Updated March 2021
by David Bradwell
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 Scottish Government describes social care as an investment in Scotland’s people, society and economy. 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 living wage. However, a report by the Fair Work Commission in 2019 highlights the inequity experienced by staff working in social care as opposed to those working in healthcare. 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
The Church of Scotland has played a significant role in social care for the past 150 years. Today, CrossReach is responsible for this aspect of the Church’s ministry, employing around 1,700 staff and mobilising over 300 volunteers in order to support more than 11,000 people each year. The Church of Scotland has committed to supporting CrossReach as a vital outworking of Jesus’ command to love our neighbours as ourselves.
The future of social care
Scotland’s population aged over 75 is projected to increase by 85% by 2039, and though many 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.
Many people feel that we need to address 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 government funding those who cannot finance their own care through the National Care Home Contract. There is widespread concern that 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?
In 2016, legislation was passed to integrate health and social care services into one system, with 31 new authorities around the country. Further changes are called for, and 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”.
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 organisations like CrossReach 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?
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Article updated March 2021 by David Bradwell