Crisis point for social care, and the need for change

Following Audit Scotland’s social care briefing, Antony Clark writes about the key challenges facing the National Care Service.

I’m delighted to be given the opportunity to write this blog for the ALLIANCE’s Opinion series. It gives me a chance to say more about the messages we laid out in the recent Social Care briefing (this link will take you away from our website) that Audit Scotland prepared on behalf of the Auditor General for Scotland and the Accounts Commission. This was an especially important piece of work for us which drew on the significant body of evidence from our previous reports relevant to social care, including health and social care integration and self-directed support. Find out more on our health and social care web hub (this link will take you away from our website).

We felt now was a critical moment to re-emphasise the challenges long experienced by both those delivering and receiving social care. These challenges, many of which are longstanding, have been deepened and exacerbated by COVID-19.

In our briefing we stated that some social care services are at near crisis point, that urgent action was needed now, before a National Care Service (NCS) was established. Services aren’t consistently meeting individual needs and too many people who need care, who have been assessed as needing care, simply aren’t getting the help they need to live the life they determine. Those messages won’t come as a surprise to anyone in the ALLIANCE. And they aren’t new messages either.

In a 2016 report (this link will take you away from our website) we emphasised the challenging task councils face responding to financial pressures and managing the market for social care provision. And our briefing highlighted that six years on difficulties around commissioning services continue. It’s clear that current commissioning and procurement procedures have led to competition between providers at the expense of collaboration and quality.

Back in 2016, The Fair Work Convention resulted in a greater understanding of how the commissioning system led to wider structural problems. The impact has been maximising employer flexibility, perhaps at the expense of employees – zero-hours, low hour and sessional contracts. We urge the Scottish Government to look again at the system changes needed, and not delay. Doing so is not simply a nice to have – it is crucial as the sustainability of the social care market is key to maintaining Scotland’s capacity to address individual care needs.

We know that social care services, when they work well, make a fundamental difference to people’s quality of life. There has been excellent work by the ALLIANCE in ensuring the voices of people receiving social care support are amplified. The establishment of the Social Care Covenant Group is also greatly welcomed.

Our social care briefing asks the Scottish Government to embed the voice of care experienced people in its planning, to ensure there is a deeper understanding of what a preventative and human rights-based approach to social care looks like.

But for that to happen a more strategic approach to investing in social care is required. This involves developing an understanding of the longer-term costs, identifying double-running costs while setting up new services, whilst moving much more resource and pivoting the focus into preventative services.

Our social care services are often intimate and personal. Giving staff the time, place, and space to deliver more than just a basic service puts humanity, value and meaning into this vital role. We’ve heard from people who think staff do not have the time to do anything but provide basic care, that because of this they are unable to deliver compassionate and dignified support. To do otherwise requires a fundamental and systemic change. For staff to feel valued and engaged in their work, they need adequate pay. But more than that, they need to come home after what can be emotionally and physically demanding work, feeling they’ve done their job well, with the time to make and develop connections with the people for whom they provide care.

Our briefing urges the Scottish Government, along with its partners, to take action to address these challenges now. Waiting for the establishment of a NCS to address some challenges is no longer a viable option. A clear plan is needed now to address the significant challenges facing social care in Scotland – doing so doesn’t require legislation. The Scottish Government needs to take action now, with clear timescales, removing any uncertainty about the future direction of social care, building on lessons learned from previous reform.

You can find more info about our work at our health and social care e-hub (this link will take you away from our website).

This opinion is part of the ALLIANCE’s Future of Social Care series. You can find other entries in the series here.

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