One of Scotland's biggest care home operators has accused the Scottish government of wasting the summer by focusing on a "premature and political" review of adult social care rather than learning lessons from the first wave of covid-19.

Robert Kilgour, who heads up Renaissance Care’s 15 homes across Scotland, suggested that the review, which is considering whether to create a national care service, was politically motivated with an eye on the Holyrood elections in 2021.

This will be of no use to care homes on the frontline in the months ahead, he says, while a rapid review over the summer months into what went wrong in care homes in the first wave “could have been saving lives this winter”, he told healthandcare.scot.  

Mr Kilgour, who has worked in the care home sector for 31 years, said he had never been prouder of the “supreme dedication” shown by staff who were like families to the residents they cared for.

However, he questioned why the Scottish government was committing to bringing in a national care service rather than building on the strengths of the sector, suggesting that private care homes were being blamed for virus deaths beyond their control.

He went on to put forward the “radical” idea of taking the commissioning of social care away from councils and giving it to the NHS.

The care home boss made the claims in a wide-ranging interview with healthandcare.scot about social care before, during and after the pandemic.

He accused ministers of “completely passing the buck and abdicating responsibility” on care home visiting, by announcing indoor visits before rapid testing of relatives was in place.

The interview took place last week as Jeane Freeman announced a dozen care homes would trial half-hour-turnaround tests for visitors.

Months of visiting restrictions were relaxed in October after campaigning by relatives.

However people working in the sector voiced fears about the timing of the announcement – just as virus levels were rising in the community.

Renaissance Care already tests more than a thousand of its staff every week.

Mr Kilgour’s big concern is whether the testing system could cope with adding, in Renaissance’s case, an additional 700 relatives every week.

In August and September when schools and universities returned, increased pressure on the system meant some of his staff were waiting ten days for the results of weekly tests – meaning some were being tested without knowing the previous week’s results.

“We are improving care home visiting because it’s the right thing to do, but we are doing it step-by-step because we can’t make a quantum leap without this testing being delivered,” he says.

“I’m really keen on getting relatives back in on a regular basis but only in a safe and secure manner and the best way to do that is to have weekly testing.”

Before founding Renaissance Care in 2004, Mr Kilgour had built up the Four Seasons Health Care group to one of the UK’s largest care home operators, into the UK’s fifth largest care home provider with 190 homes, over 10,000 residents and more than 13,000 employees.

That, and the links he maintains with care home operators in England, gives him a unique insight into social care in Scotland.

While there were problems before the pandemic, he argues Scotland is in a better position than England on staffing, regulation and funding.

Speaking about staffing, he praised the introduction of the living wage for care workers: “The big issue with me was how can it be right or fair that somebody is paid more to stack shelves in Lidl, Tesco or any supermarket, than they’re paid to look after our vulnerable elderly.”

And on care home funding, he says: “In England it’s a complete free for all; a care home that has four councils in close proximity can be getting four different levels of fees – it’s really quite a race to the bottom in England.

“There still needs to be reform in Scotland but we are coming from a higher starting point than in England – so pre-covid it’s not all bad news.”

But Mr Kilgour questions whether the review of adult social care – announced by the Scottish government in September and asked to consider a national care service – is the right way forward.

The review, which is being headed by former NHS Scotland boss Derek Feeley, was announced in September and has been taking evidence since then. It is set to report by January 2021.

It was asked to consider creating a national care service in Scotland but Health Secretary Jeane Freeman pledged this week a future SNP government would do so regardless.

“I think it’s premature and it’s political. I was calling in June for a full review of the lessons learned from the first wave,” Mr Kilgour says.

“The Scottish government has continually – even as recently as the last few weeks – said now was not the time.

“We could have had this done in the summer, we could have had a lessons learned review out by now and it could have been saving lives this winter.

“Whereas the Feeley review is not going to save any lives this winter. They could have put the money and the manpower [into a lessons learned review].

“Fine, have the Feeley review – but have it later on, it’s in the wrong order.”

“[The review] is really just looking to come up with something in January,” he adds. “[Politicians] have been looking to blame the independent sector for what’s gone on in care homes, though I’m not quite sure how they can be to blame for hospital discharges.”

Asked what the care sector in Scotland needs, Mr Kilgour has a flurry of answers – starting with funding.

“Care homes, whether independent sector or not for profit sector have to be paid the true cost of care. We have to have a level playing field.

“It’s a huge anomaly – you have local authorities commission all care and they commission care to their own care homes, that are 40 to 50% more expensive to run than our care homes.

“If a local authority is paying £750 a week to the independent sector for a service and is providing the same service in their own care homes for £1200 or £1300 a week how does that make sense? It is ludicrous.”

A panel of care providers told healthandcare.scot earlier this year that the gap between what local authorities were willing or able to pay care providers and what delivering that care would actually cost was ‘stark and growing’, leaving care companies struggling to provide services through outdated funding models.

Social care, Mr Kilgour believes, has long been a “cinderella” service ignored by politicians and government and playing second fiddle to the NHS.

The solution is a “ten-year social care plan, with cross-party support, including a workforce strategy with funding,” he argues.

“We have a long-term plan for the NHS – we need a long-term plan for social care.”

Perhaps most controversially, he suggests power over organising care be taken from Scotland’s councils and given to the NHS.

“One of the things that might be worth looking at – it might be a bit radical – is maybe NHS Scotland should be giving the commissioning budget and role, and that’s taken away from local authorities.”

“We do need more of a level playing field between the different sectors and I would like them to look at commissioning being given to NHS Scotland.

“Then NHS Scotland has that budget and then can decide whether they place it with a not for profit or independent sector provider, or a local authority care home.”

Sign up to our bulletin for key health & social care updates straight to your inbox.