What is adult social care?
Social care for adults is a supportive relationship in which carers work alongside people who have significant challenges in their lives. Social care aims to enable people to maintain as much control over their lives as possible, supporting individuals’ dignity and human rights. The Covid-19 pandemic has highlighted how much we depend upon the services delivered in the social care sector, which is different from, but complimentary to, healthcare. It has also broadened understanding of the historic underfunding of social care in Scotland.
Who is being cared for in Scotland and who is doing the caring?
More than 200,000 adults receive support for a range of life challenges related to physical disability, learning disability, older age and long-term conditions, as well as addiction, homelessness, mental health and experience of the criminal justice system. There are an estimated 700,000 unpaid carers in Scotland currently, looking after family members, friends and neighbours, and 29,000 of these are under 18. A Carers’ Charter was launched in 2018 to set out unpaid carers’ rights, and support networks have been established, with specific support targeted at young carers. Research suggests there is limited awareness of these rights among unpaid carers.
200,000 people are employed in social care, and carers should by law receive the national minimum wage. However, a report by the Fair Work Commission in 2019 highlights the inequality experienced by staff working in social care as opposed to those working in healthcare. For some services, local authorities commission providers to deliver care, usually through a competitive tendering process. Commissioning can result in further inequity between state sector care employees and others, as local authorities drive down the costs of contracts delivered by private and voluntary sector care providers. These “savings” can mean poorer terms and conditions for care workers employed in the private and voluntary sectors.
The Church in social care
In Scotland many Churches have been at the forefront of providing social care and today some of Scotland’s best known adult and children’s care providers have church origins. One of the largest charity providers of social care is the CrossReach, part of the Church of Scotland.
The future of social care:
Scotland’s population aged over 75 is projected to increase by 85% by 2039, and though many people are likely to continue to lead independent lives, as the number of older people grows there are likely to be more people with long term conditions that require care.
There is a live political debate about the question of how social care is delivered and paid for now, to help us prepare for growing need in the future. Currently, adults in need have a right to some free personal care at home, as assessed by social services. The cost of residential care to individuals is set by means-testing, with the Scottish Government funding those who cannot finance their own care through the National Care Home Contract. Some people say that the funding rates provided through the National Care Home Contract rates are too low to provide quality care.
This difference between social care funding and healthcare funding has been dubbed “the dementia tax”, as those needing care for dementia will not have their costs met in the way that the NHS meet the costs of patients with other diseases.
A discussion on the value of social care and generational fairness is needed: to what extent can we expect people to pay for their own care, and how much can we expect younger generations to pay for it through tax, when there will be progressively fewer people of working age?
We need to attract people with the right skills and values into social care so that people who need support can rely on those supporting them. Given the predominantly female workforce, what impact would implementing fair pay and working practices have on the gender pay gap? What difference would we make to future sustainability by ensuring that the workforce have effective voice and can feel more valued? How might changes to immigration as a result of Brexit impact on the social care workforce?
Reform is now on the agenda and several political parties have made proposals. The idea of a national care service, similar to the NHS, has been floated. An Independent Review of Adult Social Care in Scotland published its findings in February 2021. The Review proposes a rethink and a redesign of the current system to create a National Care Service, but not a nationalisation of care provision. It states “strong and effective social care support is foundational to the flourishing of everyone in Scotland”. The details of these reforms, and the role of Church and voluntary sector providers, are likely to be a key priority for the new Parliament, whichever party ends up in power.
Questions for Candidates:
- How will you improve the pay and conditions for frontline staff delivering essential social care services?
- How will you improve on the National Care Home contract so charitable sector providers can keep providing high quality support for those who are unable to finance their own care?
- What will you do to ensure the sustainability of social care services so that they are well resourced into the future?