedly different position to where rights were in public discourse even some five years ago and in no small part is down to the work of the SHRC and its National Action Plan for Human Rights (SNAP).But there is always a concern that the rhetoric and pervasiveness of the use of the language of rights isn’t followed through in the realities of their adherence and at what is happening at the care face. That is probably a concern which is beginning to have validity. So briefly I want to explore where rights are engaged and may be facing challenge.

The Guardian newspaper this week  had a helpful article which explored some of the challenges faced by social workers in the assessment of clients in an environment where middle and senior managers are faced with hard decisions around austerity. They have utilised a human rights based approach to highlight where there is a restriction or diminution in these rights. I have personally been highly critical of the systems which are currently operating around Self-directed Support and which seem antithetical to the exercising of a human rights based approach. However as Carlyn Miller  has shown in her recent report it is absolutely possible to use human rights to support stretched social workers to adhere to the values and principles at the heart of good social work. In that regard we need to support a hard-pressed group of workers to resist the compromises of the system which serve to limit the rights of older Scots.

However, it is perhaps in the area of procurement and commissioning that we feel a particular sharpness and restriction of rights. The statistics around Self-directed Support and the limitation of informed decision-making and exercising of choice by older people speaks to me at best of poor training and inadequate advocacy and at worse of blatant age discrimination. But they also speak to a system which is disproportionately unbalanced. How can one person/organisation be assessor, commissioner and provider and still remain transparent and equal? Certainly not in that Scottish IJB which recently declared that it wants 70% of social care provision to be provided by one provider (itself) – I wonder if they have told the older people of their communities that that is their extent of choice?

At other areas of social care in Scotland there is a deficiency of rights –

•           where electronic call monitoring systems are being used by local authorities to monitor homecare contracts but result in the demeaning of a workforce by effectively treating them as human automaton in a trustless Big Brother approach;
•           where there is a failure to properly resource providers to adequately train and support staff in our communities and care homes who are delivering the majority of palliative and end of life care;
•           where the levels of regulation and registration are such that the same is expected of an individual with 3 weeks training as a care worker as of someone who has had 3 years preparation for the role of a nurse for social worker;
•           where the inadequacy of resourcing is resulting in thousands of older Scots being prevented from being given sufficient finance to allow them to remain as part of their communities;
•           where an appropriate focus on dementia is used to mask the lack of recognition for the other mental health needs of older Scots.

And I could go on. The rhetoric and talk of rights is cheap and casual, the exercising and implementing of rights are costly and hard. It is the latter we need to engage in or we will continue to use the language of sound bite. We sometimes imagine the abuse and limiting of human rights as out there, somewhere distant from where we are and the now, the truth is that human rights are on the line right now and right here as we deliver social care in Scotland. 

Dr Donald Macaskill

@DrDMacaskill

Sex discrimination at the heart of social care in Scotland

Overheard whilst visiting friends: young 5 year old boy says to mum who is struggling to get the DVD player to work, “We will need to get dad. It’s men’s work!” The stony glare from his mother highlighted for me the way in which our children’s view of the world and the roles we play in it can be so greatly influenced by gender attitudes. Brought up 5 decades ago on one level society seemed to be giving me a clear message, namely that men did the hard physical work and women did jobs such as nursing and care. Despite advances on so many fronts I’m less and less convinced that things have changed in terms of our stereotyping of roles or that we have undertaken the serious and hard work needed to address gender segregation in society. So its not surprising a 5 year old in 2017 is still demonstrating attitudes of 50 years before.

At the end of last week the media reported the result of a historic equal pay case that could potentially cost Glasgow City Council hundreds of millions of pounds. For 12 years lawyers representing more than 6000 mainly female workers fought against the city administration which had graded jobs dominated by men, such as gravediggers and refuse collectors, above those largely done by women, such as home carers and cleaners. Last week three judges at the Court of Session quashed an earlier employment tribunal ruling that the grading system met equal pay laws.

Dependent upon a settlement the ruling has huge fiscal implications for Glasgow City Council but what it also displays is the insidious acceptable face of sex discrimination that has infected the treatment of care staff over the years.

Is it acceptable in Glasgow or elsewhere that predominantly male roles, such as gravediggers or refuse collectors, however valued a role they play, are rewarded so much more than mainly female care staff?

Why is it that we value the work of those who care so little? The fact that we are paying ‘only’ the Scottish Living Wage and struggling to even achieve that – communicates its own message of limited value and respect, as does the term ‘un-skilled.’ Yet the reality couldn’t be further from the truth. Today our care staff are engaged in multi-skilled, complex, clinical care and support – and still we reward them less than those who dispose of our detritus. It’s not surprising then that staff say they are made to feel ‘worthless.’

It seems to me that the whole of society continues to demean and devalue care. Our local authorities and Integrated Joint Boards are no doubt somewhere in Scotland as I write this issuing a tender or contract whose poor restrictive terms will make it inevitable that a care provider will have no alternative but to offer staff low terms and conditions. And probably the same authority will hypocritically laud itself as a Living Wage Employer – that is to its own staff!

Added to that when you eventually do get a contract the chances are that electronic contract monitoring will make staff feel as if Big Brother is watching them every step of their day! There is a simple truth that fair contracts and commissioning lead to fair work practice.

The Tribunal ruling against Glasgow City has helped to shine a light on discriminatory practice. With a workforce which is predominantly comprised of women at some 86% I am absolutely certain that the unequal treatment, poor terms and remuneration, intrusive work monitoring and lack of trust, are in part the result of systemic sex discrimination in social care in Scotland. Would any sector or profession dominated by men have to endure such unequal treatment and abuse?

Care is a female role so clearly not as important or worthy of reward as manual masculine labour is. That’s the message we are communicating and not just to 5 year old boys. It’s time to start challenging the status of care and stop having to scrimp and robustly negotiate for financial crumbs to provide quality services and offer decent conditions for workers.

It’s just a pity that in Scotland’s social care system expensive legal cases have become the route to achieving equality and dignity for our female workforce and by extension for the thousands they care for.

Donald Macaskill (Dr)

@DrDMacaskill

Every week there seems to be yet another report highlighting the crisis state in which the health and social care workforce finds itself. We have had dire warnings about the shortage of doctors and their levels of fatigue. We’ve had the RCN stating the pressures resulting from nursing vacancies in the NHS. Scottish Care in the spring stated that 9 out of 10 care at home organisations are struggling to fill vacancies and two weeks ago we reported again on nurse vacancies running at over 1 in 4 posts lying empty and over 2/3 of care home providers struggling to fill positions. With the added pressure of Brexit, the rising Scottish Living Wage and pressure from retail and hospitality it is an operational nightmare to try to fill posts and establish an adequate workforce.

We need a fundamental review of the workforce in social care and that cannot be undertaken in isolation from a root and branch review of the whole sector. At the moment it feels as if we are lurching from one reaction to another without a coordinated and thorough review.

Policy makers declare that we need to develop a workforce to fit the needs of the future. We keep hearing about ‘new models of care’ as if there is a utopian reality where quality person centred rights based care is just waiting to be discovered offering a cheap alternative to current models. That is a naive wishful thinking that ignores that the basics of care are inherently consistent – the heart remains the same whatever the outward form of delivery. That heart requires people, namely a well-equipped, resourced, valued and skilled workforce.

We have to accept that we will never address workforce shortage by under-resourcing the care sector. How can we build stability, career pathways and a future for staff to commit to when we have organisations with no sense of sustainability due in part to one year contracts and a lack of investment in a sector which is a major player in the Scottish economy?

There are new and innovative approaches to the care workforce with the work of Highland Homecarers and the Local Cornerstone model to name but two.  Whatever the specific model for a workforce fit for the future they have some intrinsic and consistent elements:

• Autonomous frontline workers able to make decisions and supported to take action
• Self managed teams where the emphasis is on collegiality and outcomes – a sense of making a contribution that matters
• Professional respect with colleagues in other teams
• Being part of a multi-disciplinary team with clear escalation routes and an emphasis on locality and flexibility
•  Light touch oversight through proportionate regulation and appropriate levels of information recording
• An emphasis on staff physical and emotional wellbeing as critical to a healthy team
• Excellent learning and development for staff who are enabled through rota planning to learn and to develop their skills for whatever career pathway they choose
• Appropriate and rewarding terms and conditions as well as a good level of basic pay.

These are some of the ingredients which we know when they are present staff are made to feel valued and are therefore more likely to remain in their posts. Yet what we have today is light years away. What we have at present are reports which like one from Christie & Co tell us that care homes say they are “increasingly competing with supermarkets like Aldi and Lidl who are actively recruiting and offering attractive pay rates”.

Getting it right for our workforce means getting it right for those who are supported and cared for in our communities and care homes. This should be a set of jobs valued and recognised for their benefit to the whole of Scottish society.

 @DrDMacaskill