Potential problems aplenty

The care of older people in Scotland is a national disgrace. Fairly paid, well-trained staff on proper contracts with time to care is the very least older people in our communities have a right to expect.
Over recent years, I have written reports highlighting staffing levels, budgets, structures and care strategies. Words have been written and numbers crunched – but that doesn’t tell the whole story.

I participated in a couple of care worker focus groups last year and the messages from the workers who provide care were deeply disturbing. They painted a shocking picture of care in Scotland that nobody would want for their elderly relatives. Having experienced those messages first hand, I decided we would ask a much larger group of care workers and the outcome of that work is set out in UNISON Scotland’s ‘Scotland – It’s Time to Care’ Paper.

The majority of workers believe the service is not sufficient to meet the needs of the elderly and vulnerable people they care for – both from the amount of time they can spend and the quality of care they can provide. Almost half of carers said they had limited time to spend with their clients. One in two workers are not reimbursed for travelling between client visits, while three in four said they expected the situation to get worse over the coming year. They also revealed that one in ten is on zero hours’ contracts, many more on nominal hour contracts that don’t reflect their actual working patterns.

Time to do more than just deliver a few manual tasks was important to staff and the people they care for. As one worker put it: ‘By doing the best that we can with the time given, I’ll admit I sometimes miss out a job so that I can sit for two minutes with the person receiving care. That means more to them than the dishes needing dried’.

Adequate training is another concern, particularly for newly appointed younger staff. One said: ‘Staff are not receiving the training they need to carry out their roles, only the training which is low cost or has been identified as core’. Many frankly told us they will leave the sector as soon as a better job comes up. Care has become the new retail.

The isolating impact of personalisation was often mentioned and the threat of losing contracts if they make a fuss. One worker said: ‘Stop threatening charities indirectly that you will take the SDS (Self Directed Support) contracts away from them and move to another provider if workers challenge decisions … Being told by management this is the case and we all must be quiet even though the workers sole concern is for the service user they care for and want the best for them’. Some staff told me that they wouldn’t even report carer abuse for the same reason.

These are the stories of front line workers that illustrate, all too clearly, what we guessed from the hard evidence. This report should be a wake-up call for the Scottish Government and commissioning bodies to take action to end the race to the bottom in care provision. Sadly, there is little evidence that they are prepared to do so.

The Scottish Government is dumping the largest share of the cuts onto local government. Protecting health spending is the easy political choice, but it is council cuts that contribute towards the bed blocking that is causing so many problems in our NHS. The number of patients in hospital when they shouldn’t be is the equivalent of all the beds in the Southern General Hospital. In addition, despite assurances given during the progress of the Procurement Act, Scottish ministers have moved painfully slowly to develop new statutory guidance.

Despite the cuts, a few councils have taken action and adopted the approach set out in UNISON’s Ethical Care Charter. However in Glasgow, staff and service users have been protesting at the decision of Glasgow City Council to cut mental health services in the city, currently provided by GAMH.

It is rank hypocrisy for the council leader to announce his council’s commitment to promote the living wage through procurement on one day, when the next day his council is planning to shift a service from a good living wage employer to another that isn’t. And that’s quite apart from the blatant breach of the statutory requirements under s52 of the Local Government in Scotland Act.

From April, it will be the responsibility of the new health and care integration bodies to address this issue. We recently asked the workers who will have to deliver these integrated services what they thought of the new approach. While most staff believed care integration provides an opportunity to improve services, only 6% expect conditions to improve in the next year, 68% believe the situation will get worse and 63% felt that their professionalism is or has been compromised by budget and resource limitations.

Health workers have a concern that privatisation in the social care sector will expand into community health services through integration. The private sector now employs 41% of people working in social services in Scotland, the public sector employs 32% and the voluntary sector employs 27%. The fragmentation of service delivery is causing huge practical problems for staff that have to ensure that vulnerable clients receive a service.

It doesn’t have to be this way. The Scottish Government should set out clear procurement rules for care provision that should mandate:

• The Scottish Living Wage: this will help the recruitment and retention of staff and support continuity of care;
• Improved training: to ensure that care is delivered by properly qualified staff;
• Proper employment standards: ending the abuse of zero and nominal hour contracts;
• Adequate time to care in every care visit.

All of this could be done within the existing procurement legislation, if there is the political will.

Dave Watson is UNISON Scotland’s Head of Bargaining and Campaigns. The reports on this issue can be downloaded at http://www.unison-scotland.org.uk/socialwork/index.html