Scottish Care welcomes the study and report undertaken by the Account Commission on the finance and performance of Integration Joint Boards. Its findings resonant strongly with the experience of social care providers in care home and homecare services.
We particularly recognise the analysis which highlights that the workforce is under immense pressure, and organisations are facing acute challenges of recruiting and retaining staff. Factors such as Brexit, Covid-19 and the cost-of-living crisis have all served to exacerbate these pressures.
Our experience of constricted budgets, the demand to make savings and the consequential impact this has had on the ability of citizens to access necessary care and support are all mirrored in the report’s findings.
Perhaps the most challenging part of the report is when it talks about commissioning, procurement and contracting services. It rightly calls into question our current systems which focus on competition and price, highlighting the political vested interest at local level. It rightly argues that providers in the private and third sectors are expected to take too much of the risk on within contracts, which is unsustainable. For instance, it cites a scenario where the cost of energy makes a service more expensive to deliver than the contract provides for, and yet the provider is still required to provide the service, bearing the loss.
The Report rightly illustrates the way in which private and third sector providers find that council commissioning rates are insufficient to deliver social care and support and residential, personal and nursing care, and pay expenses such as staff, training and overheads. These providers say they cannot compete with councils where pay and terms and conditions are better than they can provide due to the flat cash settlement local government receives from the Scottish Government.
The social care sector in Scotland is in a deep and unsustainable crisis, and this Report highlights why that is the case. Some of the responses to address this are within the hands of national and local Government and these need to fully utilised, not least of which is an urgent need to develop non-competitive, fair and ethical approaches to commissioning and contracting for providers.
More positively we are pleased to see case studies which evidence innovative and more effective ways of commissioning and procuring services, notably the Granite Care Consortium and the Fife Care Collaborative. What these new ways of working have in common is an emphasis on trust-built relationships, all professionals listening to one another, and all stakeholders actively involved in sharing mutual priorities.
Dr Donald Macaskill, CEO of Scottish Care stated:
“This is a hard hitting report which lays bare the real challenges facing our social care sector in Scotland and why we are falling short. It is clear that significant investment rather than cost savings are needed to give women and men the services and supports they need. We all know how we can make things work better. We need to get on and do it.
It is also clear that it is possible to work in new ways which make integrated working and services successful. This can only happen when all involved in the delivery of health and social care are around the same table and working together. It will not happen – as occurs in many parts of Scotland – where providers who deliver most of the care and support, namely the independent and third sectors, are kept at arm’s length. We need all partners to be prepared to work together and as this report shows, even after many years, this is still not happening.
Unless we all get around the table and spend as much time working together rather than seeking to cut an already vulnerable sector to the bone, we will never make integrated approaches work and we will continue collectively to fail our citizens.”
The Audit Commission report is available on: https://audit.scot/publications/integration-joint-boards-finance-and-performance-2024
