Care crisis: Is it time to change Scotland’s care sector – and if so, how?


Unique Study Summary

“We are pleased that there is now such a concerted focus on social care and its importance, but we regret that it took a pandemic to motivate our politicians.”

Dr. Donald Macaskill, chief executive of the independent care providers’ association Scottish Care, looks back on a year in which an alarming number of people died in Scottish care homes.

11,824 care home residents have died in the nine months after the pandemic struck Scotland – 24 percent more than in a normal year.

During the first wave, lessons appear to have been learned from the scandals surrounding PPE shortages and the transition of untested – and even Covid-positive – hospital patients to nursing homes, but the overall experience has sparked calls for a wider rethink of what social care should be in Scotland, how we provide it, and maybe even how we finance it.

In September, an independent review of adult social care was commissioned by the Scottish government, which is expected in January to deliver its findings.

“At its best, social care is about prevention,” Dr. Macaskill said.

“What we’ve done over the last 25 years has been to take prevention out of social care, and that’s been a great folly because it’s led to people reaching a stage of decline in their lives much earlier than they should have.”

Dr. Donald Macaskill, Scottish Nursing Chief Executive

Ironically, he believes that the introduction of free personal care in 2002 – a flagship policy of the then Labour-Libdem-led Scottish government – can be traced back to part of our present plight.

67% of home care in Scotland was basically preventive care at the time we implemented free personal care. It was shopping around for individuals, cleaning their property.

It was low-level support, but most significantly, it allowed a partnership where the worker could recognise areas of deterioration, coordinate pharmaceutical treatments, involve the GP, and find community support for someone who was isolated and lonely.

We now have eligibility criteria if you take that out – and austerity has exacerbated it -. You have to be basically one of the walking dead to be eligible for social services, that’s how high the eligibility requirements for assistance are.

“So we’ve stopped the preventative approach and that’s made it so much more difficult, so now – after being at 67 percent – we’re down to 3 percent in terms of non-direct personal care for people in their own homes,” he said.

“That’s an unintended consequence of a policy that was supposed to bring in equity, but if anything, it’s made it worse.”

Now is the time to reconsider what we expect from the treatment industry.

Dr. Macaskill suggests that any drive towards a “National Care Service” “has to include a robust economic analysis of how we’re going to pay for social care.” – whatever that means in reality.

You will have to devote money to it if you call anything a National Care Service. Some very difficult questions we have to ask ourselves: How are we going to pay for it? Will we have personal insurance, will we increase taxes, will it be a mixed model?

“How are we going to stop the inequity that someone who has cancer gets most of their care paid for, but if you have dementia, you have to sell your house?”

The notion of a National Care Service may conjure up images of an NHS version of social care, but such a move would be exorbitantly costly.

The move from HC-One to NHS Highland of the Home Farm care home on Skye cost the taxpayer £ 900,000 – could the Scottish government ever consider nationalizing all 614 privately run care homes in Scotland for older people?

The minutes of the independent review indicate something less drastic, with discussions on how to achieve “consistency” between independent, public and non-profit employers within the sector in wage scales, sick pay, pensions and study leave.

Mutated Covid strains mean that we need to reconsider how we end up in the UK.

The assessment also tends to look at foreign examples of reform proposals.

The panel of assessment includes


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