As the board met at 10am today, we stood in socially distanced solidarity with the residents, the care workers and with the deputations to the EIJB from the Council unions and Edinburgh TUC.
Here is the text of deputations to the board from the Edinburgh Trades Union Council:
Bed Based Care – Phase One Strategy
My name is Des Loughney, Secretary of Edinburgh Trade Union Council. My colleague is Kathy Jenkins who is a delegate to Edinburgh TUC. We would like to thank the Board for agreeing to hear our deputation. I will speak for five minutes and Kathy for the other five.
The reason we decided to seek a deputation is that the local trade union movement is very interested in the future of Scottish Social Care. We made a submission to the Feeley Review and participated in the Social Care debate that took place at the April Congress of the Scottish Trades Union Congress. This debate formulated a trade union policy on the future of Social Care in Scotland. When we learnt of the paper that is Item 7.1 we were curious how that fitted into thinking about the future of Social Care. We are aware that the Scottish Government will be introducing legislation this year which will take up at least some of the Feeley recommendations.
It has been difficult to digest the whole paper as we only saw the final copy on Wednesday last week and became aware that recommendations of the paper will be amended. We were sent copy of the amendment on Friday afternoon. It has been difficult to fully digest the report in the time available.
We think that the actions proposed in the amendment are positive but we have questions about points (iii) and (iv).
Before I comment on the points I wish to say that Edinburgh TUC understands the concerns of the workforce and their trade unions about the way they were informed about the proposals contained within 7.1. After all their heroic efforts during the past fifteenth months of COVID, after enduring constant anxieties about protective equipment, putting their lives and their families lives at risk, the health and well being of their residents, they did not want added further anxieties about the future of their jobs. Staff had assumed that the rhetoric from politicians and senior management regarding their value now and in the future was meant. Their experience over the last couple of weeks has dismayed staff. We welcome point (ii) of the amendment in the expectation that engagement with trade unions will be real and that staff concerns about their future are fully addressed.
We think the paper for item 7.1 does not address the public’s main anxieties or concerns about the future of Social Care in Edinburgh (and Scotland). These main concerns are:
- Have the lessons from COVID been learnt? Is the social care system going to be changed so that we are better able to deal with the remainder of this epidemic and future similar epidemics? How we are going to avoid, in future, the alarming death toll in care homes which some people say were entirely preventable. How are we going to avoid resident isolation and associated distress and mental ill health? How is Social Care going to deal with the increasing challenges of Long Covid?
- What will be the ongoing impact of austerity on social care plans. People are sceptical that any progressive plans will be delivered in full to all the people that need the service . Plans will be watered down in volume and content. Eventually a system of rationing will creep in. The EIJB needs to be very clear about whether or not the resources will be available to implement their proposals.
- COVID revealed the problems that arise when you have to deal with an emergency having poorly trained, poorly managed and poorly paid staff, so bad that there is a 25% turnover of staff every year. We hope resources as mentioned in (v) can be identified. If not we hope that the EIJB will able to specify what is required from the Scottish Government.
- What is the EIJB going to do about addressing the deficiencies of the private sector that were so clearly exposed by COVID? How does it happen that ten months into the epidemic the Care Commission has to issue a letters of serious concern to the Braid Hills Nursing Centre regarding COVID standards? On page 153 the paper allows the possibility that some residents of the homes proposed for closure may be offered accomodation within what is termed the private marketplace. What assurances can you give the public that the placements will be now and in the future safe and of good quality?
In looking at the points on the proposed amendment we consider that point (iii) should be amended. To (iii) should be added “and commissioning new build care homes to replace the places lost by the closure of the four homes to be run by the City of Edinburgh Council and staffed by local authority employees”. Taking account of all that is stated in the paper we consider that there should also be plans to build new care homes to meet increasing demands and including replacing inadequate private sector homes/beds. At the moment there seems to be an assumption that if the demand for care home places increase it will be solely met through the private sector. This , because of the problems of the private sector, is a poor and unwelcome strategy.
In relation to point (iv) I hope that there will be a thorough detailing of the investment that will be required to provide the service specified throughout Edinburgh; available to all who need the service, taking into account the impact of increasing poverty.
At the moment we are assuming that the Scottish Government will, in 2021/22 introduce legislation to set up a Scottish Care Service with a changed role for local authorities and Integration Joint Boards. I hope that in August there will be a discussion of how such changes might affect your strategy – that the possible changes will be part of an impact assessment.
Thank you for listening. I will happy to answer any questions clarifying what I have said.
EIJB ETUC deputation. 22 June 2021
Contribution from Kathy Jenkins
As Des has said, I am Kathy Jenkins. I welcome the opportunity to speak to you today in response to your social care proposals.
Des has addressed some of the issues involved in the changes proposed for care homes. I would like to concentrate mainly on recommendations 4 and 5: investment for home care and community infrastructure; and workforce planning – the measures to be taken to support the recruitment, retention and development of staff.
Before I do that, though, I would make a few wider comments. First it seems to us that Liberton Hospital is being closed at a time when NHS hospitals are under severe pressure and that changes in social care provision in Edinburgh are to some extent being driven by a need for savings/income generation in the NHS. Second, we believe that what is needed, in terms of quality of care, working conditions and cost, is a reduction in reliance on the for-profit sector and an increase in public sector provision. Third, we welcome plans to increase intermediate care and would confirm your statement that there is hidden need – known through the personal experience of people being discharged from hospital to unsuitable situations without assessment being done of their rehabilitation needs. We also see as crucial that respite care services be retained and expanded to provide support for carers. Fourth, you plan to increase the number of nursing homes through various changes including employment of nurses. As these homes will be dealing with more complex needs, will there be changes to the training, pay and conditions of other staff in these homes?
Coming to care at home, we welcome the emphasis in the paper on creating a social care system which will support people to stay in their own homes and communities for as long as possible. But this will only work if it is well resourced. Will this be the case for those over 65 as well as younger? In my experience a cap can be put on expenditure if it is more than the cost of a care home bed for those over 65, meaning they cannot be given the home care they need. Will night as well as day support be given? If this is the case, proposals will need to include provision of suitable housing.
We welcome your discussion of the 20 minute neighbourhood (and wider discussion in Scotland of community hubs), but if we understand them correctly this would need major changes in care at home provision. At present our understanding is that care at home services in Edinburgh are given by a large number of providers. This is inefficient, as different providers can be working in the same geographical area. What is needed is a rationalisation of provision around the community hub/20 minute neighbourhood to enable those needing care and home care staff providing that care to integrate into the community and support each other. Many of the current providers are in the private sector. Again, we would argue for a reduction in reliance on the for-profit sector and an increase in public sector provision. We believe this would have a positive impact on quality and know that it would have a positive impact on worker health, safety and welfare. We have looked in some detail at both published and anecdotal evidence regarding the health and safety issues faced by social care workers, and particularly those employed on poor terms and conditions in the third and private sectors. These include:
*lack of rest and welfare facilities
*lack of adequate staffing and equipment for moving and handling
*issues relating to the physical work environment, particularly for those providing care in other’s homes, e.g. poor or overcrowded housing, cleanliness, waste and waste recycling, exposure to chemical and biological hazards; slips, trips and falls
* physical environments that are not suitable for infection control, both poor or overcrowded housing and institutions like care homes
*hazards involved in lone working, including violence and aggression
*lack of sufficient personal protective equipment, e.g. appropriate grade masks, aprons, gloves, visors, goggles; and inadequacy of arrangements for dealing with contaminated PPE
And additional Issues that have direct implications for both mental and physical health through poverty and work related stress:*precarious contracts ( including zero hour contracts)
*lack of job security
*expectations of ever increasing flexibility by workers; lack of predictability of hours; the burden of risk of unpredictable social care demand and cost being placed almost entirely upon the workforce
*long working hours; high levels of unpaid overtime;
*lack of support and supervision
* growth in split shifts; shift patterns resulting in exhaustion, which then causes accidents e.g. care at home staff not paid for travel time so have to work longer hours to get basic pay; difficult shift patterns in residential care; reductions in paid sleepovers
*issues with entitlement to sick pay and holiday pay
*underuse of skills
*little ability to contribute to decision making
*an expectation for home care workers to do what have been traditionally seen as nursing tasks but without appropriate training and support
*difficulties in accessing training and certification
*inadequate time to carry out required tasks in a way that respects the dignity and care needs of the user
*administrative tasks having to be done in time designated for care, reducing further the ability to deliver quality care
*no paid time for travel between clients homes reducing further the time given to care
*the resulting low morale and high levels of stress due unrealistic workload, not enough time for clients, lack of support, not feeling valued, and the absence of meaningful recognition of the importance of relationships in service delivery
I would close with two more comments. We welcome the community mobilisation you describe but have concerns about how this will be supported given the cuts that have been made in community development staff over recent years. The proposed Three Conversations model looks interesting and hopeful, but we would have concerns that too heavy a reliance could be put on unpaid, voluntary input. This is important and valuable, but there must also be well resourced social care provision by paid social care workers alongside.
Thank you for your attention.
Delegate to ETUC
H&S officer, Unite Edinburgh Not for Profit Branch