2018 as the Year of Social Care

Let’s make 2018 the Year of Social Care

In one of the most famous broadcasts since the start of radio, George VI used the words of the poet Minnie Haskins to start the New Year in 1939

‘And I said to the man who stood at the gate of the year:
‘Give me a light that I may tread softly into the unknown.’

These words were uttered at a point in history of great uncertainty, fear and alarm at the start of the year which would see the horrors of the Second World War start to unfold.

They are also words which over time became synonymous with the start of the year, with the sense of journeying into a future which was undetermined and full both of potential and challenge.

To some degree every New Year message from politician and commentator alike has combined a mixture of reflective analysis of the year that has past and a consideration of both the challenge and the potential of the year that is to come. The recent flurry in the last few days of such messages from Scottish politicians has tended to concentrate on the extent to which 2018 is a year which because it is the Year of Young People will enable us to focus on the contribution of the young to moulding our modern Scottish society.

In this message at the start of 2018 I would like to suggest that 2018 should be the Year of Social Care – regardless of the age of those who might be in need of the essential life enabling support and care which social care offers.

I do so well aware that in 2018 we will witness the 70th anniversary of the NHS in the United Kingdom. That celebration will help us to focus on the amazing contribution which the NHS and those who work in it have made to ensuring the health and wellbeing of our communities. Over the last 70 years we have seen extra-ordinary advances in care and treatment which have helped eradicate many of the diseases which formerly scarred society, control many others and result in astonishing progress in life expectancy and the quality of life for countless millions. So, 2018 will indeed be a year to celebrate the NHS.

But we are increasingly aware of the interdependency of social care with the clinical health system represented by the work of the NHS. The integration of health and social care in Scotland underlines a reality that we have long been aware of – namely that a failure in one part of the health and care eco-system, including a failure to adequately resource, has profound impact on another connected area. At the present time, the impact of the flu epidemic which is putting strain on the NHS, stretching A&E services, and impacting on delayed discharge is evidenced in the related struggles to arrange packages of social care to enable people to be discharged and to be supported at home or in a homely setting.

The celebration of the NHS reaching 70 will be somewhat hollow and vacuous if it is against a backdrop of the sounds of a disintegrating and deteriorating social care system.

Social care in Scotland is at a crossroads as we move into 2018.

Regular readers of these blogs will be well aware that throughout 2017 I have been warning of the ‘crisis’ facing social care. We have 9 out of 10 home care providers struggling to recruit staff and in the last few weeks faced with increased staff illness, the challenge of the better-paid retail sector, and ever shortening time-slots in which to deliver dignified care – home care providers have been really challenged to keep the show on the road and deliver urgent care and support at the point of need, no matter how isolated those locations might be.
Our care home providers faced with a vacancy level of 31% for nurses, nearly a quarter of care staff leaving the sector last year and with the already real living nightmare of Brexit, they are continuing to deliver increasingly high-quality care to some of our most vulnerable citizens in palliative and end of life contexts and to individuals living with the challenges of advanced dementia.

We have, in Scotland, so much which is full of potential and promise. Staff who are quite simply astonishingly professional and multi-skilled despite being paid basic wages. Legislation around Self-directed Support which has the potential of giving real choice and control to the individual citizen, which builds support around the person rather than the needs of the system. We have the start of the Health and Social Care Standards which have human rights at their heart and which if properly implemented and supported will help to advance care. We have new legislation which seeks to put carers at the heart of an effective and resourced support system in recognition of their critical contribution. The potential therefore is evident – the challenge in 2018 is to realise that potential.

As I write this piece our politicians are discussing and debating the Budget proposals of the Scottish Government. Despite my own call for a 3-year urgent investment of £1 billion pounds in the whole social care system, that Budget has promised only an additional £66 million to ensure the reforms, developments and delivery of this critical part of our social fabric. I hope the politicians who do have influence hear the urgent calls for further substantial investment in social care in Scotland. We can no longer tolerate the shame of 15 mins visits, where dignified end of life care and support, where the opportunity of personal care, is being crowded out by the budgets of austerity which affect the old, infirm and dying most sharply. We can no longer as we move into 2018 consider it acceptable that your chronological age has become the determinant of whether you get the opportunities to live a meaningful and independent life.

‘And I said to the man who stood at the gate of the year:
‘Give me a light that I may tread softly into the unknown.’

2018 needs to be the Year of Social Care in Scotland. A year when as a society we make the choice to value those who care and the work of care as making an essential contribution to Scotland rather than being a drain on our nation; where we celebrate the astonishing dedication and skill of the 10s of thousands who today care for our fellows in challenging, emotional and draining circumstances by properly rewarding them; and when we adequately resource social care especially for our vulnerable old to enable them to live life to the full and to die well.

Our political leaders have the opportunity of leading us into that future or merely standing still at the gate.

Dr Donald Macaskill

A Message from our CEO: A Christmas Thank You

Thank you …

As Christmas Day gains momentum across the country the chorus of thank you’s will become louder in homes up and down the land.

As children with eager-eyed enthusiasm discover the capacity of Santa Claus to forgive their naughty actions.

As partners exchange just a token of what they mean to another.

As friends find wrapped in a gift an expression of their gratitude.

As families, close and familiar, occasional and detached, sit down to pull crackers, drink, share food, stories and gossip, hopes and dreams.

Christmas Day is indeed a day of thank you’s and a reminder of what we count as important in our living and loving.

So I want to add to the chorus of thank you’s…

Thank you to the homecare and housing support staff who have been out from early hours till late this evening bringing food and comfort, presence and a smile to someone who might see no one on this day. Thank you to all 60,000 plus of you.

Thank you to the staff who will serve meals, tender to the physical needs and enliven the hopes of the 33,000 people who are in a care home today. Thank you to the thousands of nurses and care home staff who are working today.

Thank you to the one who holds the hand of someone frightened and anxious as they come to the end of their life- your comfort is a gift beyond price.

Thank you to the one who through word, smile and encouragement gives a lifeline of hope when the dark fog of depression and mental distress freezes up a life.

Thank you to the one who stays longer than she should; who sacrifices her own family time to be with a lonely life; who brings the comfort of presence when the pain of aloneness is overwhelming.

Across Scotland let us hear the clamour of thank you’s to the thousands who are working today to care, to nurse, to heal and to give the gift of presence. We owe you a gift beyond purchase or price.

Thank you

Donald Macaskill


Scottish Care responds to Scottish Government announcement of additional winter funding

The Scottish Government have announced that an additional £8.4 million will be made available to NHS Boards to improve service resilience over the festive period – https://news.gov.scot/news/additional-funding-for-nhs-winter-resilience 

The funding is intended to support new ways of working in supporting people to transition through health and social care services, including:

  • well-co-ordinated, multidisciplinary urgent health and social care provision across the whole care system
  • sufficient levels and numbers of senior decision makers from all sectors rostered
  • NHS 24 providing enhanced support for self-management and direction to the right service where needed
  • promoting community pharmacies as a source of advice and medicines
  • proactive discharge planning in advance of public holidays

The announcement means that the total investment for health and social care services to deal with winter pressures and unscheduled care will now be a record high of £22.4 million this year.

Whilst Scottish Care welcomes any additional funding to support what is an extremely stretched and under-resourced sector, the timing and intentions of this funding raise questions about the effectiveness of strategic planning at national and local level.  The fact that this year’s funding represents the largest winter funding amount on record is concerning rather than reassuring given that it points to a continuing lack of proactive, preventative and inclusive planning processes.  It suggests that the issue of winter pressures on services is worsening each year, rather than being planned for and alleviated.  Social care supports are not a tap that can be switched on and off, and simply attaching a lump sum to a pressured time of year does nothing to improve the existing challenges which inhibit an individual receiving the right support at the right time such as problematic commissioning approaches, unsustainable services, recruitment and retention difficulties and a lack of meaningful engagement with independent sector social care providers.  If these issues were prioritised in a year-round way, we may not be facing the prospect of a challenging winter for care providers and workers and most importantly, the risk of individuals not being able to access the right support and experiencing negative outcomes as a result.


Media Statement: Care sector plea for urgent investment ahead of Scottish Government Budget

Scotland’s independent care sector has issued an urgent appeal for extra funding ahead of the Scottish Government’s budget proposals next week (Thu Dec 14).

And it says the time is right for the authorities to “invest seriously in the social care sector”.


In a pre-budget briefing paper Dr Donald Macaskill, chief executive of Scottish Care, the representative body for the independent care sector states:

“We are calling upon political leadership within the Scottish Parliament to give serious consideration to the necessity of urgent investment within the social care sector in Scotland.

“We acknowledge that local government has to a significant extent maintained investment in social care despite cuts in funding.  However, this maintenance alone is insufficient given the growing level of need, increase in dependency and enhanced demographic demand. If we are even going to achieve the current provision, albeit reformed, never mind the development of higher quality provision, the social care sector for older adults in Scotland requires urgent and serious additional investment.

“The sustainability of the sector cannot be secured without a significant increase in funding.”

The briefing document has been sent to all MSPs in a bid to highlight the extent of the problems facing the sector which employs more than 100,000 in Scotland – including 5000 nurses.

The briefing document states:

“The care home sector in Scotland is facing a significant crisis.  This is not a word which is used lightly because after all, we are talking about the places people have come to know as their homes, and we are holding in our concern the 53,000 members of staff who rely on the sector to make their living.  The care home sector in Scotland cannot face another year of spiralling costs coupled with even greater recruitment and retention challenges without there being an inevitable set of closures and withdrawals from the care home sector.  Whilst there has been an increase in funding over the last two years this has virtually all been taken up by requirements to pay the Scottish Living Wage.  We applaud this policy but are deeply concerned that there are signs that the Scottish Government may rightly want us to continue to pay staff more but without a willingness to fund local authorities to allow us to do so.”

In a stark warning about the future of the sector the briefing continues:

“Scottish Care has clear evidence that a good number of providers will seek to withdraw from the sector in the next calendar year unless there is a substantial redress to outstanding issues.”

It adds:

“Scottish Care believes that the time is right for all parties, importantly including Scottish Government, to invest seriously in the social care sector.  For instance, there is a real risk, which is already becoming evident, that Integrated Joint Boards will seek to reduce the use of the care home sector in order to make short term financial savings and to balance the books.  We believe that such an approach endangers the health and wellbeing of countless individuals.  It fails to adequately understand the growing challenges of dependency and clinical need, and presents a real risk to the safety of individuals and our communities.  Such an approach relies on individuals remaining in their own homes, yet it is clear that Scotland’s family carers are at breaking point and that the home care sector is in a parlous state due to equal under-investment.”

Quoting comments from one service provider, the document goes on:

“It all comes down to funding.  Without adequate funding, we cannot pay enough to attract staff.  Without quality staff, we cannot provide the quality of care we want to.  Without funding, we cannot train our staff.  The recruitment and retention problem is only getting worse… The sector is skating on a dangerously thin piece of ice which is only getting thinner and without proper funding, we are going to see many services fall into the cold dark waters and drown.”

Scottish Care members provide 89% of care home places in Scotland and deliver more than 50% of home care hours for older people as they support approximately 65,000 people

Scottish Care states:

“Prevention of unnecessary admissions to hospitals through better use of social care services (namely care at home, housing support and care home services) could result in positive preventative action and significant savings to the public purse.

“Care at home services are currently facing significant pressure which is affecting sustainability.  Recent work by Scottish Care has highlighted that more and more providers are either refusing to tender or returning existing contracts on the basis of their non-viability.  Given the scope of the independent care at home sector across Scotland, should such actions continue or gather momentum then the sustainability of enabling independent living will become impossible.”

Emphasising problems recruiting and retaining staff the document continues:

“We are facing a crisis in Scotland at the present time: 77% of care homes have workforce vacancies, 28% have seen an increase in the use of agencies for non-nursing staff, 22% is the annual turnover rate for all care staff.

“For care at home and housing support, the figures show that: 9 out of 10 care at home providers have difficulty recruiting care staff, almost 20% of organisations are not at all confident that they can continue to operate at current provision levels over the next 12 months.”


  • Scottish Care represents over 400 organisations, which totals almost 1000 individual services, delivering residential care, nursing care, day care, care at home and housing support services.


  • Our membership covers both private and voluntary sector provider organisations. It includes organisations of varying types and sizes, amongst them single providers, small and medium sized groups, national providers and not-for-profit voluntary organisations and associations.


  • Our members deliver a wide range of registered services for older people as well as those with long term conditions, learning disabilities, physical disabilities, dementia or mental health problems.



CMA publishes final report on market study into care homes

The Competition and Markets Authority (CMA) has published a new report based on its year-long market study of care homes across the UK.

The review focused on whether the care home sector is working well for older people and their families.

The report’s general findings include:

  • The current system for providing care is not sustainable without additional funding. The CMA’s financial analysis of the sector has identified a funding shortfall of £1 billion a year across the UK because councils are paying fee rates for the residents they fund which are below the costs care homes incur. This has led to care homes propping up their finances by charging higher prices to those who pay for their own care (self-funders). On average, self-funders’ fees (£44,000 per year) are around 40% higher than those paid by councils (UK average).
  • Beyond the challenges of continuing to meet existing needs, the sector must grow substantially as the population ages. However, uncertainty about future funding, including whether council fees will cover the full costs of care, currently means that there is not enough investment in new accommodation for council-funded residents.
  • Many people choose care homes during an emotionally traumatic time, but the basic information and support needed is often not available to help them navigate the system and make informed choices.
  • There needs to be greater protection in place for people in care homes. Residents and their families often find it difficult to raise concerns or make complaints, and the systems for redress and feedback need to be improved. There is also too great a risk of residents being treated unfairly, and in breach of their rights under consumer law. Examples of the CMA’s concerns include where homes are not being clear enough up front about their prices or terms and conditions, do not protect residents’ deposits effectively against the risk of insolvency, are not fair when asking a resident to leave or when they ban visitors.

Throughout the study, the Competition and Markets Authority have engaged with Scottish Care and members to better understand the particularities and nuances of the Scottish care home sector: its challenges, developments and how it operates differently to other parts of the UK.  This has included focus groups and multiple telephone interviews, plus the sharing of Scottish Care’s research and reports.

Based on the CMA’s engagement with various stakeholders in Scotland, the final report includes a Scottish summary of the market study’s findings.

It identifies two broad areas for improvement in Scotland:

  • Those requiring care need greater support in choosing a care home and greater protections when they are resident. Current and prospective care home residents must be able to make the right choices, and must be protected if things don’t work out as expected;
  • Issues around state-funded care and the provision of sustainable capacity – the market must support the state’s intention to ensure that all those who have care needs have them met. This requires that the industry must be sustainable and incentivised to invest and modernise to meet future needs.

In light of these areas, the CMA have made a number of recommendations to the Scottish Government, the Care Inspectorate, local authorities, IJBs and the care home sector.  These include:

  • A programme of actions around clear and accurate information, supported decision making and awareness raising to enable people to make informed decisions about their options when choosing a care home and to ensure they are aware of their entitlements.
  • Safeguarding actions to protect against infringements on consumer law, such as the development of detailed guidance for care homes and residents, stronger regulatory oversight of consumer law compliance and the use of model contracts between care homes and prospective residents.
  • Improvements to complaints systems such as a review of access to advocacy services and closer inspections of feedback mechanisms.

The report also gives particular focus to the issue of state funded care and its sustainability currently and in the future.  It clearly recognises the shortfall in state funding in meeting the cost of care and recognises the importance of investment in the care home sector.

Recommendations are made in this area for other parts of the UK.  However for Scotland, the CMA explicitly welcome the ongoing development of a cost of care model for local authority-funded care and the planning and commissioning roles of IJBs.  The CMA has therefore opted not to make specific recommendations other than to stress the importance of the ongoing assessment and monitoring of these actions to ensure they are delivering the changes required.  The report emphasises:

“Our concerns around the delivery of state-funded social care are important, as the delivery of an effective and sustainable social care system must be maintained.”

Scottish Care will continue to work with partners and stakeholders around these recommendations.

Dr Donald Macaskill, CEO, said:

“Scottish Care welcomes the publication of the CMA’s market study, particularly in its articulation of the reality long described by Scottish Care – that there is significant and damaging underfunding of social care in Scotland and the rest of the UK.  It highlights the impact of stripping tens of millions of pounds out of social care by Westminster and by Scottish Government, which can only serve to negatively and disproportionately impact on our older and vulnerable citizens.  Current rates of as low as £3.42 an hour to support an elderly person with multiple and complex needs for 24 hours, 7 days a week in a care home in Scotland in no way meets the true cost of providing high quality, sustainable care.  It is absolutely essential that this funding reality is addressed as a matter of urgency in order that everyone who requires care home support can receive this in a way that promotes equality, transparency, dignity and respect.”

The full CMA report can be accessed here: https://assets.publishing.service.gov.uk/media/5a1fdf30e5274a750b82533a/care-homes-market-study-final-report.pdf 

The Scottish summary can be accessed here: https://assets.publishing.service.gov.uk/media/5a201ae7ed915d458b922ec6/scotland-short-summary-care-homes-market-study.pdf 

The CMA’s financial report, published in September, can be accessed here: https://assets.publishing.service.gov.uk/media/59b2bb0ae5274a5cfcda2d18/financial_analysis_working_paper.pdf

What does good care mean? New Scottish Care film launched

Scottish Care is delighted to launch a new film, commissioned by Scottish Care and created by film maker Michael Rea, at the National Care Home Conference & Exhibition.

The film tells the story of 'what good care means', from the perspective of care home residents, relative and care staff.

Thank you to all who contributed to the creation of this film.

We hope you enjoy it and share it widely.

Scottish Care Statement on Self-directed Support to Scottish Parliament Inquiry

Scottish Care, along with a number of other organisations, was asked by the Public Audit and Post-legislative Scrutiny Committee of the Scottish parliament to supply brief written evidence for their work on Self-directed Support.

The Scottish Care evidence is contained below.

The evidence can be accessed at http://www.parliament.scot/parliamentarybusiness/CurrentCommittees/106127.aspx

You might also find it useful to read our media statement in response to the Audit Scotland Report when it was first published.





To Absent Friends Festival 1-7 November 2017

People who have died remain a part of our lives – their stories are our stories, yet many Scottish traditions relating to the expression of loss and remembrance have faded over time.

To Absent Friends gives people across Scotland an excuse to remember, to tell stories, to celebrate and to reminisce about people we love who have died. To Absent Friends, a People’s Festival of Storytelling and Remembrance is an opportunity to revive lost traditions and create new ones.

The annual To Absent Friends festival will take place across Scotland from 1-7 November 2017.

More details can be found at https://www.toabsentfriends.org.uk/content/festival/


Home Care Day: The role of home care in supporting solace at end of life

Katharine Ross, Workforce Lead for Scottish Care, shares her experiences of being part of palliative and end of life care research with home care staff

In my role as the National Workforce Lead for Scottish Care I’m constantly inspired and moved by the dedication of our care at home workforce providing care and support to some of our most vulnerable citizens across Scotland.  I’m pretty much overwhelmed with admiration when I speak to providers and front line support workers about the compassionate palliative and end of life care (PEOLC) they deliver – day in, day out.   


A Scottish Care research project I’ve been involved with explored the reality of PEOLC delivery in care homes and care at home organisations from the perspective of front line support workers.   At four locations across the country my colleagues and I were privileged to listen to the reality of delivery end of life care in individual’s own homes.  We heard extraordinary stories of physical, practical, social, and spiritual support - all of which was being delivered by dedicated and committed front line support workers.


This is a workforce which, in reality, provides the largest proportion of palliative and end of life care in Scotland -  but whose voice is often unheard and unacknowledged.

A workforce which, sadly, is all too often associated with a “shopping and mopping” service -  and which is not recognised or appreciated for the complex technical, clinical, and emotional support delivered by them day in, day out. 


We listened to their experiences and recorded their thoughts, emotions, concerns and ideas.


We heard support workers sharing their experiences of caring for older people at the end of their lives, often with little or no specialised training.  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 about 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”


 The commitment of the workforce was evident, with numerous examples of activities taking place outside of what we may consider to be a standard working day for a home care front line support worker.  As somebody said:

“We cared for somebody in their own home.  After he died, we went in to strip the bed and return the room to normal because we knew his wife couldn’t handle doing that.  We did it in our own time.”


Love and compassion were palpable in every conversation and can be captured in a comment made by one focus group participant:

 “Everyone I’ve looked after….they’re in here.  They’re in my heart.”


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. 


For care at home support workers the reality of death, loss and grief is something they’re required to face on a daily basis.  Integration activities and the redesign of primary care provision must therefore embrace this.   Support mechanisms need to be in place to develop enhanced training and education and facilitate the creation of a system which supports solace - not one which commissions and pays for end of life care in the community by the minute. 


Our findings have been captured in a report entitled Trees that bend in the wind – which was how one of the focus group participants described what it’s like being a support worker involved in somebody’s dying journey; you have to adapt, change, bend and flex to their individual journey and to experience it with the supported person.  Bending, but not breaking; trying not to lose part of oneself in the process.


But at what point do front line support workers break – physically, and/or emotionally?  There has to be greater recognition of the fact that if the frontline social care workforce breaks, so does the entire integrated health and social care system. 


Trees that bend in the wind 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.  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. 


Delivering palliative and end of life care to older people in somebody’s own home 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 home care support worker’. 


That is why I’m delighted to be working with my Scottish Care colleagues, providers and stakeholders to ensure more people understand the complexity of care at home delivery. 

Please take a few minutes to watch the short Trees that bend in the wind animation and share with your friends and colleagues.  It beautifully captures the loving, dedicated and extraordinary voices of the front line social care workforce.  

I’d be delighted to hear from you so we can ensure these voices are heard more widely. 


Katharine Ross

National Workforce Lead – Scottish Care

[email protected]