Raising the standard of residential care

We need to put dignity and respect at the heart of the residential care system. That means better care for residents and supporting the workers who care for them.

I was in the Scottish Parliament today promoting UNISON's new Residential Care Charter. It follows on from our Ethical Care Charter, which has raised standards of care for people living in their own homes. UNISON’s residential care charter calls for:

• Time to care – to allow staff to properly care for the vulnerable people they look after
• Proper training and support for staff
• Decent pay for quality work
• Adopt measures to protect and support residents, including adequate staff ratios and thorough risk assessments

This summer the Scottish Government published new Health and Social Care Standards, which will be implemented April 2018. They set out what we should expect when using health, social care or social work services in Scotland. The Standards are underpinned by five principles: dignity and respect, compassion, be included, responsive care, and support and wellbeing. The principles themselves are not standards or outcomes but rather reflect the way that everyone should expect to be treated.

Now standards in glossy documents are fine, but what matters is how they are implemented. One of the standards states; "I experience consistency in who provides my care and support and in how it is provided"

According to the Care Inspectorate, almost half of care settings in Scotland are facing difficulty in recruiting the right staff. 59% of care homes for older people reported having one or more staff vacancies. Many more are suffering from high staff turnover. Inspectors regularly identify that stable and consistent staff teams are an important component of high quality social care which supports people well.

Even the private sector employers organisation, Scottish Care, has recognised the need to address workforce issues, they said:

“Social care in Scotland faces a fundamental crisis. The Care Inspectorate report together with our own work at Scottish Care states quite clearly that we are at the point of services becoming unsustainable and unable to deliver given the current recruitment and workforce crisis. The entire fabric of social care will begin to disintegrate without serious intervention and this will have a profound effect on the sustainability of wider health and social care supports."

In Scotland, a residential care worker earns at least the Scottish Living wage of £8.45 an hour. This is significant progress, but workers can earn more stacking shelves in a supermarket. Our own surveys show that younger workers in particular are choosing less demanding jobs than care, which offer more money.

We are only going to change this dynamic if we value those who work in the sector. Yes, care jobs can be satisfying and worthwhile, but that doesn't pay the bills. Care with dignity should not be at the cost of a stretched and dedicated workforce.

Scottish Care has also highlighted a nursing shortage of 28% average vacancies in nursing homes, forcing providers to pay as much as £1000 for one agency nurse to do a night-shift.

Some providers are exiting the sector. Bield Housing and Care are closing 12 care homes in Edinburgh, Falkirk, Glasgow, Borders, South Lanarkshire and West Lothian by summer 2018. Some 160 elderly people, with dependent needs  including 24 hour personal care and feeding assistance, will be evicted from the place they have called home for decades. Many are over 90 years old.

While the Care Inspectorate does some monitoring of residential care homes, their resources are limited. Councils who contract the services do very little monitoring. Earlier this year UNISON asked councils, under freedom of information, for their monitoring policies. Overall, the responses indicate that contract monitoring is limited to returns from the contractor and review meetings with them. There is very little monitoring of the actual service delivery.

Anyone who listened to the voices of care workers in parliament today will understand that the standard of care needs to improve. 

Better care comes at a price, and so we need to have a debate in Scotland about how care should be funded. That includes difficult discussions about inheritance and contribution, directly or through taxation. It is crystal clear that we cannot go on in the same old way. UNISON's Residential Care Charter can raise standards, and help recruit and retain care workers. Older people in Scotland  deserve better.