Edinburgh Care Crisis

The Edinburgh Integrated Joint Board met on Tuesday 18th October. One of the major items on their agenda – a Scottish Government report on health and social care in the city was discussed in private (point 11 referred to in the deputations that we post here). Another Edinburgh is Possible held a protest outside the city chambers while members of Edinburgh TUC delivered deputations to the meeting. We reproduce two of the deputations here.

Image by Pete Cannell CC0

Deputation from Edinburgh Trade Union Council

I would like to thank the Board for agreeing to hear our deputation today. It consists of three people. There is myself as Secretary of Edinburgh TUC and two delegates Kathy Jenkins and Carment Simon who have been on previous deputations.  We are aware that we have asked not to comment on 11.1 as that item will be heard in private.  I will say this that the Report of 11.1 does raise some issues of great public concern which the public need to know about.

Because of the overlap between 6.2 and 11.1 I think that most of our concerns can be raised under 6.2.

The trade union movement have long been aware of the problems of recruitment and retention of all types of social care workers. We raised this issue years ago.  We predicted that the outcome of existing policies would be the crisis we face today.   We note that 6.2 states that the Scottish Government is going to provide additional support and capacity. This initiative is welcome but we are afraid that additional support will not be enough and will not mitigate the current social care staffing crisis.

The crisis is well illustrated by a leaflet that was put through my door a couple of weeks ago by the Thistle Foundation. The leaflet says that “We’re recruiting!”. The leaflet refers to “Our highly skilled Personal Assistants and Wellbeing Practitioners supporting people in communities across Edinburgh…. helping people to lead full, active and socially connected lives”.

Is the Thistle Foundation offering a skilled wage to its highly skilled workers? No, it is not. The hourly rate varies from £10.89 to £12.02 per hour. It does not offer contractual sick pay nor what seems to be a good pension scheme. It does offer a welcome payment of £500.

Our view is that you will always have problems with recruitment and retention if you do not offer skilled workers appropriate wages, terms and conditions. If the EIJB and the Scottish Government really want to solve the issue of unmet need in Edinburgh then they need a strategy starting now if it is to have any impact during the next six months. The strategy is necesssary if the EIJB and the City Council are to meet their statutory obligations.

Paper 6.2 mentions that there is consideration of setting up what is called a ‘triage team’. To us this team will cut packages of care as assessed by social workers and occupational therapists in collaboration with patients, careers and relatives. Every means will be used by the triage team to reduce hours without any consultation with interested parties. It is a reactionary solution to unmet need. Instead of a bold plan to recruit more staff and create better facilities the EIJB plans to cut the social care service that is available to the people of Edinburgh. The intention is to reduce the average care package in Edinburgh from 14 hours to ten hours per person – and ignore professional assessments.

In August 2022 we had a deputation to the EIJB which described the growing health and safety risks to staff and clients through 24 hour shift working. Following that deputation we were asked to submit more evidence. This we did in a paper that was sent to the Chief Officer and the Director of Operations. We have yet to recieve a response to our paper but  I see that there is an acknowledgement in paragraph 44 of 6.2. This says:

“It should be recognised however that, during these unprecedented times, there are likely to be occasions where the level of the demand we are facing temporarily overwhelms our ability to run services safely.”

We appreciate that acknowledgement but we would like to draw the EIJBs attention to the recommendation that we made in our paper:

“UNITE is very concerned at the current way in which 24 hour shift patterns are organised. We do not believe that such shifts are good practice. They are just an expedient way of dealing with financial constraints and staffing shortages. We hope we have made it clear that we believe that the context of organising these shifts needs to change. There needs to be more and better training for support workers and more support from management. Good health and safety needs to be a condition of funding. 

We believe that the Edinburgh Integration Joint Board needs to study the quality they expect. Once the quality standards have been established it should provide the resources so that the quality standards can be achieved for clients and social care workers. “

Contact Des Loughney at desloughney@blueyonder.co.uk if you have any questions about anything in this statement

World Skills UK. CC BY 2.0

Kathy Jenkins input 

Thank you for the opportunity to address you today.  I was heartened by reading in the Systems Pressure Update that some action is being taken and welcome the fact that the Scottish Government has provided additional resource and support.  However, I have some questions and many  concerns. It isn’t possible to raise them all, but these are among them.   

First, I want to echo what my colleagues have said regarding staffing levels and the pay and conditions of staff.   One detail I wanted to add is that in para 3 of the paper you refer to the impact of cost of living increases and in particular note the loss of social care hours due to workers not using their cars.  My understanding is that the NHS has increased mileage allowances.  I assume this hasn’t been done for social care workers, or not sufficiently.  If not, why not?   

I have concerns regarding para 12 showing a reliance on ‘external care at home’ providers.  I would ask what percentage of these are private providers.  As you are aware we are arguing and campaigning for a not for profit care service.   Obviously, this can not happen all at once, but we would like a commitment to move in that direction.

Para 13 talks about ‘cleansing the waiting list’ and and ‘over reporting’ – presumably of need.  In other discussion I have heard reference to ‘over prescribing’ of care.  We have concerns about what this means, as in our experience care provision is if anything not enough rather than too much.   

Regarding para 15, we would be anxious to know what actions are being taken/proposed to address this shortfall in GP patient places.   I have personal experience of the difficulty in finding a GP.  

This and other discussions refer to Interim Beds, Reablement, the Community Resilience Programme with the third sector and Step Down services – all presumably part of your  Discharge Without Delay programme.  It would be very helpful if you could clarify what all of these are and how they all fit together.   Additionally, we have major concerns about the fault line between free NHS services and care home services for which people pay.   I am unsure how much all of these discharge without delay programmes run into this fault line.   

The paper talks about the implementation of TotalMobile.   I have looked at some of the online material, including videos.  I can see some advantages in relation to the sharing of user and care information, but have major concerns about implications for continuity of care and increased isolation of social care workers.  Our vision would be for locally based teams who could get to know local users, provide continuity and support each other.    Trade union colleagues familiar with such systems would seek assurances that they would be used as intended  and not for staff surveillance or micromanagement. 

Para 42       I find it difficult to accept that no direct equalities issues arise from the report – in light of the fact that the vast majority of social care workers are low paid women. 

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