“Our Shared Ambition for the Future Funding of Social Care Support in Scotland” (Our Shared Ambition)1 was published in 2016 by Inclusion Scotland’s Independent Living in Scotland Project (ILiS). The publication was written alongside fifteen other disabled people’s organisations and their allies. Its intention was to stimulate discussion around ‘What social care support in Scotland should be; and ways to fund it’.
One year later, on 14th September, 2017, ILiS held a ‘Question Time’, chaired by Charlie McMillan, Director of Services and Development, at Capability Scotland, to find out what progress had been made. The panellists consisted of:
At a time when the UK Government has been highly criticised by the United Nations for failing to implement its commitments under the Convention of the Rights of People with Disabilities2, it would be interesting to see how Article 16 (The Right of Independent Living) had been implemented in Scotland, since the publication of “Our Shared Ambition”.
The chair opened with a very appropriate question: “Is social care in Scotland fit-for-purpose?”. The obvious and resounding answer was – No!
The appointment of Jamie McDougall to head up officialdom around social care was seen as a positive; but there was still a major gap between rhetoric and reality. Most of the activity hasn’t been strategic. Different initiatives didn't link into each other. They didn't add value, or tie up. They were not co-ordinated; and, ironically enough, they were not integrated, in the context of health and social care integration, they just were not integrated.
Social work was still not integrated within the context of health and social care integration. Social care had been massively reduced; and in many areas, was seen as merely an adjunct to health care.
It was plainly the fact, that disabled people were really fed-up being involved with Scottish Government advisory groups; just hearing the sound of their own voices, saying the same things about the unique and pertinent role of social care takes in their lives and participation in the wider community. Social care is not healthcare; but nobody takes the slightest bit of notice.
Disabled people now question whether there is a real intention to make integration work, because it means resources; and resources are tight. Local government and Scottish Government keep passing the buck, which leads to inconsistencies in policy implementation and inequality across the nation. Disabled people's rights are contingent on local policies and priorities, and that's not acceptable.
Again, on the positive side, there is an emphasis around promoting community empowerment, participation, and participative budgeting. There's a lot happening at local level, but if disabled people don't get the right social care support, at the right time and in the right manner, they're not going to be able to be involved in any of that; and their exclusion is only going to be compounded.
“Our Shared Ambition” had been helpful in as much as it did set out a vision; it did talk about what disabled people want; but it has such a long way to go to get people to buy into its philosophy and make it work.
So, what is its philosophy?
As with the Scottish Government’s agreed approach to child-care, “Our Shared ambition” sees adult social care support as a sustained public investment in Scotland’s wider national infrastructure for socio-economic growth. And as with physical structures, like roads, railways and bridges, social care support should be seen as a social structure (and asset) supporting those, both giving and in receipt of care, to contribute to the economic, social, cultural and civic wellbeing of their family and community. This social infrastructure will protect, promote and ensure human rights and tackle inequalities; and should facilitate the delivery of a statutory framework of common outcomes, underpinned by clear and consistent rights and entitlements.
From the discussion during this ‘Question Time’, it was obvious we are far from that ideal. There appeared to be no major leadership (either political or administrative) at a national level driving the change that we need in order to allow people to live independently; and contribute to society. The social care workforce is being treated appallingly; many are leaving the profession, feeling under-valued and over-worked. It's even difficult to track the money, to see how it's been spent; is it being spent on the right things, because there's no framework for assessing how that money's spent.
It was interesting to note how both the local government and Scottish Government boasted about how much extra they were putting into social care. The Scottish Government said it has increased its grant to local government by 13% for social care; and local Government say they’ve increased their expenditure on social care by 8.6%, at a time when their budgets had been cut by 11%.
But hang on, if Scottish Government has given local government an extra 13%, but local government has increased their social care budget by 8.6% - so, what’s happened to the 4.6% difference?
Possibly, these figures have been taken over different time periods, and bandying them about just confuses people. But as one questioner asked; “If so much money has been put into the system, why does it feel so bad?” Possibly, because the increased income, doesn’t meet the increased demand.
And the lack of prevention in social care, which would allow a little to go a long way, means that down the line more and more people are presenting with higher and more complex needs. Local authorities have seemingly not taken on board, Christie’s advice; and, in terms of reducing demand, are wasting money hand over fist.
Although there was a general welcome to extending free personal care to those under 65yrs, there was a fear that services would be concentrated around personal, or what might be called auxiliary nursing, care. Not only would this mean that the new integrated health and social care system would be seen through the lens of health, but social support in terms of promoting the meaning and practice of the social model and independent living could cease to exist.
Alternatively, free personal care will not only concentrate services in the “bed and breakfast” area of auxiliary nursing care, but it would also mean that charging will just move onto social care support. So, they give with one hand and take with the other.
The other fear exhibited was that the concentration on personal care may well dilute the political motivation to see social care as an infrastructure to the benefit of society as a whole. The money given to disabled people goes into the development of our communities. By employing people, by giving money to shops and companies, and by actively participating in the labour market, contribute to the wealth and wellbeing of society at large. If they're only getting fed and watered at 10 or 11am, there's no way they can get a job starting at 8.00am. So, the real fear is not only will there be no political leadership looking at social care as a basic infrastructure for the development of our community at large; but disabled people will merely move from a bed in a hospital to a bed in their own flat.
If personal care, in effect, is basically healthcare delivered in the community. It's a rebranding exercise. Even if social care is seen as just being about preventing people needing access to acute services, or getting people out of hospitals rather quicker, a social care system must enable people to have independent living. Otherwise, people will get up, get dressed and washed, then sit there with nothing to do and nowhere to go. That isn't good for people's health. It's not good for their mental health; just sitting there, losing bone density, and gaining deeper depression and greater loneliness. It doesn't achieve what people are wanting to achieve, even in the narrowest of healthcare terms.
One panellist even reminded everyone of an unfortunate early communications campaign around health and social care integration, with the strapline, "No Ward like Home". That did seem to be where we're headed.
Inevitably, the Big Question was raised: “Where’s the money coming from?”; and, inevitably, there were a number of answers. It was noted that there had been surveys noting the public’s approval of a hypothecated tax, but some felt there was still some room for greater savings and economies in the existing system. There was also a suggestion that new forms of taxation, such as a “tourist tax” might raise additional money for social care support. Nevertheless, the system of competitive tendering came into particular criticism, for not only does such impede the development of user-led service provision, but its added ‘social value’ is frequently over-looked.3
The Audit Scotland Report on Self-Directed Support was thought to be an accurate account about what was going on; but its suggestion that local authorities should work more closely with recipients seemed rather unrealistic, in view of the lack of resources disabled people have to participate in the community. It was regretted that people’s ‘lifetime journey’ had to be cut into pieces: children, adults, elderly. There needs to be a continuum of care to avoid these artificial administrative ‘transitions’. People do not live through ‘transitions’. Life is transitional; and so, should services. The Audit Scotland Report should have reflected that.
There was also great frustration that report after report was saying the same thing, yet nothing gets done – there is no forward momentum. Instead of writing reports, when do we start writing commitments, or better still, results! We need to see how policy and practice change lives; and how changed lives, change society for the better.
This blog, can’t detail every contribution to this highly meritorious “Question Time”, however meritable each might have been. The “Question Time” raised many questions; and finished with many questions.
The disabled people’s independent living movement requested the Scottish Government have a convention on social care support; but they didn't think that was a good idea. They wanted the movement to have a dialogue with the stakeholders involved. Now “Our Shared Ambition” is the outcome of that dialogue. Looking around the room one year later, one saw the same faces of the stakeholders involved when it was launched.
The questions left are: when do we, the stakeholders, stop talking to ourselves? When will we start talking to the public and raising their awareness of the value of social care support, to them and their communities; and the need to fund it properly? And in particular, when will the Scottish Government and local authorities join in on that invaluable debate? All of these questions lead to the quintessential question: when will the human rights of disabled people, within the UNCRPD, and the many other international human rights conventions, materialise as an immutable part of society?
 See: https://knowhownonprofit.org/funding/commissioning/procurement/importance-of-social-value-to-commissioning-and-procurement#