The straw that breaks the back of care

The last two and a half years have been a period which has been without equivalence for the care home and homecare sectors in Scotland. Regular readers of this blog will know that I have throughout sought to comment and reflect on the whole range of issues and challenges facing the social care of older Scots during this time. I found myself in a reflective mood this past week about the highs and perhaps more persistently the lows that people have been through these last few years. I was doing so because despite the challenges of dealing with an unknown deadly virus, the trauma of tragic deaths in care homes, the acute distress caused by visiting restrictions, the abandonment of those requiring support in their own homes, of disproportionate and inequitable processes such as Operation Koper, of misfiring oversight and scrutiny, of fundamental errors in guidance and clinical response, of an exhausted and burnout workforce, of struggles to recruit and retain amazing staff, of the limitation of fiscal support – despite all this care homes and home care organisations have kept going, kept caring, kept delivering care and compassion with the regularity of committed dedication and professionalism – until now.

Without a shadow of a doubt and with no sense of hyperbole I am now more worried about the survival of social care delivery in Scotland than at any time before or during the Covid pandemic.

We are living in the midst of a perfect storm and already in the last month high quality and excellent performing care homes have either closed or intimated their intention to cease delivery. The same is true of homecare organisations both closing their doors to new business and handing back care packages. The reasons are numerous and manifold from the struggle to recruit staff, inexcusable contractual practices, the critical withdrawal of funding for PPE and infection control at a time of rising Covid cases, astonishing increases in the cost of insurance and so much more. There are many reasons for concern.

But the proverbial straw which has led many to intimate to me they will simply not survive until the year’s end is the spiralling cost of energy combined with the wider cost of living crisis. This week’s dire warnings from the Bank of England of rising inflation and the increase in interest rates will add thousands onto the bills of many care organisations and will push even more of them to the edge of the survival precipice.

In the past week the media has been rightly full of stories about the sharp increase in energy costs for domestic consumers. I have warned previously that the increases in energy costs now and in October will lead many of our most vulnerable older people who desperately need a winter of warmth to place themselves in situations of risk to health and wellbeing. The increases have already placed tens of thousands of our fellow citizens into real fuel poverty.

Little attention has been given to the effect of energy price increases on care homes and homecare organisations. Simply put the cost increases have already been astronomical and have to date in the last few weeks led to some care homes closing their doors. A typical increase was shared with me this week. A small rural Scottish care home which plays a crucial role in its local community in the last year paid around £6,000 for its electricity and gas. Next year the cost will be £36,000. That is a sixfold increase for an organisation which has no private clients and whose residents are all funded by the State at a fixed rate. This is totally unfordable and without assistance that care home will close its doors and its residents will have to transfer to the local hospital or to other care homes should they be available. As I write this another email has landed on my desk stating a care home is being faced with a bill next year of £210,000 compared to £40,000 this year. And all this is because some care homes are renewing now when their fixed rate deals are coming to an end – and I shudder to think what October will bring.

I hardly need to say that the eye-watering increases in energy costs faced by care homes will lead many of them to shut and cease to deliver care. This will first and foremost be devastating for the residents of these care homes because we know that the trauma caused by care home closure has a life-shortening effect. Some of our most vulnerable citizens will become effectively lose their home and will have to either move to the local hospital or to another care facility perhaps miles away. The loss of home, of familiarity and shared company will be devastating on these individuals. Staff will lose their jobs and local communities will lose vital care services. At a national level a rise in care home closures which is presently occurring at an increasing rate will become a flood of closures resulting in very real pressure on the NHS with hospitals already overburdened unable to cope which will lead to unsustainable delays in discharge and will have a dramatic negative impact on all those who wish NHS treatment and care. Our hospitals will fill up and we will not be able to cope with the pressure. Simply put if the care service collapses and implodes because of the energy crisis then the NHS will follow soon after such is the dependency on both in the economy of care support.

In response to all this – what is happening politically? Despite people like me ringing the alarm bell for several months on this critical care energy crisis there strikes me as a degree of political head in the sand behaviour as the buck is continually passed. The former Chancellor Rishi Sunak announced a not insignificant intervention several weeks ago which will result in every citizen receiving £400 to support their energy costs. An equivalent intervention is urgently needed for the care sector, both homecare and care homes.

Today therefore I am calling on the UK Government to intervene and issue emergency funding to the care sector across the United Kingdom. I want both candidates for the Conservative Party leadership and the Prime Ministership to intimate what they are going to do to save the care sector in the United Kingdom and prevent the effective collapse especially of smaller, rural and remote care homes.

In Scotland we have a higher proportion of care homes run by smaller organisations, often family run establishments and charities. We are in a highly vulnerable situation and these organisations have no capacity to pay the mind-boggling fuel increases being demanded of them. As most of the care home and homecare provision in Scotland is paid for by the State then to maintain care the State needs to pay more or risk both personal trauma for residents and whole health and care system collapse.

The challenge facing care homes and care organisations is at a level no one can ever remember. I have had people in tears this last week wondering how they are going to survive and how they will tell families, residents and staff that they cannot continue.

There is a need to treat this care energy crisis with the same degree of emergency financial intervention as was received during Covid. The situation the care sector is in in Scotland today is significantly riskier than Covid and will have just as dramatic an impact on life and the health of our vulnerable citizens. We need urgent action from the United Kingdom and Scottish Governments and need it now. Local authorities who are responsible for paying for social care are penniless as we have seen in the media this week in relation to threatened strike action and even the additional £150 million announced by the Scottish Government yesterday will not suffice. Only Northern Ireland has acted – in their case with a £50m energy fund for care homes. The United Kingdom and Scottish Governments need to act now to save care and stop blaming one another and passing the buck.

If we don’t start to care about care then there will be no care sector left to care about or care for. There is not a lot of time left

 

Donald Macaskill