As Scottish government ministers reflect on 2022 and think about New Year resolutions, they might consider making 2023 the year that bold policy decisions alleviate the crisis in the NHS by prioritising social care. healthandcare.scot publisher John Macgill argues that the most effective way to do that would simply be to stop treating health and social care as being different things to be delivered by different organisations.

I was commenting to a former NHS person before Christmas that, although the Scottish government budget increases spending on the NHS by £1bn, more than half of that will be spent on meeting recent pay awards. I was implying that, although it’s a big increase, the extra money will simply be gobbled up in salaries.

"That's the point," they replied, "the NHS is its people. That's where government should be spending the money."

Two days later, this time in conversation with a senior NHS consultant, I was explaining that healthandcare.scot is about reporting Scottish health and social care.

"As it should be," the physician responded. "It can't just be about the NHS alone. If I had my way, any new money would go into social care because we won’t have the capacity to do anything more in the NHS until we fix how we look after how people get to leave hospital."

There is little tangible evidence that the Scottish government's ministers actually agree with this doctor. The rhetoric may be of health and social care being interlinked, two sides of the same coin, but the policies and decisions made in St Andrews House continue to consistently prioritise one over the other.

How – and when – will integration be achieved?

The principle of integration and the 2016 creation of health and social care partnerships overseen by integration joint boards, certainly put in place a framework that, in primary and community settings, gave similar weighting to healthcare and social care.

Now, the legislation to create a series of care boards within a national care service appears to unravel rather than strengthen the delivery of integration.

With the passage of the National Care Service Bill, the original questions from local authorities, the third sector and independent providers have been joined by more questions from members of parliamentary committees scrutinising the proposals.

Those questions boil down to: what is broken that this legislation will fix? And, is significant reorganisation of the bureaucracy a better approach to fixing whatever it is than simply better supporting – and funding – the integration bodies created just a few years ago?

I would argue that one fundamental reason that things are not going right for the government in health and social care is that ministers cannot see the two as being inextricably linked. Fundamentally, they do not hold the NHS and social care in equal esteem. Put simply, the political downside of being perceived to be failing to get to grips with the challenges in Scottish social care is far less, it would appear, than appearing to mismanage the NHS.

The NHS recovery plan is what it says on the front page – about supporting the NHS to bounce back and do more than before.

Additional spending is prioritised on the NHS not social care.

The current NHS pay award is more generous than what is being funded for social care.

Workforce crisis and fair pay

If you are working in a frontline role in social care you will be paid less than if you were to undertake similar duties as an employee of the NHS, where you would also not need to think about who is going to pay for you to renew your SSSC registration.

It's difficult to see how this would do anything more than exacerbate the shortage of people working in social care.

So what might a diligent government minister offer to address the concerns raised by social care providers that the system is in crisis – particularly, a staffing crisis?

One approach would be to redress the balance with a step change in the way people working in social care are paid.

Ahead of the last Scottish election, Scottish Labour, supported by trade unions, campaigned for a £15 an hour starting wage for social care workers arguing that this workforce has been undervalued and underpaid for too long.

Given the latest social care real living wage is £10.90 an hour, this would represent a full-time salary increase of around £8,000 a year. If every one of the 200,000 people in Scottish social care workforce worked full time (which they do not), this would cost £1.6 bn a year.

This is money that ministers could quite reasonably argue they simply haven't got. However, ministers do remain committed to creating a new National Care Service, the cost of which could well be of a similar magnitude.

Another way forward

There is an alternative approach to making the NHS and social care more equal – to stop treating them as being completely different.

So, three suggestions that would make both health and social care more attractive and rewarding places to work, each rooted in this simple change of mindset:

First, treat NHS and social care staff the same. Introduce Agenda for Change banding across social care, recognising and rewarding career progression in social care and making it commonplace for a healthcare assistant to spend time working as a care assistant and vice versa. It might also be wise to increase the ceiling on each Agenda for Change band to recognise, reward and retain experience.

Secondly, don’t reorganise one without reorganising the other – and, for the time being until addressing the staffing crisis, perhaps reorganise neither.

Logically, treating health and social care equally would mean we wouldn’t have 14 territorial NHS boards and 31 authorities overseeing local health and social care partnerships. Although it is in the Scottish government's manifesto, a review of the structure of the NHS remains on the backburner.

So, in the meantime, rather than create a new separate structure for social care, ministers could transform the status of the existing integration bodies overnight by funding them directly – along the way, achieving the accountability to Edinburgh that ministers say is missing.

Finally, by all means, create a National Care Service. But make it about the principles, rights and equality of care rather than administrative structures that will always be remote from, and unnoticed by, those receiving care or those giving it.

 

Read more: Scotland's National Care Service - what do we know?; Editorial: Care changes must be explained; Inside Scotland's widening health inequalities

Sign up to our bulletin for key health & social care updates straight to your inbox and you can follow healthandcare.scot on Google News.