The Report of the Independent Review of Social Care in Scotland was published last week.
Chaired by former NHS Scotland chief executive Derek Feeley, the review was set up by first minister Nicola Sturgeon last September. It followed public outrage over the scandal of 1,800 Covid-related deaths in care homes in Scotland during the first wave of the pandemic.
But while the care home deaths were the immediate trigger for the review, the problems in Scotland’s social care system go much deeper.
Feeley’s report opens with a fairly damning description of the current state of social care in Scotland.
It is a system based on “unwarranted local variation, crisis intervention, a focus on inputs, a reliance on the market, and an undervalued workforce."
One key issue highlighted—though not in these terms—is the extent to which the smooth running of Scottish capitalism relies on “unpaid care”. This usually means women and the family.
Feeley cites research that shows that around 700,000 people are currently providing unpaid care. They represent a larger workforce than the paid health and social care support workforces combined.
The value of unpaid care in Scotland is estimated at over £36 billion a year. For comparison, in 2019 the NHS Scotland budget was £13.4 billion.
Reliance on unpaid care has increased with the imposition of austerity policies since 2008.
In the report’s words, “As the older population has increased and resources have been focused increasingly on those in greatest need, a smaller proportion of the adult population is in receipt of social care support than was before austerity.”
It adds that this results in “the needs of a number of people are probably not being met and for others they are being met in a crisis response rather than to anticipate or avoid such interventions”.
Holding that system together is an army of underpaid, undervalued and, as the pandemic has shown, essential social care workers, 83 percent of them women.
Their experience is highlighted in the report by the example of Carmen Simon, like many of her colleagues, a migrant worker.
She says, “I have been a support worker for adults with multiple/complex needs since 2011. I currently juggle four part time jobs, two of them still in the field of adults with complex/multiple needs.
“In one of my social care roles as a support worker for a private provider I get paid £10 an hour, the same hourly rate since 2015. In my other social care role as a personal assistant, I get paid £9.30 an hour.
“I rely on benefits to make ends meet at the end of the month.”
Given a social care system clearly not fit for purpose, what alternatives does Feeley propose?
His central recommendation is the creation of a National Care Service, equal in status to the NHS.
Since 1948, there has been a sharp break between the National Health Service and care services. The NHS is free at the point of need and funded out of general taxation. The social care system is based on a postcode lottery which rations services on the basis of charges and ever tighter “eligibility” criteria.
Not surprisingly then, the recommendation for a National Care has been warmly welcomed by unions including Unison Scotland. It was also backed by most of the major social care charities.
Among the report’s other recommendations are an end to the current system of rationing services via eligibility criteria and charges, an end to competitive tendering for services, and the payment of the Living Wage to social care workers.
Many of these demands do not go nearly far enough. The GMB union for example is rightly arguing for £15 an hour for all social care workers. But that may still be a bridge too far for an SNP government.
Despite its warm words for care workers, it did not include payment of the Living Wage to them in its draft Covid-Recovery Budget.
But the biggest weakness of Feeley’s Report is that he explicitly rules out the possibility of nationalising social care.
More than 60 percent of residential care in Scotland is now in the hands of private providers.
A report in 2019 found that private providers offered less training, had lower pay and higher staff turnover than Third Sector or local authority-run homes.
So it is perhaps not surprising that homes owned by the giant HC One in Scotland have seen a high number of deaths during the pandemic.
The truth is that without taking residential care back into public ownership, the logic of competition and the market will continue to shape social care.
Feeley’s proposal for a National Care Service in Scotland should be welcomed. But it needs to be one which is based on need not profit and in which all social care workers are paid at least the £15 an hour
It should be shaped by workers, service users and their families, not by the lust for profit of private healthcare providers with their headquarters in offshore tax-havens.