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Scottish Care responds to draft Scottish Budget

The Scottish Government have today (14 Dec) published details of the draft Scottish Budget for 2018/19.

Scottish Care has, in the days before the draft Budget, highlighted the need for the Scottish Government to prioritise the older persons social care sector in any funding decisions.  In so doing we have stated the immediate crisis that the care at home and care home sector is currently experiencing.  With fundamental problems of recruitment and retention, of resource allocation and sustainability, we have stated very explicitly that the ability of providers at current resource levels to continue to deliver care to some of our most vulnerable citizens is very much in question.

Whilst we acknowledge the additional £66 million allocated to Local Authorities to deliver on some elements of social care, we are extremely disappointed that the Finance Secretary has chosen not to sufficiently prioritise social care by more substantial assistance.  Our pleas have fallen on deaf ears and we have been unable to convince our MSPs that the care of our citizens matters sufficiently to fund it adequately.

Dr Donald Macaskill, CEO of Scottish Care commented:

 “This draft Budget is deeply disappointing and its decisions are shameful.  When will our politicians wake up to the reality that we are sleep walking into the breakdown of quality support and care of our older citizens across our communities?  They have failed to heed the warnings and regretfully it is not they who will suffer but the older person isolated at home, reduced to even less frequent visits; it is the worker whose dedicated care that will be pushed into ever shorter and undignified time slots; it is those who simply will not get care because the money has run out; it is the family member who already stretched in their caring will be expected to care beyond capacity.

 I hope our elected representatives will in the coming days and weeks speak to those lives, I hope they will find arguments based in humanity rather than finance, to answer why they have chosen not to care about care.”

#careaboutcare

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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.

 

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The £1billion care gap – latest blog from our CEO

Over the last few days Scottish Care has issued a briefing paper to all MSPs and a subsequent media briefing.  In both we have called for our political leadership to prioritise social care funding in Thursday’s Scottish Budget.

At the Health and Sport Committee Inquiry into Care Home Sustainability on Tuesday 12th I was challenged by the SNP MSP Ivan McKee to quantify the gap of funding that I believe exists in social care in Scotland today.  I did so in calling for an additional £1billion over the next three years and not just for older people’s care.  I want to add to that statement in this blog.

First of all we need to, as a society, start to do the serious work of calculating the true cost of care.

At the moment we are all – from Local Government through to Integrated Joint Boards – engaged in the arithmetic of austerity.  What can we afford to do and what can we afford to stop doing.  I have already commented on the human dangers and cost of this game of chance – but it exposes the urgent need for us to move beyond the short term focus of a budget to the long term need to determine the true cost of care for the decades to come.  We have not done this work.  That is why together with others Scottish Care is supporting the call for a Commission on Social Care which critically must include an analysis of not just what care will need to look like but how we are going to pay for that care.  One without the other is meaningless.  Such a Commission has to be rights based, person centred in its focus and fully inclusive of all voices.

Secondly, the debate needs to move beyond the assumption that care is a cost we cannot afford towards recognising social care as an economic driver and contributor.

The 200,000 people who work in social care contribute greatly to the economy and those who are enabled to work by the care given to their relatives are a key economic benefit to our economy.  So why don’t we, like the Welsh Government has recently done, decide to make social care an economic priority, as equally worthy of investment and enterprise activity, just as significant a player as the next inward investor?  Why don’t we recognise the potential of social care to enable Scotland to be an economic driver and growth agent with the care of our citizens at the centre of our growth?

Lastly, where did we get the £1billion figure?

In their report on social care in late 2016 Audit Scotland said:

“If councils and IJBs continue to provide services in the same way, we have estimated that these changes require councils’ social work spending to increase by between £510 and £667 million by 2020 (16–21 per cent increase).”

From Social Work in Scotland report (Sept 16) 

Now I am the first to accept that we need to remodel the way we deliver care by drawing on community capacity but only to the extent that that is safe, enabling and enhancing of life.  I am the first to argue that we need to transfer resource from acute into community settings.  But the last year alone has shown in countless reports how far short we are in terms of a robust funding of social care.  So my call for £1 billion over three years is about 10% of the current annual spend, which is roughly £3billion.

Such a figure and level of investment would:

  • Move the care at home and housing support sector closer to the delivery of a preventative approach which is outcomes focussed and time flexible; one built upon the outcomes of the supported person, respectful of the autonomy of the worker by training and equipping them better, and respectful of the provider by moving from time and task tendering to a commissioning model which is collaborative.

  • Move us closer to really embedding the Self-directed Support legislation which is clearly not working for the majority but only for a small minority . Indeed a submission from COSLA to the Public Audit Committee for an evidence session on Thursday (14th) highlights the funding crisis for SDS.

  • Move us closer to a situation where we are able to start plugging the gap Brexit is already creating in the workforce; to addressing the fact that 9 out of 10 organisations have care vacancies and we have a 31% nurse vacancy level; to meet the vacancies we fear might arise from the growth of the early years care sector.

  • Move us to a context where social care really can be a career of choice, properly funded with terms and conditions which are appropriate for the astonishingly professional work undertaken and where we can continue to attract the best of our society.

  • Move us to a place where we might be able to fund the developments around the reform of the care home sector in Scotland.

And in addition to all that we need to address how we are going to fund the plethora of proposals and initiatives which are impacting on social care for older people – be that the extension of Free Personal Care to those under 65 or the plans to extend Safer Staffing legislation to the whole of the social care sector; the embedding of the new Care Standards or changes in registration of the workforce; the right aspirations of the Palliative and End of Life Framework or the Third Dementia Strategy.

The gap between policy and legislation and implementation is widening; the gap between what is currently resourced and what is demanded is even greater. The cost of failing to bridge that funding gap will be met by the lives of the most vulnerable of our citizens who will be left unsupported and with diminished or no care.

The cost of the fiscal gap may be £1billion pounds over the next three years – the cost for citizens is being felt now and is immeasurable. The Budget offers an opportunity to cut some of that distance.

Dr Donald Macaskill

@DrDMacaskill

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University of Stirling – 2018 Dementia event

In the new year, the University of Stirling will be staging a 2 day event to showcase ongoing work by the Dementia and Ageing Research Group and the Dementia Services Development Centre.

The Dementia @Stirling #DARG18 event will take place on the 7th & 8th February at the Iris Murdoch Building at the University.

For more details on this free event, including the full programme and how to book your place to attend, please visit the registration page for Dementia Care, Design and Technology.

 

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Cognitive Stimulation Therapy – Workshops

We have been advised by NHS Education Scotland (NES) that there are a few places still available on their planned Cognitive Stimulation Therapy workshops which are taking place in January 2018. The deadline for applying for a place is January 5. Please see below for details on locations, dates and how to secure a place. 

 

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Scottish Care to give evidence to Parliamentary Committee on care home sustainability

On Tuesday 12 December, Scottish Care CEO Dr Donald Macaskill will give evidence to the Scottish Parliament’s Health and Sport Committee.

Following the announcement from Bield Housing Association that they are withdrawing from the residential care sector, the Committee is holding an evidence session relating to care home sustainability.

Prior to this session taking place, the Committee issued a short targeted call for views with the following questions:

  • What impact does the recent announcement of the closer of 12 residential care homes have on your area?
  • Are there concerns regarding the sustainability of residential service provision (in your area)? and if so, how could they be addressed?

Scottish Care’s response can be accessed here.

To read other responses, click here.

The following organisations have been invited to give evidence:

  • CCPS – Coalition of Care and Support Providers in Scotland
  • Scottish Care
  • COSLA
  • Bield
  • Care Inspectorate
  • Scottish Federation of Housing Associations
  • Lothian Integration Joint Board
  • Fife Integration Joint Board
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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.