The gap between the care families expect their loved ones to receive at home or in a care home, and what providers are actually being equipped to deliver, is stark and growing, a panel of care providers has warned.

“People expect 24 hour a day care when in fact we are paid to carry out three hours of care a day,” a care home director has told healthandcare.scot.

“People’s expectations of what can be provided is actually completely unrelated to what we are funded to provide, and people’s expectations aren’t unreasonable.

“…There is a huge disjoint between what the public expect and what we are paid to do.”

Holyrood’s health and sport committee is due to begin an inquiry into adult social care next month, but given the current pandemic this will undoubtedly be pushed back until later in the year.

healthandcare.scot convened a series of roundtable meetings of members of the providers’ organisation Scottish Care around the country last month to discuss consultation questions posed by the committee. At one of the meetings, the care home director’s sentiments were echoed around the room.

“People are coming in now to care settings when they are frailer and their dependency much higher,” the care home director added. “Those people used to stay in hospital but are now coming into care and the funding models and contracts haven’t kept up.”

An integral part of care provision across Scotland, independent sector providers are commissioned by Scotland’s 31 health and social care partnerships and paid according to a rate set annually through the national care home contract.

 

While statutory services still make up the majority in island communities and very rural areas like the far north and west of Scotland, in other places the independent sector can be the sole provider of care home services.

There is no shortage these days of warnings from partnerships about the increasingly difficult financial positions they find themselves in. Last month ‘serious warnings’ about the state of Fife’s finances were issued, while Argyll and Bute authorities said there were ‘no easy options left’ in terms of where cut backs would have to be made as financial resources continued to slip away.

At the four roundtables, care home providers explained the way this can manifest is when, in a bid to save money, local authorities try to pay independent providers the lower residential care rate for an individual that in fact needed more expensive nursing care.

“It’s the council chancing their luck,” a provider said. “We are under such scrutiny for going for additional support or nursing care. There is no understanding of somebody living with a diagnosis of say, dementia, and what their experiences are like – the lack of knowledge of people living with dementia is phenomenally frightening.

“District nurses are coming in and making decisions on a clinical basis but we need to dump the biomedical model and look at the social model.

“Around 80% of our client group are living with a diagnosis of dementia. They are not receiving the services in the community that they are legally entitled to and they are not getting their one year post-diagnosis support in most cases.

“There is no conversation about the impact on relationships for that person. They have nursing needs but because a district nurse can come in and say essentially there’s no bandages, so no nursing requirement they are then classed as residential - it’s nuts.

“It is often the most physically fit patients that can take the most time because they need to go out into the community – their care can be very time-consuming because it’s about fresh air, their location and social dynamics.

“You can’t get extra funding for that because it’s not part of their package to go out for a walk for an hour a day…more often than not it’s time that is needed to help someone – the very thing that you cannot get funded.

“If you do put the time in and the person improves and presents in a much more content way people come in and say ‘well you don’t need that funding any more’. You then put the individual right back to the beginning and they decline again.

“We face a choice of carrying on doing this sort of thing free of charge with a lot of pressure on you and your employees, or you can stop doing it and still burn your staff out because of the conditions – they become exhausted.  It’s a vicious circle with funding right in the middle.”

The inspection and regulation of Scotland’s care services is compounding the problem, providers say, where they are punished because they don’t meet people’s misguided expectations:

“We need an honest dialogue, shouted from the rooftops, that is about what providers are paid for in care homes and home care services. People are discontented with what they get because they don’t understand, and they then complain meaning we are investigated for not meeting people’s expectations – even though we’re not paid to meet them.”

She says the Care Inspectorate – the national scrutiny body for care services – is not interested in the amount of funding providers get:

“They see it as people want a certain level of care within this framework and you have to reach the outcome that that person expected… therefore a complaint is upheld if you didn’t do it but you were not paid to do it. You end up with a vicious circle.”

Holyrood’s health and sport committee will hold the first of its evidence sessions next month on adult social care.

That an inquiry is even being carried out has left the director of a large homecare provider that covers west and central Scotland exasperated.

They explained there is “already over 20 years of very rich research evidence there from bodies like the Kings Fund, York University, and the Social Care Institute for Excellence, that quite clearly outlines the structural issues in the sector, and the challenges with the workforce and for providers.”

They added: “I’m quite concerned and frustrated that we are at the stage of going into an inquiry when there are already years and years’ worth of research evidence.

“…There are hundreds of civil servants working on the reform of adult social care - they have had access to all that research and evidence yet we have an inquiry body saying now ‘we still don’t understand what the issues are’.

“As a taxpayer I find it incredible that that’s the position we are in.

“…The frustration I have as a care provider is that when I go along to meet individuals – including politicians and councillors – they tell me that they don’t really understand the complexities but if they’re operating in that area it’s their responsibility to find out about those complexities.”

A director of two care homes in the west of Scotland told healthandcare.scot they are equally frustrated that “after 20 odd years, we are still having the same discussions.”

She explained: “I think we know what the problems are and there never really seems to be an answer.

“I have seen some improvement certainly, but it would be nice to get to a point where there was a proper understanding of the valuable work that care providers are doing and the support they need to do that, not just as a care provider that is a major employer in small communities.”

 

This is the first of four insight articles written following consultation meetings of members of Scottish Care, held in Ayrshire, Lanarkshire, Fife and the Highlands.

You can read the background to the roundtables convened by healthandcare.scot.

Follow healthandcare.scot on twitter to keep up to date with all the relevant news, views and insight.

 

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