Financial and workforce challenges for social care in Scotland

Two new reports again highlight the problems facing social care in Scotland but offer few indications that a credible solution is on the horizon. 

The Accounts Commission annual overview of local government is rarely a cheery read. It again highlights how the Scottish Government has dumped austerity onto councils with 7.6% real-terms cut since 2013/14. This compares with a 0.4% cut to other budget areas. An increasing proportion of this reducing budget is also committed to central government priorities – a long way from the promise to end ring-fencing!

This year’s report pays particular attention to health and care integration. The Chair’s foreword summarises his concerns:

“Of particular note for us this year, Integration Joint Boards (IJBs) continue to

 face very significant challenges and they need to do much more to address

 their financial sustainability. The pace of progress with integration has been too slow and we have yet to see evidence of a significant shift in spending and services from hospitals to community and social care. I continue to be concerned about the significant turnover in senior staff in IJBs. This instability inevitably impacts on leadership capacity and the pace of progress.”

Unsurprisingly, a majority of IJBs struggled to break even. Without additional funding from partners, 19 IJBs would have recorded a total deficit of £58 million. 14 IJBs had not agreed on a budget by the start of the financial year, and half had unidentified savings. The projected funding gap for next year is £208m. This is reflected beyond next year in the medium-term financial strategy which shows increased demand for social care costed at £683m by 2023/4.

Many IJBs have highlighted workforce issues as a high-risk area, and not just at a senior level. The Scottish Government and COSLA have finally published an integrated health and social care workforce plan. This is long overdue, but in fairness at least there is one, along with a recognition that workforce planning is not an exact science.

The headline estimate is that Scotland will need 20,000 WTE more health and care employees in the period up to 2023/24, which they hope will be reduced by up to 10,000 WTE through mitigating actions like efficiency savings (cuts), technology and redesign. 

The significant number is over 14,400 home care staff, a group that is likely to be heavily impacted by Brexit and the UK government's immigration policies. This is a sector that already has high turnover rates. The overall vacancy rate in social care is almost twice the Scottish average.

Analysis and scenario planning is fine, but the real test of workforce planning lies in action. The principal plans appear to be: 

• Growing the numbers of staff in training. This is particularly important for the NHS, where most staff groups require formal qualifications. This includes a focus on community-based and mental health staff, which is essential if there is to be a meaningful shift in care from hospitals to the community.
• For other groups, the focus is on retaining the existing workforce, encouraging returners and widening access to the sector. Creating better career pathways and implementing the Fair Work Framework are essential initiatives.
• Pay is recognised as a critical issue. To say that ‘there have been some challenges in implementation’ of the Real Living Wage is something of an understatement! Sadly, there is little sign of any plan to address this.

Overall, the plan is again stronger on process than action. The NHS element has well-established workforce planning and some detailed plans to address shortages. There is at least a welcome aim to elevate workforce planning into a whole system position.

The weakness is in the social care sector. The fragmented, and at times chaotic, social care system in Scotland is in major need of reform. I fear that without that reform, we will again be looking at evaluation reports which highlight workforce gaps and financial problems for years to come.