It’s a bit of an understatement to say that the NHS in Scotland is currently living in interesting times.

Nobody would have wished a pandemic like Covid on anyone but, as a hospital doctor, it’s been humbling to see the extra effort everybody in the NHS has made in dealing with this along with the efforts of shopkeepers, taxi firms and food outlets in keeping things going.

The messages from the Scottish Government have been pretty clear too – stay home and save lives. Nobody can really argue with that.

I would suggest a change, however, to one of its policies. Health and Social Care staff are to receive a £500 bonus from the Scottish Government to thank them for their efforts, the announcement of this being made in last November. While nobody would begrudge that payment to some workers the award of it to already well-paid medical staff is causing disquiet among my colleagues.

Personally, I see no reason why I should get an extra £500 (actually less than £300 after tax but that’s another story) for doing my job when I’m already getting paid more than other NHS workers already.

There are about 160,000 healthcare workers in Scotland meaning that the cost of this will be, for NHS Staff alone, some £80M. For the money that is to go to doctors you could increase the salaries of care home workers longer term – surely a better use of the cash.

Before the emergence of COVID-19 and the government lock-down, it was widely recognised that there was something seriously wrong with Scotland’s social care system. Social care in Scotland faces a “fundamental crisis”, experts warned after a Care Inspectorate report in 2017 found more than a third of care services had unfilled staff vacancies the previous year (Care Inspectorate, 2017).

This against forecasts showing not only increasing demand for adult social care services in Scotland, but also an increased demand from people with more complex care needs (Audit Scotland, 2016, 2018; Public Health Scotland, 2018). The crisis in Scotland’s adult social care system is underpinned by a workforce that are some of the lowest paid workers in Scotland. Many earn less than £10 per hour. The vast majority, 83%, are women. Most have unpaid caring responsibilities out with their work.

The emergence of COVID-19 and its consequences have shone a blinding light onto Scotland’s social care system. Following the announcement of government lockdown measures in March 2020, in order to increase NHS bed capacity, nearly 1,000 hospital patients in Scotland were discharged directly to care homes – without being tested for the virus. The announcement of a policy to test all hospital patients twice before discharge to care homes was made on 22nd April 2020. In some cases, it took weeks for care workers to receive basic PPE. This only happened because thousands of care workers spoke out, writing directly to the First Minister.

In the week ending 19th April 2020, almost half, 46% of all COVID-19 deaths in Scotland were in care homes. On June 3rd 2020, National Records of Scotland (NRS) announced the statistic that more people had died of COVID-19 in Scotland’s care homes than in the country’s hospitals. NRS recorded 1,818 deaths linked to the virus in Scotland’s care homes since the outbreak began (National Records of Scotland, Show You Care – Executive Summary 2 June 2020).

This was the very group of vulnerable people that government measures were supposed to protect from the virus. Estimates as of 11th June 2020, were that only around one quarter of care home staff in Scotland had received testing for COVID-19. Only on 25th June 2020 were social care workers finally afforded proper sick pay. GMB Scotland’s surveying of its social care membership found that over 75% of workers were scared to be tested for fear of testing positive and having to be off work, in receipt of only statutory sick pay of less than £96 a week. The level of financial detriment that workers were being left in was fundamentally undermining the testing regime and exposes a lack of coherent planning.

Scotland’s social care workers have shown their skills and bravery during the COVID-19 crisis. Yet these skilled workers remain undervalued and underpaid. The average hourly rate of pay of the over 1600 who participated in our questionnaire survey was £10.64 an hour. The average hourly wage in the UK is £14.80 (Statista, 2019). GMB believes that there needs to be a minimum care wage of £15 per hour.

GMB also believes that we need uniformity of terms and conditions across Scotland which include, but are not limited to, protection for council staff on better conditions, permanent and full-time contracts where desired, flexible working arrangements, good pension contributions and drive for workers to join the pension scheme, better staff ratios, an equality proof job evaluation scheme, permanent full sick pay across the entire sector. Scotland should also establish an independent National Care Service which recognises trade unions and national collective bargaining. This should involve discussions on the future role of the Scottish Social Services Council (SSSC) and the Care Inspectorate; this would include options for progression if desired. The Scottish Government should also ensure trade unions are included throughout all aspects of development and implementation of changes in the social care sector. Social care workers have highlighted frequent changes to their contracts, sometimes without any notification from their employers. Low pay and workers’ contractual rights must be improved if we are to solve Scottish social care’s recruitment and retention problem.

Social care workers need time to deliver dignified and compassionate care. Two of the five standards the Scottish government cites as key components when delivering health and social care are dignity and compassion (Scottish Government, 2018). Social care workers desperately want more time to deliver dignified and compassionate care continuously. Service users certainly deserve this. Put simply, social care workers are looking after too many service users with not enough time allocated to their often complex care needs. The reason? Understaffing and high staff turnover. Add to that the high levels of sickness due to the stresses involved in delivering social care – “always up against the clock” – as one social care worker put it, and one understands the barriers to providing quality social care.

So the Scottish Government should set a figure for improved investment in Scotland’s social care sector. Any future commissioning to be driven not by profit but in order to ensure a high quality of care, delivered by a professional and properly valued and rewarded workforce.

A valued social care workforce should be rewarded in their pay and terms and conditions for the amazing job they do. This would also make a statement about how Scotland views the rights of low paid women and the importance of gender equality in the workforce and wider Scottish society.

This is an extract from GMB’s Show You Care Executive Summary, which can be read in full here.

Background.

Over the last year, Scotland’s army of social care workers have been right on the front line of the Covid pandemic.

Often without adequate PPE, and – until June 2020 – without adequate proper sick pay, they worked exhausting shifts in care homes across Scotland to tend to their elderly and extremely vulnerable adults. When hospitals removed patients into care homes at the start of the pandemic, it was these care workers that took on the burden of work. Tragically, care workers were often the only people there to comfort and support elderly residents of care homes in their final hours before succumbing to this disease, with families unable to say goodbye. We cannot underestimate the physical and emotional burden this has placed. 

The crisis has only highlighted the huge role that care workers play in Scotland’s social fabric, and how under-appreciated they have been up until now, and even in comparison to the health work force throughout the pandemic.  With a rapidly ageing population – c.68% rise in over 75s predicted by 2035 – the role of, and need for social care staff is only going to become more pronounced, to uphold the social rubric of Scottish society. 

The case for change.

In its recently published paper “Show You Care”, the GMB Union surveyed 1,600 Social Care Workers across Scotland. Their average pay was just £10.64, well below the UK hourly average wage of £14.80. This inadequate pay disproportionately affects women, who comprise 83% of the workforce. Similarly their total package for sick pay, time off and travel time is vastly insufficient. 

The survey revealed that 82% of social care workers feel undervalued by their managers and 89% believe social care is not adequately funded. This undervalue is compounded by a lack of training and development opportunities in the profession, leading to issues of staff retention and recruitment. Many believe a lack of support and time is compromising the quality of care they can provide. 

The Scottish Government is to be commended for having conducted an extensive review of adult social care, published last month by Derek Feeley. It acknowledges the fact that the social care workforce in Scotland feel ‘undervalued and under recognised.’ Its main recommendation is to create a new National Care Service which directs funding for the social care sector. On pay, the review notes that increasing the social care support wage bill to the Real Living wage will cost £15.5m, with this acting as a floor, requiring an extra £100m per annum for every £1 p.h. extra. This indicates an additional cost of £500m for a £15 per hour wage. 

ScotlandCan

Scotland needs to take an active role in recognising the value of, and supporting care workers. The Scottish Parliament could make a commitment to paying a minimum care wage of £15 per hour a key pledge – as a way of honouring their response to the pandemic, but also the thankless work they do generally, day in, day out.

Any pledge will signal to society their work is valued and important. Just as the US created a ‘GI Bill’ for soldiers returning from World War II, so can the pandemic provide the impetus for a ‘GI Bill for social care workers’. 

The Feeley report, and its recommendation to replace competition with collaboration in the Social care sector could provide the mechanism to push through a new £15 an hour minimum care wage. This should be supported with a clear learning and development programme to be rolled out to all staff, incentivising retention.

Increased funding for such initiatives needs to come predominantly through extra Local Authority support (with public funding currently at 84% of all costs) and more private sector investment. At a minimum, Local Authorities need to streamline and equalise the funding they provide to privately run care homes, who currently receive less funding per resident than their state counterparts. The private sector will then be able to pass on this increase directly to their care workers, bringing them in line with their public equivalents. There is also scope for the public sector to provide a certain amount of this funding deficit and for it to be matched by the private sector, as long as this cost is not passed onto the residents themselves. Support for funds can also be redirected from senior public sector pay packets. 

In showing their commitment to the care sector across the entirety of the UK, Scottish MPs could campaign for the £15 per hour pledge to be adopted across the UK, demanding that the Scottish Government guarantees any extra funding that flows to Scotland be dedicated to the social care sector.

Adequately paying our social care staff is just part of the solution to reforming our care system, in both Scotland, and the UK. The impact of raising carer wages to £15 per hour will inevitably have a knock on effect on the pay we should offer other health workers, operating within the care system and beyond, i.e. junior nurses – any rise for carers should not be conducted in silo. A fair wage for all those key workers is required, worth the value of services required. This starts with providing an adequate minimum social care wage.