Social Care Reform

The Church is consulting with the Scottish Government on proposals to reform the country's adult social care system.

In the wake of COVID-19, Health and Social Care Secretary Humza Yousaf is leading on plans to reform Scotland's adult social care system and set up a National Care Service. The Church, which has played a significant role in social care for the past 150 years, is consulting with MSPs on the proposals. These have been informed by a wide-ranging Independent Review of Adult Social Care.

More than 200,000 adults receive support from an estimated 700,000 unpaid carers and 200,000 people employed across all aspects of social care. Many social care workers report not feeling valued in relation to the work they do: experienced care workers can earn less than entry-level retail workers.

The Church is urging the Scottish Government to introduce policies and spending priorities which will result in a better managed and resourced social care system. Such a system could become a dynamic force for a Just and Green Recovery, making Scotland a fairer, more empathetic and enabling society that empowers the cared for and carers to help make their communities flourish and live life in all its fullness.

Five areas of focus

The Independent Review makes 50 recommendations to improve adult social care. From these, the Church has identified the following five themes, which we believe have the greatest potential for making a positive difference to vulnerable people across Scotland.

Adopt a human rights and equalities approach to planning and delivering social care support, which upholds the rights of those being cared for and of unpaid carers

The Church believes that everyone in Scotland has the right to flourish and live as fulfilling a life as possible, and that this can be facilitated by the adoption of a human rights approach to social care. A human rights approach affirms that the purpose of social care is to support individuals and enable them to meet their needs, choices and aspirations for a good quality of life and to fulfil their potential as far as possible. It also affirms the rights of unpaid carers to be listened to, informed and empowered in decision making.

Better support and recognition for the distinct and valuable work of community-based volunteer-led social services

Church congregations are involved in many such services, and we believe that these groups have valuable experience in keeping communities connected and resilient. We welcome ‘A Connected Scotland,' the strategy for tackling isolation and loneliness, and urge the government to engage meaningfully with the third sector and local faith groups as they implement the strategy.

To cover their expenses, many groups rely on precarious, short-term funding streams which impose heavy administrative burdens, such as writing multiple reports or making new applications. This takes up valuable time of key staff and volunteers which could be spent on developing and delivering services.

Experience shows that these services can work best when the following factors are in place:

• Support and co-operation from the local authority and health and social care partnership, with recognition for the services' distinct identity, rooted in the community
• Training and involvement in health and social care networking and planning
• More secure, longer-term funding for key roles such as volunteer co-ordinators. This would make a huge difference to the sustainability of services and unlock more staff and volunteer time and energy.

A more valued national workforce for the social care sector, with improved and consistent pay, conditions, training and professional development

Scotland's care sector needs to attract people with the right skills and values so that those who need support can rely on those supporting them.

A report by the Fair Work Commission in 2019 highlights the inequities between staff working in social care and the NHS. Some care workers are employed directly by local authorities, and others by private or voluntary sector providers that must bid competitively to win contracts from local authorities. This commissioning process drives down costs and can lead to poorer terms and conditions for care workers employed by the private and voluntary sectors.

A National Care Service could ensure consistency in rates of pay, terms and conditions, training and progression to develop a fairly paid, properly valued and professional workforce, with good career paths. Given that the workforce is predominantly female, these improvements could contribute to the wider national objectives of gender equity and equal pay.

A more ethical and collaborative approach to commissioning care services

Good commissioning in social care is about creating a partnership of purchasers, providers and service users to work out future demand and use resources in the best way to provide high-quality, sustainable support. Rather than forcing care providers to compete with one another to reduce costs, the commissioning process should become much more collaborative. Such collaboration must encompass:

• Delivering the best possible outcomes for those who use services
• Requiring all providers to embed Fair Working practices
• Ensuring price is not the main consideration when support is being designed
• Ensuring that the individual being cared for plays a meaningful part in designing their care.

Commissioning currently takes place at local authority level, and we recognise that local accountability and responsiveness to local conditions are important. However, we hope that a National Care Service may be better suited to tackle the inequalities within the current system, placing social care services on an equal footing with the services provided by NHS, and better able to standardise the workforce terms and conditions, training and succession opportunities.

Reforming the care home sector

The COVID-19 pandemic exposed the pre-existing fragility in the care home sector and highlighted the way in which we undervalue our older people and the workforce (paid or unpaid) who support them. The sector is funded by a mixed economy of privately funded places, places funded by a Local Authority under a National Care Home Contract, and some charitable funding.

The National Care Home contract is insufficient to meet the full costs of care, leaving providers to bridge the financial gap in other ways. Over 75% of care homes in Scotland are now privately run, and because of the commercial pressures many of these care homes are large-scale operations offering terms and conditions to staff that only meet minimum standards.

In addition, there is a ‘leakage' of public funding for social care, where private sector care providers' profits go to the shareholders, rather than being invested back into the sector.

The Church of Scotland urges the Scottish Government to introduce policies and spending priorities in line with proposals for a Just and Green Recovery in response to the economic, social and environmental impact of COVID-19. This includes protecting marginalised people and those on low incomes by redistributing wealth and providing adequate incomes for all. We also support setting a minimum level of reinvestment in services as well as nationwide standards of pay and conditions for workers.

Learn more

To receive our full briefing on social care reform, please email Clare Flenley (cflenley@churchofscotland.org.uk).