Social care in Scotland is in crisis with severe staffing shortages and too much focus on cash restraints means care is not being delivered properly and needs action now, spending watchdogs have warned.
A new report by Audit Scotland found urgent improvements are needed and said lessons should be learned from previous restructures, in the police and fire service.
Relatives told of a “a battle” to access support while providers said services were nearing crisis point due to staff burnout and high vacancy rates, which have been exacerbated by the pandemic.
The report comes ahead of the National Care Service being introduced and calls for realistic budgets and a clear plan for measuring improvement.
Sector leader Dr Donald Macaskill, chief executive of Scottish Care, said the industry was at risk of “disintegration and collapse” years ahead of its introduction.
He added that the sector cannot wait for the “promised land” of nationalisation before changes are made.
The report found that service users and carers do not always have a say in the support that works best for them, despite a policy of self directed support, and care is focused on crisis interventions rather than preventative measures.
There was evidence home care visits are being planned on a 15-minute basis “which prioritises tasks over relationships”.
Some 36% of services reported vacancies in December 2020 with the highest number in home care services.
The report highlighted that a fifth of staff do not have a permanent contract while 13% work more than 50 hours a week.
Sector leaders say pay is not adequate to attract staff, although the Scottish Government say a planned increase will result in workers being better paid than many in England and Wales.
Around £5.3billion was spent on social care in 2019/2020 and the report warns of the toll an increasingly aged population will take on resources.
The Scottish Government has committed an extra £800 million to the sector this parliament term and a planned national insurance rise is expected to bolster resources.
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But Stephen Boyle, Auditor General for Scotland, said: ”We cannot wait another five years until the planned National Care Service is in place.
"Action must happen now, and at speed, by the Scottish Government. There must be clear timescales for delivery, demonstrating that lessons have been learnt from previous reforms of health and social care services”.
Dr Macaskill said: “The social care sector in Scotland is in crisis now to a degree few of us have ever experienced.
“The report is absolutely right in saying that the Scottish Government must work with its partners in addressing issues now as a matter of urgency.
“To do that means listening to, talking with, respecting, and valuing the voice and contribution of the employers and organisations who provide social care.
According to the report the current method of competitive tendering for social care services is based on framework agreements where too often, care provider organisations do not know how many support hours are needed on a day-to-day basis.
The report says this leads to employers passing on the risk to staff by giving them contracts that maximise employer flexibility (zero hours, lowhours, and sessional contracts). This can mean workers having their shifts cancelled if demand falls or being asked to do extra hours at short notice if demand increases.
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Scottish Conservative Shadow Social Care Minister Craig Hoy MSP, said the report should be a “wake up call” for the government
He said:“Instead of pressing ahead with a wholesale bureaucratic overhaul of services, Ministers must engage with carers, staff and those who need support to ensure the highest level of care is being delivered.
“Covid has exacerbated the pre-existing staffing shortages which the SNP have repeatedly failed to get on top of. Our current social care system is completely unsustainable unless ministers act now.”
Henry Simmons, Chief Executive of Alzheimer Scotland said there was an “urgent” need to increase dementia care and support after the breakdown of services during the pandemic.
He said:”This can only be delivered by highly skilled, well trained and motivated social care staff, yet still we have not seen the full implementation of the Fair Work Convention’s Social Care Enquiry recommendations.
“These recommendations highlighted the need to bring an end to the most negative aspects of commissioning processes, to deliver a fair set of terms and conditions for all social care staff.
“We also need to ensure that the current crisis does not detract from ending the glaring inequalities and unfair treatment of people with advanced dementia, who at the moment are having to pay for elements of their care that are quite clearly health care needs and should be free at the point of delivery.”
Kevin Stewart, Minister for Social Care, said the government was “already considering” many of the issues raised in the Audit Scotland report, including staff recruitment and retention, the need for a greater emphasis on preventative and person-centred care and a focus on ethical commissioning.
He added: “We invested £300 million of new winter pressures funding in October, to maximise the capacity of the NHS and social care system this winter.
“We have already made available additional funding of up to £48 million to enable employers to provide an uplift to the hourly rate of pay for staff offering direct care within Adult Social Care to a minimum £10.02 per hour from the 1 December 2021.
"This takes pay for adult social care workers in Scotland significantly higher than the National Living Wage of £8.91 - which currently applies to many social care workers in England and Wales – and we are planning an even bigger rise to £10.50 per hour in the financial year 2022-23.
“We have recently announced an additional £4 million to expand support for unpaid carers this winter, including to enable them to take breaks from caring.”
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