The Future Delivery of Social Care in Scotland
SCVO believes that the contribution of the voluntary sector to health and social care is significantly undervalued and that this is holding back progress on improving people’s outcomes and experiences. In our response, SCVO is putting the case to the Health and Sport Committee that the sector has to be given a key role in strategic decision-making in order to shift spend to prevention, early intervention, reducing inequality and wellbeing. The Auditor General has confirmed that good quality social care is what most people need and what protects them from needing higher tariff health interventions. Yet social care remains undervalued, with a commissioning system which dehumanises the very people it is supposed to serve and who need our care the most continues. Transformational change can only happen if the importance of the sector is recognised and it is supported on to a more sustainable footing.
Recognising the importance of the voluntary sector
The voluntary sector delivers the highest quality social care, and the vast majority of community activities that promote wellbeing, inclusion and social interaction. The sector deserves to be taken seriously and local authorities and health boards need to recognise that. The sector is expertly placed to address many of the key challenges facing integration joint boards (IJBs) such as citizen participation, community empowerment, early intervention and prevention. The contribution of the voluntary sector should not be underestimated: 2% of all Scottish public spending (£1.45bn of £73.4bn) is on voluntary sector contracts and 31% of adult social care workers (around 43,400) are employed in the voluntary sector. The involvement of the voluntary sector in IJBs varies significantly across Scotland, though this can often be interpreted as tokenistic.
Sustaining the voluntary sector
Despite the key role played by the voluntary sector, many organisations are being placed in financial peril by the current system. There needs to be a fundamental redesign of the commissioning and procurement process for IJBs, such as removing competitive tendering. The current predominance of one year contracts is deeply damaging to the voluntary sector, creating massive instability in the form of yearly redundancy notices, which restrict the ability to plan strategically and place challenges on staff retention. This latter effect is also produced by the lack of inclusion of funds in contracts for staff wage uplifts or pension contributions for the sector delivering partnership priorities. A tendering system geared towards voluntary sector competition frustrates innovation, demoralises staff, and ultimately hinders the care people receive.
Cross-sector partnership working
The need to improve partnership working with the voluntary sector has been consistently and clearly articulated across the spectrum, including in the Health and Sport Committee’s own report of 2017, and the Ministerial Steering Group of February 2019. There are numerous examples across the country of successful cross-sector partnerships, a sample of which are documented in SCVO’s Positive Partnerships collection. Central to these are the building of trust, regular and honest conversations, the sharing of data and other resources and collective decision making. The learning from these must be shared across the country and be something for everyone to aspire to.
The purpose of integrating social care and health services is to improve the outcomes and experiences of the people using those services and their families. That requires a genuine partnership of everyone involved, not least the voluntary sector. The sector delivers the highest quality of social care and leads the way in innovative service redesign across the board, from community empowerment to early intervention. Yet many voluntary organisations feel excluded from decision making and placed in unsustainable financial situations. Both of these challenges must be addressed comprehensively if we are to see the success of health and social care integration.
Allan Young, Engagement Officer, email@example.com, 0141 465 7533