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


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