Let’s recognise care as a social good

The campaign for a National Care Service in Scotland: a contribution to a discussion. By HILARY HORROCKS (Edinburgh trades union council delegate). This article was first published on the People and Nature blog. We repost it here with the author’s permission.

Health is a devolved matter in the not-so-United Kingdom, and that has allowed successive Scottish governments to bring in progressive measures that are missing in England, such as abolition of prescription charges for everyone and free personal care for the elderly.

The Scottish National Party (SNP) government certainly sought to distance itself from Westminster during the first stages of the Covid pandemic, when it seemed to follow scientific advice more carefully, and kept the public better informed with daily briefings by the First Minister.

Between the first and second waves of Covid last year the virus was just about eliminated in Scotland – but like Westminster, the government at Holyrood failed to use the summer to bring in mitigating measures to reduce infection. So in the autumn, the return of schools and universities, coupled with the loosening of restrictions, led to a rise in cases similar to England’s.

Mask wearing has remained a legal requirement in Scotland, including for all secondary school pupils, and is generally well observed – but cases remain worryingly high, particularly in poorer areas.

Here, as in England and Wales, the terrible toll of deaths in care homes at the beginning of the pandemic brutally exposed the disastrous policy of freeing up NHS beds by transferring elderly hospital patients to care homes with no proper testing.

In the aftermath, the Scottish government commissioned an independent report on Adult Social Care (the Feeley Report), which recommended setting up a National Care Service (NCS).

In addition to the care homes scandal, social care in Scotland is beset with problems, exacerbated, as they are everywhere, by deindustrialisation and consequent social deprivation; decades of austerity; and the loss of skilled care workers because of Covid and Brexit.

Edinburgh Campaigners protesting at plans to close publicly run care homes (2021) Image by Pete Cannell CC0

Nowhere is the crisis more painfully clear, perhaps, than in the tragic rate of drugs deaths among young people, now at a record high.

The Scottish government has put out a long document listing their proposals for the NCS. These formed part of the SNP manifesto at the Scottish elections in May, in which it emerged the largest party and now governs in a working coalition with the Greens. Their proposals, designed to cover those with mental or physical disabilities, the elderly, those with dementia, recovering from alcohol or drug addictions, the homeless, children and families needing support, will, they say, be implemented within a year.

The guiding principles in the document sound promising at first sight: ensuring that care is person-centred, human-rights based, and is seen as an investment in society; nurturing and strengthening the workforce, and giving greater recognition to and support for unpaid carers.

The title of the plan – a National Care Service – is obviously designed to evoke parallels with the setting up of the National Health Service in 1947 and its radical reform of state welfare. However, it is anything but. Crucially, it fails to recognise the devastating impact of cuts to health and welfare and of the inroads of privatisation; and, in general, it does not move the debate beyond a neo-liberal framework.

The proposals are out for public consultation. The public can give its views in an interactive version of the document. However, you are restricted to giving responses to set questions, many of which don’t address the substantive issues. But unions, community groups and others are responding with their own independent contributions.

What follows is a summary of their most important criticisms, and is designed to open a discussion, not only in Scotland.

The role of care in society

“Care needs to be recognised as a social good”, Mark Smith, a researcher of social care, has written. “This is compromised by continuing to locate it within an economic system the primary motive of which is profit maximisation.”   

A fundamental criticism of the Scottish government’s proposals is that no amount of government directive can make a difference, and that root-and-branch reform is needed.

“Most insiders in the profession recognise that the social work system is pretty broken”, Colin Turbett, a frontline social worker in the West of Scotland for nearly 40 years and author of Doing Radical Social Work(2014), says.

In the past few decades, he continues, the role of social workers has become restricted to the performance of statutory public protection duties, instead of the broader preventative welfare role they performed in the past.

“They only become involved when the situations of the people they work with might be beyond help, their skills being largely spent trying to mop up when earlier involvement might have prevented escalation.”

Social workers typically spend most of their time behind  computer screens, rather than engaged with the individuals who need their help.

A public service

Critics of the NCS proposals insist that it should be a public service, completely not-for-profit, and principally delivered through local authorities. The Scottish government, in contrast, envisages a continuing role for the private sector, currently owners of 80% of care provision in Scotland.

This, despite the fact that the private sector is leeching funds out of care provision into property speculation or offshore tax havens; and that the record of privately-run care is far from good.

One of the major providers, Advinia Health Care, who own 11 care homes in Scotland, were second on the list of those homes that saw the most deaths during the first Covid wave.

The Scottish government and the health authorities directed the evacuation from hospitals to care homes, apparently blind to the fact that the care providers most likely to accept patients were those most motivated by profit.

Advinia Health Care is ultimately owned by a company registered in the tax haven of Gibraltar and has been the subject of an attempted financial investigation by the regulator in England. The Care Inspectorate reported in May of this year that they had found in one Advinia home unsafe disposal, storage and management of clinical waste, including PPE, while staff had not been given the correct PPE or shown how to use it properly. 

The commitment of the Scottish government to the private sector in the context of its NCS proposals was confirmed, alarmingly, when it emerged recently that the £100,000 contract for the initial design of the proposed new care service had been awarded, even before any consultation has been concluded, to the Edinburgh branch of PriceWaterhouseCooper.

Scottish TUC general secretary Roz Foyer commented: “While this is only a small contract, beginnings matter. South of the border, the past year has seen the continued growth of the consultancy gravy train with massive contracts awarded to companies with clear interests in private-sector provision of public services. We do not want this replicated in Scotland.”

How can a National Care Service be funded?

The Scottish government points to the inadequate provision of social care by local authorities, completely failing to acknowledge the harm inflicted by decades of cuts to council funding. 

Only with proper funding can local authorities build up the infrastructure that would allow them to absorb, in a National Care Service, not only the current private/third sector provision of social care in the medium term, but also the increasing demands on social care in the long term.

The government, say campaigners, should ring-fence resources to provide good-quality care and fair pay and working conditions to carers, who should be respected as skilled workers. Collective bargaining must be set up immediately to agree national pay and conditions between a National Care Service and trade union representatives, and to provide regular high-quality training.   

Common Weal, a Scottish-based “think-and-do tank”, argues in its Manifesto for a National Care Service that private providers should be bought out, as happened when the NHS was set up, but over time.

Given the parasitic nature of private care, isn’t there an argument for a more radical move? Private providers could be offered a role in a publicly-funded system, subject to stringent checks, but they should not be offered compensation.

Free at the point of need

On charging for care, the Common Weal Manifesto says: “All charges for care would be abolished. The National Care Service should be funded from the public purse, either from tax or a new national insurance scheme based on a universal “pooling of risks” with all contributing as per their income, irrespective of the care they may or may not receive.”

In accommodation-based services, Common Weal argues, “people would be expected to contribute a portion of their income […] [they] would no longer be required to sell their assets to pay for residential care.

“The funding shortfall should be met through a more equitable system of inheritance tax, in which the rich pay more than those who bought their council houses, or through other taxes.”

What about local control and accountability?

The Scottish government proposes that under a new care service, local councils would hand over ALL their current social care and social work responsibilities to management bodies called Integrated Joint Boards.

These have already been in place for some years, and they have been proved not to work. Elected councillors do sit on them, but in practice get overruled on local decisions.  

And the government’s new care service would be ultimately accountable to a government minister, meaning more centralisation and less ability to create and administer services at a local level, where they are most effective.  Common Weal describes the government’s NCS as “an attempted power grab by central government and a further assault on local democracy”.

Campaigners envisage an NCS run by local authorities, as the existing democratically elected and accountable bodies, but also call for a further devolution of care services to local community hubs, which “can actively involve service providers, those needing care and those with lived experience to create local, flexible, inclusive services”, as the Edinburgh Trades Union Council (TUC) response to the government’s proposals put it.

The idea of community hubs as centres for public service delivery and voluntary activity has been revived during the pandemic. “Notions of community empowerment already enshrined in law”, Common Weal says, “ought to be compatible with the decentralisation of public services and bottom-up community partnership and control. The National Care Service that Scotland needs could be managed and delivered at local level through community hubs.”

Above all, providers, workers in the service, and users, have to be involved in the planning and management of social care. “People in Scotland deserve far better”, says one of the Common Weal team, “but we will not get that so long as those responsible for the current system are responsible for redesigning it”.

Outcomes of the EIJB meeting

The Edinburgh Integrated Joint Board, which organises integrated health and social care in the city, met on Tuesday 28th September. The meeting time and date had been changed twice at short notice. You might think that the board was trying to evade protest. In the event there were rallies outside the City Chambers, both in the morning at 9.30 and again at 2.30. The campaign to save public care homes has had an impact. But despite the opposition the board proceeded to confirm the closure of the Dumbrae home – which they intend to transfer to the NHS as a more specialised facility. From the outset the board, and the City Council have tried to exclude Dumbrae from the list of homes scheduled for closure – continually referring to four homes slated for closure. Our view has been simple – there were nine publicly run care homes in Edinburgh – if the board gets its way there will be four. That’s five closures however, you dress it up.

So what about the other four homes? The board talks about a ‘comprehensive consultation’ on the closure of the four homes, but it is not going to happen anytime soon. The EIJB will discuss it again at their October meeting and will consult with the City Council and Lothian Health. At the board meeting there seemed to be agreement that there will be two parallel and linked consultations. One will be on the four homes closure issue and the other will be on the overall social care provision in Edinburgh up until 2030. Once the nature of the consultations have been decided they will will last three months. There will then be a period of evaluation (perhaps a month according to officials) followed by the writing of a report for the EIJB. It seems that the EIJB is going to postpone an actual decision on the four homes until after the local authority elections in May 2022.

In these circumstances it’s really important to keep up the campaign in the context of a vision of a publicly run and democratically accountable service that meets the needs of Edinburgh residents. We will discuss next steps in the campaign at our meeting on Thursday October 7th at 6.30pm.

Unison issues this Press Statement following the board meeting

Care home closure is ‘slap in the face’ to Edinburgh’s most vulnerable, says UNISON 

UNISON, the union for carers, has expressed deep dismay at the decision to close an Edinburgh care home. The decision was passed by the Edinburgh Integration Joint Board (IJB) – which commissions health and social services from the City – at a meeting yesterday (Tuesday). UNISON, Scotland’s largest union, has been campaigning to prevent the closure of five council-run Edinburgh care homes, including Drumbrae. A further four council-run homes – Ferrylee, Clovenstone, Fords Road and Jewel House are all being earmarked for closure but subject to public consultation. Tom Connolly, UNISON Edinburgh City branch secretary, said: “The people of Edinburgh can feel very let down by this decision to close a much-needed local service, not least the elderly and vulnerable who reside in the care home and now face an uncertain future. “UNISON will continue its campaign to save public sector-run care homes and prevent them going into private hands. People need to come before profit and UNISON will continue its fight to save Edinburgh’s public run care homes and call for all private run care homes to be brought into the public sector.”Greig Kelbie, UNISON regional organiser, said: “The decision to close Drumbrae was made without any public consultation and is a real slap in the face to the most vulnerable people in the city. “UNISON understands there is a substantial waiting list for homes in the area, so if the need hasn’t gone away then why should the services?” 

Edinburgh TUC’s deputations to the EIJB

The Edinburgh Integrated Joint Board met to discuss proposals for care home closures today (28th September). Campaigners made online deputations (statements) to the meeting.

Photo by Ian Mullen

There were two statements from the Edinburgh Trade Union Council.

The first from Des Loughney:

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 and our comments on the paper that is item 4. I will speak for a few minutes and Kathy for the rest.

A some of you will know we had a deputation to the full City Council meeting on Thursday 23/9/21. We listened to the debate on the Council’s amended coalition motion including the comments by EIJB members. We are not sure what were the consequences of the Council adopting the motion. Has the EIJB been sent the motion accompanied by a presume a covering letter? Will the EIJB formally consider the Council resolution?

On the assumption that the EIJB has knowledge of the Council motion we draw your attention to the clause (2) which reads:

2)           To request the consultation should be as comprehensive as possible covering all aspects of the bed-based review and include the Trade Unions as well as care home residents, their families and/or their support workers or carers, current care home staff and the wider public.

It seems to us that in the Report that is before you today doubts are expressed about the legal power of the EIJB to carry out the comprehensive consultation that is defined in the Council motion. There must be doubts on the EIJB’s capacity to carry out a comprehensive consultation.  In the circumstances we are of the view that the EIJB should ask the City Council to carry out the consultation. An advantage of this route is that the consultation is much more likely to address public and trade union concerns. After what happened earlier this year we do not have any confidence that a consultation run by the EIJB will address trade union and public concerns. The EIJB seems solely concerned to persuade the public to accept its proposed plan. Read the rest here.

The second from Kathleen Jenkins

Thank you for the opportunity to address you at what is clearly a crucial time for social care in Edinburgh.   I have spoken to you at your June and August meetings.  I would like to reiterate some of what I said then and make some additional points. 

Your documents and proposals deal only with NHS and local authority facilities and yet, we know from a recent FOI request that in relation to residential care for those over 60:

203 are cared for in LA homes
241 are cared for in not for profit sector homes 
1464 are cared for in private sector homes

And yet there is nothing in your documents and proposals regarding the future of  the last two sectors.   

In relation to care at home (all ages) 
880 people receive LA care at home
1229 people receive not for profit sector care at home
3188 people receive private sector care at home
Read the rest here.

In our next post we’ll look at the outcomes of the EIJB meeting.

Care Provision in Edinburgh

We asked Edinburgh City Council eight questions about how care provision in Edinburgh is distributed between the public and private sectors. They answered six of our questions. We will be getting back to them about the two they didn’t answer. We wanted to know about the number of private organisations contracted by CEC to provide care at home – the council must know this. The responses we have so far show how skewed care is to the private sector. We believe that there is no place for profit in care.

Here is the text of the council’s response

Freedom of Information (Scotland) Act 2002 – Release of Information

Subject: Care provision In Edinburgh

Thank you for your request for information of 23/08/2021. Your request has been processed and considered under the Freedom of Information (Scotland) Act 2002 and the information is provided below.

Your request and our response:

Q1. How many (elderly, > 60 years old) people are currently being cared for in residential care run by the local authority in the City of Edinburgh? 

203 at the end of August.

Q2. How many (elderly, > 60 years old) people are currently being cared for in residential care run privately in the City of Edinburgh? 

1,464 at the end of August.

Q3. How many (elderly, > 60 years old) people are currently being cared for in residential care run by voluntary/ not-for-profit organisations in the City of Edinburgh? 

241 at the end of August.

Q4. How many people are currently receiving care at home from local authority services in the City of Edinburgh? How many hours of care are currently provided by this sector? 

880 people, 7,225 hours per week (all ages, week ending 30 August).

Q5. How many people are currently receiving care at home from private organisations in the City of Edinburgh? How many hours of care are currently provided by this sector? 

3,188 people, 54,595 hours (all ages, week ending 30 August).

Q6. How many people are currently receiving care at home from voluntary/not-for -profit organisations in the City of Edinburgh? How many hours of care are currently provided by this sector? 

1,229 people, 48,463 hours (all ages, week ending 30 August).

Q7. How many private organisations currently provide care at home in Edinburgh?

Q8. How many not for profit organisations currently provide care at home in Edinburgh?

Unfortunately, we are unable to provide you with the information for questions 7 & 8 because it is not held by the Council. The Care Inspectorate hold details of organisations who provide care services.

National Care Service Consultation

CARE ABOUT CARE   

Our care service needs to be improved.

It is urgent to

  • Take profit out of care
  • Improve pay & conditions for workers
  • Make care local & accountable
  • Ensure adequate funding
  • Make care a free service

At the moment there is a Scottish Government consultation about care. 

You can make sure everyone in Scotland is looked after properly by giving your input. 

A response can take as little as ten minutes. 

The deadline for this is 2 November 2021. 

The consultation is long & complex. 

If you are short of time just answer Questions 1 & 2  on page 15 – suggested answers below – you can copy and paste or copy and edit to personalise your response

Q1. What would be the benefits of the National Care Service taking responsibility for improvement across community health and care services? 

Tick all the boxes

Other – please explain below

A NCS would have the potential to bring these benefits, but only if partnered with  Local Authorities who  have the capacity  to work with their  communities to create local, flexible, inclusive services (and who are democratically elected and accountable to their populations). This would depend on the NCS  introducing National Sectoral Collective Bargaining to ensure good education, training, pay and conditions to social care workers.

Q2. This consultation and the National Care Service which will result from it may very well be superficial and not lead to real and sustained improvements in care provision.

There is a recognition that there is a need to improve community health and social care and that current structures are inadequate. If we are serious about good practice, ‘suggestions for significant cultural and systemic change’ have to be explored. This consultation does not allow for such an exploration.

For an effective care service we need to take profit out of care, improve pay & conditions for workers, make care local & accountable, ensure adequate funding and make care a free service.

This is the web address of the consultation  

https://consult.gov.scot/health-and-social-care/a-national-care-service-for-scotland/consultation/

If you have a bit more time to work on the questionnaire:

Click here for suggestions for responses to questions 1 – 8

Click here for suggestions for responses to questions 22 – 54

Click here for suggestions for responses to the ‘Valuing the Workforce’ section

For information and discussion about social care reform, see the Common Weal policy papers:  and news . 

Save Our Care Homes – Campaign News

The next critical date in the campaign is September 14th when the Edinburgh Integrated Joint Board is holding a special meeting to discuss the closure proposals. We understand that they intend to take a decision on closure at this meeting and then open a period of consultation which will run until the end of the year! Unison have organised a protest at the City Chambers to run at the same time as the board meets and Another Edinburgh is Possible are calling for the maximum possible attendance on the day. Please share with your friends and bring placards and banners. There’s a Facebook event that you can share.

Councillor Gordon Munro has received a number of written answers from Ricky Henderson on the care homes issue. You can see the details here.

Most revealing was of the answers is this:

‘ Throughout 2020/21, the Bed Based Review was ongoing and we deemed it morally unacceptable to admit into the care homes where the future of the home is under discussion.’


In other words they stopped admitting to the care homes over a year ago and then used their low occupancy rates as an argument for closure!

Save Our Care Homes – Protest Report

There was a lively Save Our Care Homes protest outside the City Chambers on Tuesday as the Edinburgh Integrated Joint Board met for its August meeting. 

Image by Pete Cannell – CC0 public domain

There were deputations to the board from Des Loughney and Kathy Jenkins from Edinburgh TUC, and from Unison and Unite the two unions that represent workers in the care homes. [Click on the links to read the deputation statements].

The board agreed to postpone a decision on the closure of five out the nine local authority care homes in Edinburgh until the end of the year and use the additional time to engage in consultation. Initially the board was going to make the decision at its’ June meeting.  There had been no meaningful consultation at that point.  So, the delay and the new interest in consultation is a real victory for the campaign.

The board’s initial rush to close the homes and the way they informed workers and residents only days before the June meeting was callous and incompetent.  The way the board has operated has highlighted the lack of democracy and accountability in the governance of social care.  And good quality people centred care seems to have been largely absent from their considerations.  No reference to the experience of Covid and none to the fact that the homes slated for closure have generally had much higher ratings for care quality than their private sector counterparts.

Saving the homes is the first priority of the campaign but in doing so we are also fighting for the future of care in Scotland.  We have written to the leaders of all the political groups on the council asking that their group makes a clear, public statement of opposition to the closures.

Here are some of the contributions made at the rally – first Councillor Gordon Munro

then Mary Alexander from Unite

Willie Black from Another Edinburgh is Possible

and a speaker from the City of Edinburgh Council Unison branch

Save Our Care Homes – Protest

Join the protest rally outside the City Chambers as the Edinburgh Integrated Joint Board meets on Tuesday 17th August. It’s likely that the board will hold a special meeting in September to make the decision to close 5 out of the 9 local authority care homes inn Edinburgh. We want to build a campaign that is so strong that when that meeting takes place the board has no option but to drop its’ closure plans. Three Edinburgh City Councillors sit on the board. We’ve written to the leaders of all five party groups on the council demanding that their group takes a clear and unambiguous public position in opposition to the closures.

Report from the Save Our Care Homes Public Meeting

A big thank you to everyone who advertised the meeting and all those who attended and helped make it a success. In the event 82 people registered for the meeting and 65 attended all or part of it.

This report includes video of the speaker contributions, a summary of the information, ideas, useful online links that were shared during the meeting, and a copy of the City of Edinburgh Council Unison branch’s newsletter on the Care Homes.

There are still a few things to add and if you spot anything that we’ve missed please email and let us know.

The meeting was chaired by Robyn Kane and in this first video you can hear Nick Kempe who is an active campaigner on social care. Nick was the first of the speakers.

Nick followed up after the meeting with some reflections on the overall discussion:

He suggested that if the Edinburgh City Councillors come out firmly against the closures then it will put the Edinburgh Integrated Joint Board in a very difficult place. However, he noted that if the recommendations of the recent Feeley report on social care go through then this element of local democratic control will be lost.

Nick also commented on the apparent lack of planning for the consequences of closure and the serious consequences for many residents with the likelihood that most would have to move into private care homes.

He also suggested that the Board is probably locked into Private Finance Initiative (PFI) arrangements with the private sector which may constrain their decisions and we may want to use a Freedom of Information Request to make this information public.

Following Nick we hear from Graeme Smith, chair of the City of Edinburgh Council Unite branch, which represents some of the care home workers.

Graeme was followed by Ian Mullen from Unison, which represents many of the care home workers affected by the closure proposals.

We also heard from family members of the residents who live in the effected homes. This video clip features Ray Whittingham.

Here are some of the suggestions for future action that were made during the course of the meeting – note that the next meeting of the Edinburgh Integrated Joint Board is on Tuesday 17th August.

  • Demo outside of City Chambers: identify suitable dates?
  • National campaign: UNISON is involved in campaigns against closures throughout the UK. Can these be joined up? This is a national issue. In Scotland, the Feeley report leaves the door open to private provision. The National Care Service is shaping up to be a commissioning body only. Our campaign should also address wealth retention. Outsourcing services means the outsourcing of profits generated by the community.
  • Identifying providers: Four Seasons and Equity Investors should be targeted for profiteering from public money and the elderly and vulnerable.
  • Reach out to residents and their families. Their voices must be prioritised.
  • Contact We Own It for support and joint action.
  • Allyson Pollock and Willie Black to get in touch with Paul Laverty – possibility of a short film to share on social media/future meetings (staff, residents and their families should be front and centre here).
  • City centre lightshow?
  • JIB is driving privatisation. This is about public provision and assets/community wealth. Save our Services should collate our case (again with staff/residents/families to the fore) and present it to the Board with media invited. What dates are they meeting? 

Many people shared online links that you may find helpful:

Please sign and share the Save our Care homes petition

Community Care page: human rights and family access

Edinburgh Integration Joint Board Proposals (PDF)

2021 Care Inspectorate report to Scottish parliament. Record of private care homes is always worse than those remaining in the public sector

Ferrylee report presented to Scottish parliament in March 2021

Integrated Joint Board meeting, June 2021.

Liberton hospital webpage

Care and Support Workers Organise! Facebook page

The CEC Unison branches newsletter on the care homes