In recent weeks the Scottish Government has been urgently trying to put more money into social care as it looks to get people out of hospitals to free up space for covid-19 patients.

Only last week Health Secretary Jeane Freeman said reducing care packages during the pandemic is “not acceptable” and urged councils not to cut critical support after warnings from across Scotland that people would potentially have to go without their normal levels of help.

Campaigners have been warnings that a national strategy is urgently needed to stop homecare organisations collapsing and thousands of carers losing their jobs after risking themselves to support people through covid-19.

But the winding route that money takes before it gets to the frontline has been causing problems long before the covid-19 crisis began.

And the result of focusing on the “cheapest price” means people’s care could be suffering.

Covid-19 has thrown these concerns into sharp focus. In recent weeks there have been warnings that many home care providers are on the brink of bankruptcy as they struggle with staff absences.

The Scottish Government and COSLA promised that any additional costs borne as a result of the virus will be met by central government.

Although much of focus in the pandemic has been on care homes, representative body Scottish Care has warned home care providers are on a financial “knife edge”.

Some health and social care partnerships are adapting their relationships so care providers facing “astonishing” costs in areas such as PPE do not go under.

In Edinburgh, the partnership has told care providers they will not be penalised if they cannot fulfil their contracted hours due to staff absences caused by covid-19.

But others are not budging from buying care ‘by the minute’, even though the coronavirus crisis has made it nearly impossible for care workers to stick to these timescales.

There are signs that the usual commissioning process could be changing. An annual pay rise for care staff, which can get held up in negotiations for up to eight months before it gets to frontline workers, was recently fast-tracked.

healthandcare.scot convened a series of four meetings of care home and care at home providers who are members of Scottish Care earlier this year. Each group debated the questions posed by the Scottish Parliament’s health and sport committee during the investigative phase of its inquiry into the future of social care.

Evidence sessions due to take place in the coming weeks have now been postponed as a result of covid-19.

In the third of a series of pieces based on these roundtable events with care providers across Scotland, care services say the rate they get per hour – or per care home resident – just isn’t enough to provide high-quality support.

Among the most critical of the claims is that councils – which get funding from government that they use to commission, or buy, social care – are effectively underpaying external providers.

“It is not enough to do the little extras that we want to do, like making sure you stay with that person to help them out on something you haven't been commissioned to, because nobody else will and they have got nobody else there, as it’s only us going in to see them,” one care at home service owner told healthandcare.scot.

In contrast councils allocate themselves more funding for the same service. One meeting attendee said they got around £400 less each week for every person in their care home, compared to what a council would pay itself.

A common refrain was that some in councils were looking for the “cheapest rate possible”, even trying to place people in cheaper care options when they needed a higher level of support.

“The local authorities pay the very basic, but they don’t expect to get the very basic service,” was how one meeting attendee summed up the relationship.

Another highlighted one of the inconsistencies in the current system, asking: “Are we really looking for a person centred, outcome focused service delivery? Or are we still just looking for tasks being done on the cheapest price?”

healthandcare.scot has reported how councils are mandating the use of apps to track how long care workers spend at people’s homes.

Critics say this is another way for local authorities to pay less and changes a relationship that should be about support to one that is about the bottom line.

One home care provider director pointed out rates paid by councils were often well below the level needed to guarantee workers got the living wage and fail to reflect how much each hour of care costs the employer.

“There is no other industry in the world that would accept payment like this on a per minute, per second billing basis,” they said.

One Scottish Care independent sector representative said that despite funding challenges, privately-owned and third sector care homes tended to perform better in inspections than those run by councils.

“So imagine what we would do if we were properly funded,” they said.

 

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