SCOTLAND needs to take urgent action to fill a £10.66bn black hole in budgets over the next 14 years to make revolutionary changes to adult social care in the wake of the Covid pandemic.

The public services spending regulator Audit Scotland says a plan is needed to cover the huge costs are that are needed in a blueprint for social care changes including creation of a new National Care Services.

There have been more than 10,000 Covid-related deaths in Scotland, about a third of which have been in care homes, sparking demands for changes.

The average of £760m a year extra Audit Scotland says is needed is equivalent to 0.5% of Scotland's gross domestic product (GDP) - the monetary measure of the market value of all the final goods and services produced in the nation.

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An audit examination has revealed that to make necessary changes to how care homes are run until 2035 would need huge investment rises.

Official auditors say that a clear plan and timescales are needed quickly if it is to forge ahead with the plans for the creation of a National Care Service on "an equal footing with NHS Scotland" which was one of the key recommendations of a report by former NHS Scotland chief executive Derek Feeley.

Options for financing include mandatory social insurance or a new local tax.

The SNP pledged in its manifesto to begin establishing Feeley recommendations including a National Care Service in the first year of the new parliament, with Nicola Sturgeon saying it will be a “top priority”. It also vowed to scrap all non-residential social care charges as part of that.

According to new Audit Scotland's analysis seen by the Herald, spending on adult social work care, needs to rise incrementally from £4.35bn in the next financial year to £7.66bn in 2034 as radical changes are brought in related to the Feeley report aimed at raising standards in care homes across Scotland.


According to the analysis £136.6m extra is needed in the next financial year alone to pay for the Feeley changes - taking adult social work expenditure from £4bn to £4.35bn - which includes 3.5% annual spending growth.

One in 24 Scots relied on some form of social care support and services at the start of 2018 with care homes housing 34,000 people Some 68,000 required care support at home, apart from informal, unpaid care, often by family members.

Eligibility for social care support is determined by a needs assessment and is not dependent on age or medical condition.

Whilst age is not a qualifying factor, the majority of social care users are over 65. But the number of people aged 75 and over in Scotland is projected to increase by around 70% over the 25 years from 2018 to 2043.

Funding of the system has always been an issue. In 2018/19, £3.8billion was spent on formal adult social care in Scotland. But the adult social care in Scotland is funded by local authorities who have seen pressures on their budgets rise over the last decade or so.

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Antony Clark, Audit Scotland' interim audit controller says there is a lack of clarity about how the social care revolution will be funded going forward.

"More detailed work and engagement is required by the Scottish Government on understanding demand and the cost of providing new models of care and how it will be funded. A clear plan and timescales are also needed quickly," he said.

The extra cost of the radical changes to social care is over and above the £4 billion the nation currently spends on adult social care and is over and above an expected 3.5% a year spending growth.

Additional annual cost will include £436m for expanding access to social care support and investing in prevention.

Some £116m will be needed to increase free personal and nursing care sums paid for care home residents.


A further £51m is needed to cover the cancellation of non-residential fees.

Some £32m is needed to re-open the Independent Living Fund and £19.5m is required to increase the real living wage for frontline and auxiliary adults social care staff.

One of the most radical steps outlined in the Feeley report was moving accountability under the new system for social care from local government to Scottish ministers.

In the vast majority of Scotland’s 32 council areas, health and social care services are commissioned by Integrated Joint Boards (IJBs).

But local authorities have retained responsibility for procuring and contracting care from providers, which is different from commissioning. Some say this means that the procurement process is not necessarily distinct from those of other council services.

Health Secretary Jeane Freeman has said there would be work with local authorities to find the “best way” to secure the review’s recommendations and the “spirit of its intent”.

Feeley, who spoke to more than 1,000 users of social care and experts to develop the blueprint for the future, said the services themselves would be provided by councils, private companies, voluntary and community organisations.

The review considered nationalising the private care sector but concluded that it would be too expensive, time consuming and there would be no guarantee of improved standards.

It did, however, call for greater financial transparency from the private care sector to ensure there isn't "leakage" of funds that could be reinvested in raising standards.

A Scottish Government spokesman said: “We have been clear that over this parliament we will substantially increase funding for both the NHS and social care.

“To deliver the National Care Service we will increase public investment in social care by 25% over the parliament - so by the end of the parliament we would have budgeted over £840 million of increased annual support for social care compared to current spending.

“We believe social care services, just like health care services, should be provided on a truly universal basis, free at the point of use.”