Social Care Reform

Philippa Whitford Excerpts

Thursday 18th March 2021 Westminster Hall

[Dr Philippa Whitford (Central Ayrshire) (SNP) [V]]

Thank you very much, Dr Huq. I pay tribute to social care staff for all they have done during the pandemic and recognise that they, too, suffered bereavement when they lost residents to covid who they had been looking after for a long time. Instead of sympathy, they often faced criticism and attack in the media.

Like the NHS, social care has faced huge pressures during the covid pandemic, so it was shocking that it was not mentioned at all in the Budget. While the Chancellor claimed the UK was in good shape when covid hit due to the Government’s management of public finances, it actually came at the end of a decade of austerity, with the NHS on its knees and an £8 billion social care funding gap in England alone. Service cuts had led to under-provision, with Age UK identifying that almost 1.5 million people do not get the support they need. While most think of frail, elderly people when they talk about social care, it is also critical to allow those facing end of life to be at home if they wish, and to ensure that younger people with a disability can participate fully in society.

The Government’s Green Paper, first announced in 2017, has been postponed yet again, despite the Prime Minister boasting in the 2019 election that he had a plan for social care that was ready to go. Perhaps he was mixing it up with his oven-ready Brexit plan.

More recently, we have been told the delay is due to cross-party discussions, but I certainly have not seen anything, nor apparently has the shadow Minister for Care. Several MPs in this debate have suggested that the Government should propose an insurance-based model, and Germany and Japan are often held up as examples. However, closer examination shows that both systems have increasing shortfalls and that co-payments are, therefore, growing markedly. Taxation still provides the greatest solidarity and security. The Secretary of State has announced plans to reverse some of the most damaging aspects of the Health and Social Care Act 2012 and promote integration of health and social care. Of course, the devil is in the detail, and there was very little of that about social care in the White Paper.

Scotland faces exactly the same issues as the rest of the UK: an ageing population, a growing need for social care support, and the challenge of retaining and recruiting care staff, particularly with new visa requirements increasing the difficulty in recruiting from the EU. However, there are significant differences in both the provision and structure of health and social care in Scotland. After devolution more than two decades ago, the structures of the healthcare market, including hospital and primary care trusts and the purchaser/provider split, were reversed and the Scottish NHS returned to being a single public body with local services provided by geographical health boards. Since 2014, Scotland has been working on integrating the NHS with social care through the establishment of integrated joint boards. They manage half of the total Scottish healthcare budget for the provision of all community services.

Of course, covid highlighted how much further we have to go, as social care is a much more fragmented landscape. The pandemic, however, stimulated a lot of close working, including projects I was part of during the first wave. One involved colleagues from acute medicine, geriatrics and the local hospice holding online meetings with care home staff to discuss difficult cases and provide advice and training in symptom management and end of life care. The other was to try and identify unpaid carers, who often grow into the role so gradually that they do not recognise the part they play. The aim is to reach out to them when they attend their local community pharmacy and encourage them to make contact with our local carers’ hubs, where they can access support, benefit advice, PPE or even just have a chat. Due to their pivotal role, unpaid carers are now being invited to receive the vaccine.

Having been involved in redesign projects over many years as a breast cancer surgeon, it was fantastic to see the usual barriers to innovation simply collapse, and the relationships formed during the pandemic will definitely accelerate integration going forward. Due to its size and rural nature, Scotland already had significant digital health infrastructure, and video consultation systems, such as Near Me, were extended to all areas. Care homes were provided with devices and digital support to connect staff and residents to their families and, when needed, to the NHS. The Scottish Government underwrote sick pay to ensure that staff could isolate if necessary. As well as providing PPE to local social care providers, health boards offered access to NHS locum banks to reduce the need for agency staff and ensure safe workforce levels.

Scotland is unique among the four nations in having provided free personal care to those over 65 since 2002, with the provision increased in 2011 and the age threshold removed in April 2019 by Frank’s Law—named after the footballer, Frank Kopel, who developed early onset dementia. Such provision encourages people to stay at home, which most of us would prefer. Two thirds of social care is provided in people’s own homes. That means there is a need for a strong home care sector as well as residential and nursing care homes.

It is important to remember that social care is delivered by people for people, so it is critical to recognise the importance of relationships and the need for continuity, dignity and respect. Social care staff also need respect for their skill and dedication, and for what they do for those we love. Part of that recognition should be paying care staff properly for a tough job that most of us could not do.

The Scottish Government have funded the real living wage for care staff since 2017. They fund overnight sleepovers at the full rate, and they provided a 3% pay rise last year. Social care staff in Scotland have also received the same £500 thank-you payment as their NHS colleagues this month. Unfortunately, the UK Government refuse to exempt it from tax or benefit deductions.

Care staff should not be described as unskilled workers, which we hear from the Home Office, just because they are paid too little. That fails to recognise the difference between wealth and worth. As many MPs have said this afternoon, caring needs to become a career and not be a low-paid stopgap before someone gets a better job on the checkout at Tesco’s. However, this is not just about basic pay rates; it is also about overall terms and conditions and the ability to take pride in one’s work through having an ongoing, satisfying relationship with the person receiving care, not just a rushed, 15-minute transaction.

Last autumn, the Scottish Government commissioned an independent review of adult care in Scotland. The Feeley report has now been published. It proposes the creation of a national care service, with national contracts, clinical standards, training and terms and conditions, to ensure greater equity and consistency across Scotland. It promotes a human-rights-based approach for the care recipient, with the principle of seeing social care as an investment rather than just a financial burden; it should allow everyone to participate fully in society. One recommendation is that all non-residential services should be provided free, in the same way as healthcare is.

We will be the next generation of care users, whether as a recipient of care or as an unpaid carer seeking respite for a loved one. We therefore have a vested interest in reform of the structure and provision of social care in all four nations of the UK and in how the people who deliver it are trained and have access to career development, but also how they are valued. To improve the quality of social care, we must invest in those who deliver that care. Caring needs to become a profession, and a profession that is respected.