29 November 2023

Social care commissioning system is ‘out of whack’, new publication finds

Eight sector leaders provide perspectives on the viability of ethical commissioning and procurement, through interviews with journalist Pennie Taylor

A new publication from the Coalition of Care & Support Providers (CCPS) explores the viability of an ethical approach to planning and purchasing social care, with eight sector leaders providing their perspectives on the current landscape through interviews with journalist Pennie Taylor.

The publication, “It’s out of whack!”,  highlights how commissioning and procurement has a significant impact on the delivery of support services, sustainability of providers, the workforce and on people receiving support.

Download the publication (PDF)

Interviewees consider how meaningful partnership, community-level co-production and innovative thinking could address unprecedented service challenges.

As reflected in the publication title, which draws on a comment from C-Change CEO Sam Smith, the consensus view is that the commissioning system as it stands is unbalanced.

CEOs, directors and managers interviewed make clear the risks not implementing reform poses to providers, and the major steps still required to realise the “collaborative, rights-based and participative approach” that was outlined in Derek Feeley’s Independent Review of Adult Scotland Care.

Catherine Garrod, CCPS Programme Manager – Commissioning and Procurement, said: “The expert voices in these interviews demonstrate how Third Sector care and support providers already deliver high quality personalised care and support and work to improve the outcomes of the people they support, in spite of the system.

“These are voices that need to be heard and included in finding the solutions to make the shift we all want – and need – to see for people who require support.

Pennie Taylor said: “The concept of ethical commissioning and procurement has been embedded in the proposals for a National Care Service for Scotland, but a new way of working cannot wait for that. Instead, the people I spoke to for “It’s out of whack!” all want to see action taken to galvanise change, using existing legislation to kickstart widespread reform without delay

“These features spotlight great examples of doing things differently, and describe first-hand experience of current practice that is far from ethical. They eloquently demonstrate the passion, commitment and creativity that keeps the Third Sector going, whatever the odds.”

Interviewees in the publication are Ben Bradbury, Business Development Manager, Capability Scotland; Ian Bruce, CEO, Glasgow Council for the Voluntary Sector; Drew Collier, Director of Development, includem; Dr Ron Culley, Chief Officer, Quarriers; Louise Moth, Contracts & Commissioning Manager, Scottish Autism; Julie Murray, Chief Officer, HSPC; Sam Smith, CEO of C-Change; and Andrew Thomson, Deputy Chief Executive, Carr Gomm.

The publication was commissioned by CCPS’s Commissioning and Procurement Programme, which is funded by the Scottish Government.

Find out more about the Commissioning and Procurement Programme

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25 July 2023

4 Steps Guest Blog: “What is the ethical defence of unequal pay?”

Old concepts of moral principle, politics and logic help explain the absence of fair work in social care, says Ron Culley

Ethos, demos and logos were concepts used by the ancient Greeks to make sense of the world around them: ethos referred to the development of a moral principle or argument, rooted in human values; demos referred to the body politic, to the rules of self-government; and logos referred to reason and rationality, the logical flow of an argument.

Two-and-a-half-thousand years later, and it seems to me these concepts are still useful in making sense of the world around us. The principle of fair work in social care, and the limited political progress that we have made towards it, can be helpfully understood by applying these concepts.

Ethos

The ethical argument for fair work in social care is plainly put. If social care workers across different sectors are delivering similar taxpayer-funded public services, why should the level of pay be different? Given that care workers are providing work of equal value, is the Scottish Government justified in mandating that a Healthcare Assistant in the NHS be paid £14 per hour, a homecare worker in a council £16 per hour, a support worker in a not-for-profit social care provider £10.90 per hour, and a care worker in a private sector care home £10.90 per hour? All of these jobs are comparable in terms of skill and responsibility.

So is it fair that the Scottish Government and Local Authorities have decided in favour of unequal pay? And let’s consider the fact that most people working in the care sector are women and that, on average, women continue to receive lower pay than men. Is it right that the Scottish Government and Local Authorities have not gone further to correct this injustice? Were there to be a reprioritisation of political choices, tens of thousands of women could be taken out of a low wage job. In short, the ethical defence of unequal pay is very difficult to present.

Demos

To explain why this situation nonetheless persists, we need to understand Scottish politics. The reality – however much we might want to pretend otherwise – is that the NHS is politically more important to the Scottish Government than the social care sector. It’s why many arguments about investing more in social care are actually framed around alleviating pressure on the NHS, and not about supporting people to realise their rights as citizens or to give expression to their personal agency. By this argument, social care is only important because to get it wrong damages the NHS, and a struggling NHS is a vote loser.

The other way democratic politics plays into this is in the stewardship of the public finances. There simply isn’t a strong enough tax intake to fund the health and social care system that many people would like, so we have developed a system that supports the cheap outsourcing of public services to the third and independent sector (euphemistically referred to as ‘best value’). That would be fine if it were a level playing field and all providers (including monopolistic providers like NHS Boards and Councils) had to compete for business on the same terms. But that would risk violating one of the golden rules of Scottish politics, that public sector delivery is best (despite evidence that the third sector consistently delivers higher quality care and support).

Logos

The problem with all of this is that it contains flawed logic and makes for poor strategy. What happens if we pay public sector care workers significantly more than third or independent sector workers? The answer is there is a migration of talent and experience from one to the other. As a result, the third and independent sector is weakened, especially given that the labour market has been structurally imbalanced by Brexit and Covid.

How will providers in the third and independent sector respond? I doubt there will be a dramatic implosion – there’s too much market diversity for that to happen. Rather, what we’ll see is a gradual reduction in service delivery across the sector – less care delivered by less people. That in turn will generate more unmet need. And where will those people go? I would imagine social work, GPs and Emergency Departments. Only this time, there’ll be no-one else to turn to.

Ron Culley is CEO of Quarriers, a member of CCPS’s Board and Chair of our Committee on the National Care Service

Find out more about our 4 Steps to Fair Work campaign

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