Scotland’s national spending and delivery watchdogs says workforce pressures, increasing financial challenges and the lack of service users' voice in the care they receive continue to threaten the sustainability of social care in Scotland.

The Scottish government has committed to begin the legislative process to set up a national care service by June this year, to be fully operational by May 2026.

But a joint briefing by the Accounts Commission and the Auditor General for Scotland says some services are in ‘near crisis’ now and cannot wait five years for the creation of a new organisation.

In the briefing published today, Stephen Boyle, Auditor General, says:

“Action must happen now, and at speed, by the Scottish government. There must be clear timescales for delivery, demonstrating that lessons have been learnt from previous reforms of health and social care services.”

A failure to move toward preventative approaches has resulted in a tightening of eligibility criteria and increasing levels of unmet need, according to the report, with many people who rely on social care left in an increasingly precarious position.

William Moyes, Chair of the Accounts Commission – the independent watchdog for Scotland’s councils – adds a failure to take immediate action “presents a serious risk to the delivery of care services for the people who depend on them”.

Bringing together their assessments of Derek Feeley’s independent review of adult social care, the government consultation on a national care service and The Promise, which takes forward the Independent Care Review, today’s report echoes calls for the Scottish government to remove uncertainty around funding and about the scope of services within a national care system.

The government has pledged at least an additional £800m of care spending by 2026, but local councils have warned this severely underestimates the true cost of a national care service which could exceed £1.5bn.

An additional £1.1bn for Scotland’s social care sector is also expected to be raised through the UK government’s health and social care levy, however there are concerns this has already been earmarked for NHS recovery.

Responses from the NCS consultation are expected to be published by the end of next month; at this point, the Auditor General suggests, the government must establish both what services are to be included and the legislative steps needed to progress.

The Scottish government has taken its first steps in laying the groundwork, contracting  management consultancy giants PwC and KPMG to advise on project design and delivery, to the tune of almost £700,000.

Responding to the joint Audit Scotland and Accounts Commission briefing, Jackie Baillie, health spokesperson for Scottish Labour, says only big companies have benefitted from the SNP’s plans, and that reforms must “work for those who use the services and for those who provide them”.

The head of Scottish Care told healthandcare.scot before Christmas that social care providers are not thinking about the national care service as the ‘nightmare happening at the moment’ needs urgent attention. The 200,000-strong care workforce face low pay, poor terms and conditions, and rising sickness rates, all while being undervalued and seen as little more than a “lapdog” of the NHS, Dr Donald Macaskill said.

According to today’s report, key to positive change will be stable and collaborative leadership during this time of major upheaval,

However, the briefing says cultural differences between local councils and the NHS, as well as high turnover of senior staff, an ageing workforce and increasing short term posts, has affected leadership capacity and the integration of health and social care more widely.

It says: ‘Partner organisations work in very different ways, and this can result in a lack of trust and understanding of each other’s working practices and business pressures. There can also be tendency to put the organisation first when alternative actions would benefit partners.’

Gaps in data and shortcomings in information sharing across organisations, a common thread of concern among key players in social care, will also impede progress according to the joint assessment by the watchdogs.

Social care minister Kevin Stewart has said the government will commission an investigation into the management of data to support service delivery and planning.

Meanwhile, according to the report, commissioning of services, which tends to focus on cost rather than outcomes or quality, has led to competition between providers and left councils unsure of how to fill gaps.

This comes as the health and social care partnership in East Lothian has been told at least two providers working in the county have been left at risk of folding as a result.

Sara Redmond, Chief Officer – Development at the Health & Social Care Alliance, said: "From our extensive engagement with people of lived experience of social care, the issues raised are sadly no surprise, and the ALLIANCE would echo their calls for immediate action in many areas, such as data collection, and improving pay and conditions."

Responding to today's report, Mr Stewart said: “We are committed to delivering a National Care Service by the end of this Parliament in order to ensure everyone gets the high quality care they are entitled to, regardless of where they live in Scotland.

“As part of this we are already considering many of the issues raised by Audit Scotland, including staff recruitment and retention, the need for a greater emphasis on preventative care and meeting individual needs, a focus on ethical commissioning and ensuring the voices of people who are receiving care services are amplified.

“However we are not waiting to act to protect and enhance Scotland’s social care services, which we know are facing intense pressure at present. That is why we invested £300 million of new winter pressures funding  in October, to maximise the capacity of the NHS and social care system this winter and in particular to bolster the caring workforce by increasing their numbers, providing them with additional support.

“As part of that we have  already made available additional funding of up to £48 million to enable employers to provide an uplift to the hourly rate of pay for staff offering direct care within Adult Social Care to a minimum £10.02 per hour from the 1 December 2021. This takes pay for adult social care workers in Scotland significantly higher than the National Living Wage of £8.91 - which currently applies to many social care workers in England and Wales – and we are planning an even bigger rise to £10.50 per hour in the financial year 2022-23.

“We have recently announced an additional £4 million to expand support for unpaid carers this winter, including to enable them to take breaks from caring. We are continuing to work with those with lived experience to shape response to the ongoing impact of the pandemic.

“We remain committed to developing options to remove non-residential charging as soon as possible.”

More detailed audit work is expected to follow today's briefing paper later in 2022/23. 

 

Read more: Scotland must not rush into National Care Service; Home carer: We were never trained for this; Ministers order review of social care data ‘landscape’

 

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