The Scottish Socialist Party has delivered the following submission to the Scottish Government consultation on the delivery of a National Care Service in Scotland.
It reiterates the SSP’s support for a National Care Service which is publicly owned, publicly funded, and free at the point of need – with genuine democratic control and accountability, and greatly improved conditions for workers. A recent opinion poll revealed that 69% in Scotland want a care service that is publicly owned and free at the point of need.
Scottish and UK Government proposals fall far short of what is required to fix our broken system of care. The Scottish Socialist Party agrees with the conclusion reached by Professor Allyson Pollock, clinical professor of public health at Newcastle University, who said ‘by returning private care provision to public hands we would ensure accountability, quality of care and prevent public money from passing to private shareholders and investors. As it stands the national insurance levy is a bailout for these debt-laden, profit-seeking companies.’
INTRODUCTION
The Scottish Socialist Party welcomes this opportunity to respond to the Scottish Government’s consultation on the delivery of social care. The Government will be aware we also made a submission to the Feeley Review in 2020.
We spent the last year campaigning for a national care service that is free at the point of need, publicly owned and run and fit for the 21st century. And we commissioned an opinion poll which revealed 69% of respondents support the proposal as the most appropriate reform following the lamentable number of deaths in Scotland’s residential care homes.
Our activists also conducted hundreds of street stalls across the country petitioning for a social care service configured on the above basis. We petitioned in town centres, we hosted several online discussion Forums involving care recipients, social care professionals, academics, trade union leaders, unpaid carers and relatives. We collected tens of thousands of signatures, wrote numerous letters to the press, spoke with several broadcast media outlets and corresponded with UK and Scottish Government Ministers. We also spoke to many care staff at length about their conditions of employment, joined protests and lobbied politicians. In short, no one has done more to make the case for a national care service in Scotland that is free at the point of need, publicly owned and run and fit for the 21st century.
COVID
In our submission to The Feeley Review we noted ‘Few would suggest the COVID pandemic caused the current crisis in residential social care because it was unfortunately well established before then. Nonetheless the latest figures show that almost half those who perished from the disease died in Scotland’s residential care homes. Whatever else may be said about the virus it is a disease that affects the elderly particularly badly and our care homes were simply not fit to withstand what befell them’.
Looking back over the past year one is forced to conclude that as a society we let down Scotland’s elderly and vulnerable in their hour of need. Until we implement profound and substantial improvements to social care provision the Scottish Socialist Party fears we will continue to do so.
THIS CONSULTATION
Much of this consultation, particularly the funding arrangements, have been overtaken by the UK Governments 2021 Health and Social Care Bill passed in September. Prime Minister Boris Johnson had gone on record in July 2019 promising to ‘fix Britain’s broken social care system once and for all’. The Bill’s recommendations are largely taken from the Dilmot Review published in 2011. He accepted his ‘broken system’ had been further ‘cruelly exposed by the COVID pandemic’ and acknowledged ‘Governments have ducked this problem for decades’. In announcing an extra £36bn across Britain by 2025 he promised to set aside another £1.1bn for Scotland.
The Scottish Socialist Party whilst acknowledging the Prime Ministers intervention after so many previous failures is nonetheless not convinced this sum will be anywhere near enough to ‘fix’ the deep seated problems within social care provision in the UK.
The Scottish Socialist Party criticised the Feeley Review’s terms of reference as being much too narrow to include the fundamental reforms we deem necessary and we are disappointed the Scottish Government has made the same mistake here.
This consultation dismisses the social care solution which in our view enjoys greatest public support. And it does so without making any attempt to weigh up the many advantages this, the most progressive of options, offers. This regrettable approach means the Scottish Government now echoes the view of the UK Conservative Government. ‘It would be enormously expensive’ it argues ‘to take social care into public ownership’ adding ‘While some services may be provided directly, we expect that the national care service will continue to commission services from a range of providers as IJB’s do at present’. [P6 Chapter 2]
In other words the vast majority of provision will remain in private hands despite their many failures exposed by the Care Inspectorate in Scotland.
The Scottish Government stands therefore alongside Boris Johnson who also insists ‘Free care for all is needlessly expensive when many can afford to make a contribution’. [House of Commons Sept 13th]. So those who cannot afford £100,000 per year therefore must accept inferior support!
This was not the view the new Holyrood Parliament took in 2002 when, virtually unanimously, it voted to introduce free ‘personal care’ in Scotland – the only part of the UK to do so – and was universally congratulated for it.
One wonders what Scottish Ministers and the Prime Minister are so frightened of that they cannot bring themselves to outline the case for following the same course taken in 2002, as well as outlining the option most Scots wish to follow now?
This attitude is reminiscent of those voices raised in 1946 who opposed the establishment of the NHS. Left to these gentlemen and ladies we would never have an NHS today. They show no appetite in our view for facing the enormous challenge in front of us as far as the provision of adult social care services are concerned.
Such an approach would never have seen us through the COVID pandemic.
The public will wonder how many more people must die prematurely, or fail to receive the care they need, before we face up to our responsibilities as a civilised society in the 2020’s?
The Scottish Socialist Party is therefore disappointed by the limited remit of this consultation. We believe the ‘tinkering’ they recommend is wholly inadequate given the extent of the challenge facing us.
CONTEXT IN WHICH THIS CONSULTATION TAKES PLACE
More than 50,000 extra deaths have been recorded in Britain’s care homes from COVID-19 with nearly 5,000 in Scotland. These figures don’t show however that many of our fellow citizens died poor deaths, often alone and neglected in their hour of need as social care provision in Scotland was ‘overwhelmed’.
The public were horrified both by the number of fatalities and the appalling conditions uncovered in Scotland’s, largely private, residential care homes. The picture uncovered was a shocking one and merits, above all, a national promise not to see its like again.
According to official figures some 245,000 people in Scotland receive social care support. As of March 2019 35,500 people were being cared for in residential care homes, 90% of them over 60 years of age.
Age UK estimate 1.5m in Britain don’t get the social care they need. At the same time there is a demographic ‘time bomb’ ticking as the population as a whole ages and the ‘baby boom’ generation of the 1950’s and 1960’s retires with an increased risk of dementia and a growing need for even more social care!
One in seven people in receipt of social care in Britain pay more than £100,000 per annum for that support. Almost 80% of that adult social care provision is provided by ‘for-profit’ companies who take a significant proportion of money out of the public purse and distribute it to shareholders around the world!
It is little wonder then that a Panelbase poll, commissioned exclusively for the SSP in January, found 69% of respondents supported a national care service free at the point of need, publicly owned and run and fit for the 21st century. The proportion of women aged 40-65 in the survey who backed the plan (the cohort in our view most familiar with the situation in care homes) was 79%.
Given this picture we believe public demand for 21st century standards of social care made available to everyone who needs it will grow and grow. To provide anything less is, we believe, short changing generations of citizens who are entitled to nothing less after a lifetime of service to their country.
THE SCOTTISH GOVERNMENT’S ‘NATIONAL CARE SERVICE’
The Feeley Review highlighted the dislocation inherent in a sector with 1,100 different care home providers competing with each other for ‘customers’. This shows that we have in fact no ‘national’ care service to speak of. Rather we have a set of commercial companies each with a fiduciary responsibility to their shareholders which is clearly more powerful than any public obligation. That picture was reinforced when Southern Cross went bust in 2014 and left residents and care staff at the end of a long queue of creditors.
The Scottish Government proposal to amalgamate the 31 existing ‘Health and Social Partnerships’ across Scotland into one and call that a ‘national care service’ does not, in our view, provide a meaningful solution to the profound problems we face. Nor does it amount to a ‘national’ care service. Such ‘bureaucratic window dressing’ as it has been termed will not satisfy care recipients, staff or an anxious public looking for substantial improvements.
‘ON A PAR WITH THE NHS’
‘Our plan for social care provision in Scotland puts it ‘on a par with the NHS’ insists The First Minister. Yet her claim – which we refer to repeatedly in the course of this submission – unfortunately advocates nothing of the kind. The inference that it does, inflicts in our view, further pain on those families who lost loved ones in Scotland’s ill-equipped care homes during the COVID scandal of 2020/21.
The First Minister then promises this national care service ‘on a par with the NHS’ can be delivered for £148m. Many will wonder how such a claim can be made when, unlike the NHS, it is not free at the point of need, not publicly owned or run and plainly not fit for the 21st century.
Furthermore when the UK Government, which makes no such grandiose political comparisons for its reforms, believes it will require at least £1.1bn to make even minor improvements to care provision in this country, we fail to see how the Scottish Government can deliver theirs on 1/8th of that budget!
The truth is the Scottish Government has earmarked £146m/year for a bureaucracy which will merely oversee the continued private provision of social care.
Those who compare what the Scottish Government is recommending, on a fraction of the funds even Boris Johnson promises, will recognise the ‘mess’ Professor Allyson Pollock, clinical professor of public health at Newcastle University, refers to at the heart of Britain’s privatised care system.
The £12bn per annum Boris Johnson has allocated, as Professor Pollock reveals, represents above all a massive public bailout for private care companies. If the fees paid by ‘self-funders’ are to be capped at £86,000 over a lifetime as he proposes, when one in seven presently pay more than £100,000 a year, it stands to reason the bulk of the Prime Ministers new money will go to subsidise private care providers who own 83% of care home beds.
According to the Competition and Markets Authority the care home industry was worth £16bn in 2018 with 5,500 different providers operating 11,300 homes and 456,000 beds for older people. Yet, as Professor Pollock has pointed out, ‘it is virtually impossible to track where that public money is going’. [The Guardian 14th Sept 2021]. We do know however that the quality and extent of that care is declining because the number of adults receiving local authority funded care fell by 26% between 2009 and 2014 as the UK implemented its austerity’ policies. [Source: National Audit Office]
SCOTTISH GOVERNMENTS RECOMMENDATIONS INCONSISTENT WITH ITS STATED AIMS
‘In future’ states the consultation document ‘we want to make sure our social care system will consistently deliver high quality services to everyone that needs them, throughout Scotland’. [P1 – Overview]This is a noble aspiration. Yet it is in effect an admission that this is not presently the case.
‘The Independent Review of Adult Social Care [IRASC] recommended the creation of a national care service, with Scottish Ministers being accountable for adult care support’ adding ‘The NCS will define the strategic direction and quality standards for community health and social care in Scotland…will have local delivery boards to plan, commission and deliver the support and services the people of Scotland require.’
But the ‘independent’, i.e. private sector, will continue to deliver 80% of the services.
The Minister for Mental Wellbeing and Social Care ‘believes social care services, just like health care services, should be provided on a truly universal basis.’
But his plan doesn’t do anything of the kind. Current provision is not ‘universal’, is largely private, discriminates against those without the money to pay for it themselves and often charges those who can more than £100,000 per annum.
He goes on ‘The Independent Review acknowledged that current structures have not delivered the improvements intended … and recommends the creation of a national care service, with Scottish Ministers being accountable for adult social care support.’
Yet again omitting to mention that the provision of that support will continue to be delivered mainly by private companies!
Accountability in the administration and deployment of such vast sums of public money as are involved in the NHS for example to ensure the strategic decisions enjoy the support of the public is a concept widely lauded. The Scottish Socialist Party is not alone however in feeling that such ‘democratic accountability’, and the ethos that accompanies it, is in fact in short supply in Scotland’s public institutions and governance.
We would very much like to see any new national care service be subject to genuine democratic scrutiny and control. Perhaps the new national care service could become the catalyst for democratising all such decision-making in future to allow for genuine public scrutiny and change.
‘A national care service will provide us with consistency, equity and fairness, and the accountability needed to deliver high quality services across Scotland’ insists The Minister for Mental Wellbeing and Social Care.
But will it? Can he guarantee this consistency, equity, fairness, accountability or high quality?
No, of course not. Not whilst it remains in private hands and under the control of commercial companies. His proposal for a national care service delivers little beyond a Chief Executive, a set of Deputy Chiefs all ‘on a par with the NHS’ at least in terms of their hefty salaries!
Yet with £45m of its budget already earmarked for a modest pay increase for care staff the residual figure is utterly inadequate to improve the overall quality of care in Scotland so urgently demanded.
‘This year we provided £64.5m to ensure social care workers are paid at least £9.50/hour’ the Minister boasts. Yet his figure is barely above the minimum wage. It will certainly do little to halt ‘the brain drain’ that saw 33% of care staff leave the profession in 2019. And this haemorrhage is likely to be surpassed this year by those who leave the profession once the immediate pressure of the COVID pandemic is behind them.
‘The delivery of social care support is currently the statutory responsibility of local government under the 1968 Act. Scottish Ministers are responsible for the delivery of social care support.’ [P3- Chapter 2]
Yet again the fact is that support is overwhelmingly ‘delivered’ by private companies that in our view leads to a fundamental conflict of interest between the public good and private profit.
THE CRUCIAL ISSUE OF FUNDING
In the SSP’s response to Feeley last year we highlighted the view of Sir Simon Stevens, Chief Executive of NHS England, who spoke for many when he said [5/7/20] ‘After at least two decades of talking about it, we do not have a fair and properly resourced adult social care system in this country with a proper set of workforce supports.’
That failure meant thousands of elderly people in Scotland died before their time as the Covid deaths took their toll.
We also asked, in our response to Feeley, what more graphic illustration do we need of a failing system when one third of our most dedicated, valuable, hard-working and motivated carers leave the profession annually? What impact do we think their departure has on the quality of care recipients receive? Scotland as a nation deserves far better.
‘WE NEED TO INVEST IN QUALITY SOCIAL CARE’
Prime Minister Boris Johnson said on Sept 13th 2021 ‘We need to invest in quality social care’ with the clear admission being that we have consistently failed to do. So just how far will his £36bn go over the next 3 years? In the first instance half of it is to go towards reducing NHS waiting lists after the enormous backlog built up under the COVID pandemic. Social care will therefore see very little of the £36bn for the next three years.
Only thereafter is the majority of the £12bn/annum to be spent on improving the quality of social care in Britain. So where will it go?
As Professor Pollock has pointed out, given there is to be a £86,000/lifetime cap on ‘self-funder’ payments, when some people are paying more than £100,000 per annum at the moment, it stands to reason the bulk of the £12bn earmarked will be paid from the public purse directly to the private sector who deliver 80% of the care.
There is a promise to raise the minimum wage of care staff to £9.50 per hour. Yet the national minimum wage, currently £8.91 [outside London], is already due to rise to £9.96 by 2023. [Source: The Low Pay Commission]Additionally we need to recruit 100,000 new carers merely to fill the vacancies that presently exist in a service with appallingly high levels of turnover. This says nothing about the need to provide staff to serve the anticipated extra demand for adult social care the demographic trends have already identified by 2030.
Given all these pressures one begins to see how little money is actually going to improve the quality of frontline social care provision.
So the extra £1.1bn/year is, as the SSP made clear in its earlier submission to the Feeley Review, nowhere near enough to keep even the modest promises made by Scottish Ministers!
What will be left for care quality improvements? And what about the anticipated increase in demand posed by ‘the demographic time bomb’ the retiring baby-boom generation and increased dementia diagnoses and an aging population brings? Or for meaningful improvements to the poor pay and conditions staff endure?
A FAIR DAY’S PAY FOR A FAIR DAY’S WORK
There were 206,400 people employed in the social care sector in Dec 2019 and another 800,000 acting as unpaid carers. Yet there are 120,000 vacancies for care home staff across Britain today.
The Scottish Government admits ‘the levels of pay within the social care workforce are low’. They are in fact poor. And they reflect an institutional failure by all those agencies who had responsibility for ‘delivering’ this service and ‘overseeing’ the system for many decades.
In this private sector industry low pay, zero hour contracts and high turnover are endemic. The degree to which care staff feel ‘undervalued’ and bullied is another scandal. As is the lack of access to further training or career development. [P3 and P13 Chapter 7]
Indeed it is hard to find another sector or profession in such a poor condition. This is truly an indictment of the thousands of employers who are primarily responsible for this dismal picture. And yet no one is held responsible for this ‘system failure’.
The Scottish Government can apparently do nothing. ‘There is currently no ability to set [common] minimum standards for workforce conditions with individual providers; this leads to a variety of workforce conditions across the sector’. [P3 Chapter 7] Adding to the litany of failure it accepts ‘The social care sector is generally not well unionised’ and ‘Many providers do not recognise a trade union, especially among personal assistants.’
This chapter provides a depressingly lengthy picture of this failure in accepting ’general levels of pay within social care are low’, ’staff have indicated this leaves them feeling undervalued’, ‘there is currently no ability to set minimum standards for workforce conditions’, ‘The social care is generally not well unionised’ [not for the want of the unions trying, but again because of the anti-union philosophy of private employers]This situation exists in our view because this is a sector that is in effect governed by private companies and company/contract law.
The Scottish Socialist Party believes this is an unacceptable state of affairs.
To the Scottish Government’s recommendation number 44 that ‘Specific priority should [?] be given to pay, travel time, sick pay arrangements, training and development, maternity pay, progression pathways and pension provision.’ The question is surely when and by whom?
Question 88 of this consultation asks ‘What do you think would make social care staff feel more valued in their role?’ And its long list of multiples choice options includes improved pay, removal of zero hour contracts, collective bargaining rights and full access to training and development.
The only acceptable answer to this question in any civilised society, given the events of the past 18months is surely, ‘All of the above, And urgently!’
The Scottish Socialist Party therefore advocates a transformation in the employment practices of this profession. We support a £15/hour living wage [including a carer’s premium] for all qualified staff with a guaranteed number of hours available to them each week as Unison and the GMB advocate. Contracts of employment that respect and attract employees rather than repel them must become the norm. And in that regard the Scottish Socialist Party believes every worker in the sector must be guaranteed at least 16 hours per week as a necessary accompaniment to the £15/ hour rate. This is a proposal now supported, as we understand it, by the Scottish Trades Union Congress [STUC].
Career-long training programmes with plenty opportunity for progression must also be introduced urgently. Attracting young women and men into the profession must also play a part in solving the chronic recruitment and retention challenge. And if we are to retain them we must champion the tremendous rewards that await those inspired by such human-to-human support and empowerment.
The cost implications of all these reforms are clearly considerable. But the cost of doing nothing has, as we have found to our cost over decades now, been higher still.
CONCLUSIONS AND THE WAY FORWARD
In reading the consultation document one cannot help but conclude that Scottish Government Ministerial ‘oversight’ has, for many years, been compromised by the fiduciary responsibilities of Scotland’s private care companies to make profits for their shareholders out of the provision of adult social care. And there are clearly large profits to be made.
There is no doubt in our minds that this central conflict stands in the way of the many urgently needed improvements to the way the system of adult social care is delivered.
The Scottish Government must show greater urgency in our view in addressing this central deficiency and recognise its own past failures in this regard. The impact of COVID further exposed these profound and deep-seated deficiencies in the provision of adult social care in this country over decades.
The public mood today is, as the Scottish Government well knows is angry. And, as our own opinion poll has shown, the Scottish people have made it abundantly clear that they want a national care service that is free, public and fit for the 21st century. Nothing else will do.
The Scottish Socialist Party agrees with the conclusion reached by Professor Allyson Pollock, clinical professor of public health at Newcastle University who said in support of such a national social care service ‘by returning private care provision to public hands we would ensure accountability, quality of care and prevent public money from passing to private shareholders and investors. As it stands the national insurance levy is a bailout for these debt-laden, profit seeking companies.’
We further believe the First Minister cannot possibly reconcile her much repeated promise of ‘a national care service on a par with the NHS’ with the fundamental contradiction in her comparison, And to suggest it can be done for £146m is simply not credible.
Whilst ‘a national care service in Scotland on a par with the NHS’ enjoys huge public support, it is not being proposed by the Scottish Government. The public, in our view, will not accept one that is not free at the point of need, not publicly owned and run, and not fit for the 21st century.
It says a great deal about the predominant political culture that Scottish Ministers and the UK Prime Minister are both too quick to dismiss the only long workable term solution to the crisis currently facing adult social care today and the huge challenges posed by tomorrow.
The Scottish Socialist Party by contrast believes that it is only when we have arrived at the position we have outlined in this submission will the crisis in adult social care provision in Scotland finally be ended