Last Thursday, the Cabinet Secretary for Health and Sport announced that workers in adult social care were to be “guaranteed” the Living Wage for every hour of a sleepover shift. This would, she said, “make a real difference to those whose hard work enables thousands of people across Scotland to live with dignity.”
Life, as they say, comes at you fast, and quite how much difference this is going to make may come as a surprise to the Cabinet Secretary. Support workers in Scotland’s largest health and social care partnership area, who probably spent the weekend celebrating their impending pay rise, would have done well to read a paper considered by the IJB the day before the announcement.
The paper said that by April 2019, the partnership will have made a “wholesale move to alternative [overnight] support arrangements”, which can only be interpreted to mean the end of sleepovers. The paper was approved, and providers have now been informed. On top of that, we understand that these alternative arrangements are highly likely to be taken on by the council’s arms-length provider body, Cordia, not by existing providers.
The implications of this shift for people supported by the third sector are quite staggering; and the timeframe matches, to the day, the timeframe set out for implementation of the promised “pay boost” to third sector workers.
This is not a coincidence: for all that the partnership’s statement says that this radical redesign is intended “to improve care, provide a richer outcomes-based independent living experience for service users, and ensure more appropriate working conditions for workforces”, the paper makes it clear that the key driver here is the huge cost of implementing the Living Wage.
I am painfully aware that nobody likes a Smart Alec who turns around when something serious happens and says “I told you so!” but on this occasion it’s impossible to resist. CCPS has been telling the Cabinet Secretary and her officials that this would be the likely outcome since it first became clear that sleepovers were to be included in the Living Wage commitment. That’s why, a few weeks prior to implementation in October 2016, sleepovers were exempted for what was described as a “transitionary year”.
Communicating this to IJB Chief Officers, Scottish Government officials said that the exemption was being granted in recognition of the fact that “it may take time for partnerships and providers to adjust to [implementing the Living Wage for sleepovers], including through service redesign, where appropriate” (my italics).
It is now apparent that the extent of this redesign encompasses the complete eradication of sleepovers in our sector. It is also clear that this transitionary year should have been spent planning, at national level, for mitigation of the risks that were so clearly highlighted – and evidenced in considerable detail – by CCPS and its members. Instead, all that happened in practice was the instigation of a handful of action learning sets and design ‘sprints’, the involvement of providers in which had to be fought for pretty robustly.
The operational challenges that this development will present to providers are hard to overstate. Instead of implementing the Living Wage for sleepover shifts – which was going to be tricky enough, but ultimately worth it – organisations will now have to spend the next 18 months removing sleepovers and (presumably) liaising with Cordia about the replacement arrangements (if, indeed, they will be replaced). And guess who will be charged with breaking the news to support workers that they won’t be getting a pay rise for sleepovers after all, because sleepovers won’t exist.
Given that the majority of support workers are already full-time, the introduction of waking nights in particular will require potentially hundreds of new recruits, at a time when even existing vacancies are impossible to fill. And whilst it may come as a surprise to the occupants of St Andrews House – and of Commonwealth House in Glasgow, come to that – the truth is that providers have been working hard to review their sleepover provision for several years now, particularly with respect to the introduction of tech solutions. Most feel that they have to a large extent already achieved what is achievable in this regard, certainly to the degree to which they (and their commissioners/care managers) consider to be safe, provide protection and maintain a suitable level of quality.
This brings me to the most critical issue. It is enormously revealing that the partnership isn’t talking about reviewing individual care packages to test whether people’s needs can be met without sleepovers: it says that this will be a “wholesale move”. As Mrs Thatcher was fond of saying, there is no alternative, at least not one that involves retaining sleepover provision, or continuity of care by existing providers. Pete Richmond of Partners for Inclusion pointed out the dangers of this approach very clearly in a recent blog for Third Force News.
Quite where self-directed support fits into this picture, with its seemingly quaint agenda for choice & control for individuals over the care they receive, I couldn’t say, but no doubt the partnership will elaborate in due course.
Nobody is saying that care arrangements, once put in place, must never again be reviewed or amended: the potential of new staffing configurations and tech developments must always be considered, but the driver has to be the needs and preferences of the individual supported, not the unmitigated consequences of a strategic policy choice.
As colleagues will be aware, I’ve been working in and around social care and social policy for decades, and I can honestly say that I have never seen such a wholly admirable policy backfire so spectacularly in such a short space of time. Even those who have been cheerleading for this – the ones who’ve told me that by pointing out the risks, I am ‘complaining’, even ‘scaremongering’ – must surely have been given pause by these new developments.
It all calls powerfully to mind the statement attributed to a senior US army officer during the Vietnam war: “In order to save the village, it became necessary to destroy it”.
Annie Gunner Logan