The organisation representing Scotland’s independent care sector is calling on policymakers to act now to address issues holding the sector back – and undermining efforts to recruit and retain care staff.

Scottish Care says, while its members support the principles and ambitions of a new National Care Service, the urgent focus of the Scottish Government and local government body COSLA must be on existing care services, which continue to face huge pressures.

Last month, the chair of Scotland’s NHS chief executives’ group told a parliament committee that NHS leaders haven’t got the capacity at the busiest time they have ever known to devote the time to help co-design the new NCS.

Scottish Care Deputy Chief Executive Karen Hedge says many people involved in the sector feel the same way - they want to be involved in shaping future provision, but can’t be at the moment:

“The intent of the national care service from the government's perspective is  really that access to timely, consistent, high quality health and social care support across Scotland. And it's clear to us that intervention is required in social care because, at this point in time, people aren't getting the right care and support in the right place at the right time.

“Of course, that was also the intent of the [2014] Public Bodies Joint Working Act. I believe we already have in place really good legislation, really excellent policies. But we have a huge implementation gap. So we need to make sure that any vision for the national care service also outlines how we bridge that gap.

“But, our members are still responding to the aftermath of the pandemic. So the time and the space they need to be able to engage with and to consider and contribute to a national care service is non-existent.

“I would ask for there to be an immediate removal of all non-essential work from care providers – all the demands being put on providers to respond to surveys, documents to fill in and events they are expected to attend. Many of our managers are out there pulling shifts right now. They don't have capacity to engage. So we'd be looking for an immediate step down of all that, at least until after winter pressures are over.”

The future of independent provision

The Scottish government says it wants the independent sector to be part of delivering the new NCS but Karen Hedge said that providers told the recent national care home conference  that  they felt they hadn’t been listened to at consultative forums.

The National Care Service Bill includes provisions that would exclude some types of  organisations from bidding to run publicly funded services. Health and Social Care Secretary Humza Yousaf explained at this year’s SNP National Conference that he was “tired of having private companies who can end up having bank accounts in the Cayman Islands, making that profit and shipping it away into tax havens, and other parts of the world”.

Scottish Care says to focus only on such providers, which represent “one very small part” of the picture, misses “the richness that exists” across the sector. The organisation suggests the 4% cap on the return allowed for publicly funded care provided under the care home contract is a much lower margin than would normally be deemed financially viable. The organisation says there needs to be an immediate uplift applied to both the national care home contract and locally negotiated contracts – which does not currently cover the increasing costs of insurance, energy, or food.

Ms Hedge says a combination of factors are leading some providers to question their future:

“To be honest, it adds to the perfect storm that they're already experiencing.

“You'll know that most care and support in Scotland is delivered by small family run organisations providing a small number of hours of care and support, people who maybe have one or possibly two or three care homes.

“After the way that they've been hauled out by politicians and media about the pandemic, that part of the Bill is not really encouraging them to hang in there. I have real concerns, with all the pressure that they have been experiencing, that they may just quit the market, which of course has longer and wider implications.”

Workforce

The Scottish government says it is committed to ensuring employers are funded to ensure people working in care get the real living wage. In October that was increased to £10.90 an hour but the increased rate has yet to be passed on to independent providers.

A challenge that has now arisen is that people are moving away from care assistant jobs in social care to equivalent roles in the NHS.

Healthcare assistants in the NHS are on, at least, Agenda for Change band 2. The latest pay offer from the Scottish government proposes that their starting salary be £21,814 a year – £11.16 an hour.

Karen Hedge says this is about more than simply pay.

A care worker in a care home or in the community must be registered with the regulator, the SSSC. The person doing the equivalent job in the NHS does not need to be professionally registered at all.

While the cost of that registration is being met for care workers in council owned services, and sometimes by other employers, often care staff have to pay that fee themselves.

“We would ask the Scottish government to suspend all registration fees for social care staff,” says Ms Hedge.

“Because, if your registration comes up, then why would you pay to re-register when you could go and get a job in a hospital and get paid more, but not have to be professionally registered?

“This is difficult because we very much agree with having professional registration. But there could be some help with paying the fees, as the unions have negotiated for statutory care workers.

“Otherwise, it's not fair work. It becomes unfair work with the government funding some but not others.”

Read more: Only 1 in 4 care homes fully staffed; Over regulation “neuters life” in care homes; Unions: Social care workers need action now.

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