Self-directed care - rhetoric and reality

Self-directed care is right in principle, but does not always match with the reality of care provision in Scotland today. The rhetoric of choice and control is often used as cover for a deteriorating service.

The Self-Directed Care (Scotland) Act comes into force today and requires local authorities to offer personal payments if requested. I was interviewed by the BBC today on the impact this legislation will have on care in Scotland.

This approach works well for some service users, but can be an unnecessary burden for others. We should therefore be careful not to turn this into another one-size fits all approach to social care. UNISON signed a joint statement as far back as 2006 with the Scottish Personal Assistant Employer Network supporting direct payments while recognising that this approach should not be used a cover for cuts. However, by 2012 it was becoming clearer that assessments were focused on making savings rather than delivering better care. We illustrated these concerns with case studies in our report, ‘Personalisation in Scotland – The Facts’.

Today, cuts in budget provision means that the individual service user often has a smaller budget to buy equivalent services. This has contributed to the ‘race to the bottom’ in home care as highlighted in UNISON Scotland’s recent ‘Time to Care’ report. Staff, often paid little more than the minimum wage, on zero-hours contracts, with little training, are literally running about trying to provide the same service.

Many service users don’t understand or want the responsibilities of being an employer. As a consequence the service is being privatised with agencies providing the staff rather than the envisaged genuine personalised service. With budget cuts service users are being forced to choose a cut price ‘personalised’ service that is short on quality.

Self-directed support is leading to cuts in collective provision, such as day centres. This leads to greater social isolation that we know has a damaging impact on health. Social isolation is associated with a higher risk of death in older people regardless of whether they consider themselves lonely. A study of 6,500 UK men and women aged over 52 found that being isolated from family and friends was linked with a 26% higher death risk over seven years. Our home care members report that they are often the only living person some elderly people see in days. All the more reason to allow more time to care.

There is also no legislative requirement that a personal employer checks for Protection of Vulnerable Groups Scheme membership. Our discussions with home care staff indicated that many would be reluctant to raise care abuse concerns, particularly when they are employed on zero-hour contracts. Given the disparate nature of this service it is difficult for councils and regulators to check on the quality of care in the same way as they do in residential settings.

Overall, self-directed care is still right in principle and works well for some groups of service user. However, it isn’t suitable for everyone and has some big downsides, particularly when budgets are under financial strain.

SLP Conference Motion 2014 - Time to Care

Scottish Labour Party Conference – March 2014

Socialist Health Association Scotland – Contemporary motion

Time to Care  

Conference believes that a priority of the Scottish Government should be urgent action to maintain and improve the standards of care provision to elderly and vulnerable people.

Conference notes that care services are coming under increasing strain with too few staff being asked to deliver services with insufficient time to care while facing cuts in their pay and conditions of service.

In UNISON’s ‘Scotland it’s Time to Care’ report, care workers explain in their own words the reality of social care in Scotland today. They tell us the service they provide is not sufficient to meet the needs of elderly and vulnerable people they care for. Either in terms of the time they can spend or the quality of care they can provide.

An increasing number of care workers are being placed on zero-hour and nominal-hour contracts, which like blacklisting has serious consequences for service user and staff safety. Conference therefore welcomes the inquiry into zero-hour contracts by the Westminster Scottish Affairs Committee.

Conference also believes that fair pay for care workers, including the Scottish Living Wage, is essential to raise standards, reduce turnover and ensure continuity of care. Conference therefore notes with dismay the rejection by SNP MSPs at the Scottish Parliament Infrastructure and Capital Investment Committee on March 12^th of Labour amendments to the Procurement (Scotland) Bill which would make the payment of the living wage a requirement in public contracts.

Conference believes that care services will be only be of a sufficient standard when they are  designed in conjunction with users, adequately resourced and delivered by adequately paid staff with sufficient time and training to do their jobs. Conference therefore calls on the Scottish Labour party to campaign for:

·         The Scottish Living Wage as a contract requirement to help the recruitment and retention of staff and support continuity of care;

·         Improved training to ensure that care is delivered by properly qualified staff;

·         Proper employment standards including ending the abuse of zero and nominal hour contracts;

·         Adequate time to care in every care visit.

Those who rely on care services deserve nothing less.