There has been a great deal of talk this past week about how important it is that we support and care for individuals as close to their home as possible, including yet again an emphasis on hospital at home – as well as an increased commitment to focussing on prevention and healthcare at home from the First Minister. Yet what is often missed in the political rhetoric and proclamation is a proper understanding of what it means to support and care for someone in their own home or in a homely setting.
Some of that reality was portrayed in research which was undertaken by Scottish Care, Care Forum Wales and the Homecare Association in conjunction with Sky News and which was published this past week. It made for distressing and worrying reading and made me personally question whether we have become blinded to the need for humanity in our national response to the current social care crisis.
Entitled ‘It feels like we don’t exist’ the Sky News item explored the human cost of the social care cuts happening across the country and not least in Scotland. I’ve mentioned these cuts to care more than a few times over the last few months, but they have – unless you receive care and support or work in the sector – gone largely unnoticed and under the radar of the mainstream media. What they mean is that effectively most Health and Social Care Partnerships – the bodies who oversee and pay for the majority of care home and homecare delivery in Scotland – are having to make savage cuts of tens of millions of pounds in order to make their books balance this year and certainly into the next fiscal year. What that means – is not that there are queues outside our hospitals for our politicians and media to see – but that there are invisible impacts which mean thousands of people are having their care and support cut, or are not being assessed at all and that less and less is being spent on the support and care of some of our most valuable citizens. This is a process of cuts to life which is going largely unseen.
The Scottish Care research painted a sad and depressing insight into the reality of the current social care crisis in Scotland. Specific results from Scottish Care membership said that:
- Over 80% of respondents stated that councils have reduced the number of care packages that would previously have been awarded.
- 90% stated that councils have reduced the overall number of hours commissioned within care packages.
- Over 90% stated that councils have asked providers’ to complete care tasks that are unrealistic within the commissioned time.
Such reductions place untold stress on the sustainability of vital care providers across Scotland and diminish access to an adequate level of person-led care. As commissioning and procurement bodies cut packages beyond the true cost of adequate care for our communities, care providers are struggling to stay afloat.
A provider told me of the increasing pressure to do tick box care. One spoke of the request from a Council to support someone up out of their bed, to help them to have breakfast, to make sure they had a wash for the day and to do all this in 15 minutes! This is obscene and inhumane. Another provider spoke of the fact that their care organisation had been fined on numerous occasions because the carer had made a cup of tea or had taken out the rubbish for a supported person – all because it wasn’t in the ‘care plan’. All of this smacks of a system where money talks and compassion walks, where we have turned care and support into a functional set of tasks rather than what it should be – a relationship of dignified humanity which enables a person to flourish and thrive. Behind the rhetoric of more and more money being given to social care is the perverse truth and reality of a system of social care that should shame every Scottish citizen.
I am writing all this being very aware that when care is cut this impacts on not only the person themselves, on the workers but also the wider family who depend so much on a functioning social care system.
Tuesday next, 4th February, is the annual World Cancer Day when we are asked to focus on the lives of those living with cancer and how we can improve health, and social care supports to enable people to live better with cancer. So often in these discussions the experience of older Scots living with cancer, and in large part supported in their own homes, goes missing from our focus.
With our ageing population more and more of those who live into older age are being diagnosed with cancer as well as the reality that positively those diagnosed younger are living longer with cancer. We often ignore the fact that older patients often present unique concerns, such as decreased tolerance to certain treatments, multiple co-existing medical conditions, and the functional challenges in daily activities which often come with age. These factors all necessitate a tailored approach to cancer care for the older citizen but in a system where we are struggling to do the basics humanely such focus and personalisation seems impossible. But it is urgent that we develop such cancer specific supports.
We know from recent research on cancer care that the role of homecare and social care is absolutely vital. Studies have shown that the benefits of home-based supportive care for advanced cancer patients is enormous. We need to resource social care to deliver more effective high quality cancer care.
What we have instead is the comments I hear from so many living with cancer, which is about rushed workers, staff constantly having to look at their watches, always on the move, and yet despite the care by the clock they are requested to make they still continue to show compassion, professionalism and care.
All our citizens, regardless of age deserve the best possible care and support in their own home or in a homely setting. This will not be achieved by ignoring the disintegration of social care across Scotland. We have to wake up to that reality and ignore the saccharine statements of assurance of a system that is working. We have to really accept that to care for someone in their own home, whether they are living with cancer or not, in a manner which affirms their rights and dignity – cannot and should never be done with a stopwatch in your hands.
Donald Macaskill
