At the heart of the social care sector in Scotland there is a systemic discrimination that is often not named or called out for what it is – it is a discrimination based on sex or gender. Over a year ago in its exploration of the Gender Pay Gap, the Economy and Fair Work Committee of the Scottish Parliament in its important report ‘No Small Change’  identified that gender segregation was a real phenomenon within the care sector in Scotland. Indeed, the evidence submission from Scottish Care to that Inquiry argued that gender discrimination was at the root of a great deal of the issues facing the sector. Yet more than a year later has anything changed? – absolutely nothing other than a wider dialogue and acceptance of the challenges of gender discrimination in care and all that entails. Indeed part of this wider valuing of social care has seen the same Parliamentary Committee’s acceptance of the important economic contribution of social care to the overall economy of Scotland. (See Scotland’s Economic Performance) So at the risk of simplification what do I mean by discrimination and why is it an issue? Put simply discrimination is when you treat one group or sector in society in a manner which is less favourable than the way you would treat another person or group. We can easily recognise the racism which considers one group as being less than another because of their county of origin or the colour of their skin. We have become increasingly aware and critical of the way someone who might define their sexual orientation as lesbian, gay, or bisexual might be the victim of homophobia and hate crime. But I would contend that we have become almost blase, dismissive or immune to gender and sex discrimination? Maybe we shouldn’t be surprised. The great strides of the feminist movement in the 1960s have passed into history. There are increasingly very few folks around who remember the fact that a woman employed by a public authority when she returned to work having had a child was often demoted had she been in a management post. Such occurrences seem the stuff of history text books and yet they were happening less than 50 years ago. We have come a long way in some areas and yet in others we have stood still or even gone into reverse. One such area is the way as a society we think about care as a personal responsibility and care as a professional role. We still think of care as primarily a female activity, almost as if the male of the species has not been endowed with the biological attributes to care for someone other than their own self; as if the skills of empathy, compassion and affectiveness were solely female genetic constructs. I would suggest in the face of this that we need to develop a response to this sex and gender discrimination – a response fit for the new age we find ourselves in. Such a response, I would contend, has numerous strands to it but at least must include the following: • A re-designed early years and child support system that enables real participation of all in the workplace. There has long been widespread recognition that a critical enabler of female and male participation in the workplace is a coherent, high quality and affordable child care and early years system that gives parents confidence to go out into the workplace. Despite improvements we are some distance from achieving this in Scotland. Childcare is still ridiculously expensive and for many the thought of working in the care sector when they have young children is simply unaffordable. Our Government could significantly incentivise investment in social care by giving special credit status to enable care workers to benefit from reduced or even free child care. • An increased emphasis in challenging stereotype and gender segregation in primary and secondary education. We know that many children have consolidated their sense of occupational identity and thus role segregation by mid way through primary school. We must give children opportunities to understand that care is without gender and is both a responsibility of and opportunity for all. The increased emphasis on inter-generational working and shared facilities is serving to put a spotlight on what can be achieved in changing attitudes to older age and frailty. Significant investment from central Government and making this a key cultural and economic priority would consolidate these early foundations. • A real focus on workforce in social care – and that is a whole system and a root and branch reformation of practice. On the one hand there is a growing recognition that social care is an enabler of economic performance and community wellbeing but on the other the way we reward and remunerate those who care suggests a low societal esteem and community value. Undoubtedly the Scottish Living Wage sought to be a step-change but it’s patchy implementation has brought even greater fragility to the care sector. Pay on its own won’t address the challenges of fair work though failing to adequately resource a decent wage will remain damaging of future development. But more needs to be done. This includes addressing the reality that in the medium to short term most of our workforce will be older. As a result we need to address one of the major barriers presented by those who return to or enter the care sector later in life. That is, alongside low rates of pay, the costs of retraining and qualifications. The work of Scottish Care in its recent report ‘The Experience of the Experienced’ has helped to focus upon the unique and distinctive contribution of the mature workforce. It has also highlighted that we need to re-frame and re-design our current learning and qualification frameworks to enable greater appreciation of prior-learning and skills than that which currently occurs. But re-framing conditions has to also be inclusive of the principles of fair work. Is it fair that in social care we effectively electronically tag our frontline workforce? Can we expect fairness in work practice when the way we commission care fosters a lack of trust, embeds low value in the worker and creates employment practices which are less than they could be? • We need a re-gendering of the whole care sector. The inescapable reality of our history is that because the care of our most vulnerable has been seen as women’s work then we have accepted it as a task constituting low skill and worthy of lower financial remuneration. We have not done the same for equivalent male dominated areas of work at a similar skill level. There should be an immense shame in the fact that despite nearly 50 years of equal pay legislation we still have women paid less than men for equivalent jobs. Indeed why is it that men undertaking manual jobs are paid so much more? – well the answer is probably pretty obvious – the financial and political decision making not least in both local and national government have been for long dominated by men. We need a dramatic challenge to the gendering of the role and task of care – better paid workers with fairer conditions employed by providers who operate under realistic and properly resourced contracts. We need a re-conception of care which is evident across the whole of society from children’s books to the latest soap opera. This has to be broader than social care commentators. It entails a cultural and societal multi-media strategy. The American Pulitzer Prize winning journalist Susan Faludi famously wrote in 1991 a book called ‘Backlash: The Undeclared War Against American Women.’ In it she argued that the 1980s saw a backlash against feminism, especially due to the spread of negative stereotypes against career-minded women. Her work has become a classic text of gender and sociology and warns women of every generation that the gains of feminism should not be taken for granted but that re-defining and valuing contribution is a continual challenge. With some glorious exceptions, such as the #metoo social movement, I suspect she has been largely prescient. The care sector in Scotland has huge potential to contribute yet more to the Scottish economy, to re-frame our communities as places that welcome older age and frailty, that recognise care is the responsibility of all regardless of gender. We have the potential of creating a dynamic, valued and skilled social care workforce. But it will involve a dramatic shift in cultural thinking and current social norms – re-defining care so that it becomes gender inclusive means that that task becomes all our concern and not just a woman’s work. Donald Macaskill @DrDMacaskill   The Scottish Care workshop ‘Kaleidoscope of Care’ on Friday 28th September explores many of the themes covered in this blog.

This week I gave evidence at the Health and Sport Committee on the proposed Health and Care Staffing Bill, specifically in relation to Part 3 of the Bill relating to social care. Last week, colleagues from the NHS presented their perspective. Whilst the intention of the Bill may be well-founded, the unintended consequences of introducing it could have significant limiting effects for the sector. Social Care in Scotland has come a long way to begin to create the conditions required for improvement and innovation; you can see this in our policy such as the Health and Social Care Standards introduced earlier this year, our legislation such as the Self Directed Support (Scotland) Act, and in our practice such as the new methods of inspection implemented by the Care Inspectorate. I am proud to represent an ever-evolving sector which retains at its heart an asset-based individualised approach to providing care that is grounded in Human Rights. As human beings, and as a society, our wants, needs and wishes change, and this means that to be able to meet the needs of our older citizens, and others who access care and support, we must be flexible to those demands. On top of this, the market itself is ever-changing as we are living longer and in times of austerity, we need to be able to think differently about how care and support is delivered. The biggest concern that I have is that the purpose of legislation is to freeze its components and the proposal to enshrine the use of a tool in statute puts at risk several things:

• It does not allow for professional flexibility, or for a multi-disciplinary approach, or the development of the new models of care and workforce development that the sector so desperately needs to be sustainable.
• It does not consider significant parties to the process such as commissioners who would need to respond to the potential increased demand in resource, or, social workers, who would need to be available to assess those who access care and support in order to provide the data for the staffing tool.
• There is a real risk of the legislation directing resource, meaning that limited funding may be directed towards meeting staffing requirements, or towards meeting the potential additional administrative burden upon a sector who already have to report both to the Care Inspectorate and to their commissioners.
• Most significantly however is the potentially devastating impact upon the recruitment and retention crisis that the sector currently faces. The SSSC workforce data report published last month shows a Stability index of 77.1% that means almost a quarter of staff are changing roles or leaving. Our own data shows that more people leave than enter the sector within their first 6 months of employment, and that the nursing vacancy rate is currently at 32%. This cannot continue, as evidenced by last weeks headline news that 19 care homes closed because they cannot recruit nurses. We must too bear in mind that last year some of our providers were paying £1200 per night for an agency nurse, and that whilst the number of nursing agencies has increased by 18% in the last year, there is no greater pool to draw from. Creating legislation does not in itself create nurses.

The whole issue that the Bill has been created to address needs a solution that is co-produced from across the health and social care landscape, offering opportunity and flexibility to free up systems and allow the optimisation of the workforce through a multi-disciplinary approach, with career pathways which value our staff and enable them to progress, and to allow for the use of technology and other solutions which the National Workforce Planning Group may already be exploring or which may not even exist yet. A care home is not a clinical setting, it its by its very definition, a home. People who live there are surrounded by their own possessions and sometimes their furniture and décor. And as is also the case for our care at home workforce, they build relationships with those who both live and work there. We need to enable our skilled workforce across the sector to exercise their expertise and professional judgement and allow them time to just ‘Be’ with the people they support. Fundamentally, the Bill in its current format puts that at risk. Our evidence is in, next week the regulatory bodies will be presenting, and thereafter the committee will make their decision on how to proceed. Every single vote will count. #careaboutcare You can watch live or pre-recorded on SPTV  and you can see our submission here Karen Hedge National Director, Scottish Care