Robert Kilgour, founder and executive chairman of Renaissance Care, identifies fundamental differences in social care between Scotland and England but warns that dark clouds developing north of the border may be a sign of things to come in the south.

As we all take a deep breath, steady ourselves and get ready to battle on into what we all know is going to be an incredibly tough and challenging 2023, I want to take a moment to focus on some of the fundamental differences in social care between Scotland and England, particularly in funding and staffing since devolution and the establishment of the Scottish Parliament. The sector south of the border may not be aware of some of these differences and also of some worrying dark Scottish clouds circling ready to unload more misery on the care home sector up north. These clouds may provide food for thought in England regarding the possible direction of travel of the Westminster government and the English regulator, the Care Quality Commission.

A recent calculation of the make-up of care home beds in Scotland showed 85% independent and voluntary sector, 11% local authorities and 4% NHS. In addition, we have our own equivalent of the CQC in Scotland called the Care Inspectorate which carries out exactly the same role.

This article does not address the recent large cost increases in so many basic essential items, insurance and energy, the wholesale sector staff shortages, and the overall funding and banking pressures hitting our sector really hard just now, because we’re all struggling with these wherever we are in the UK.

These issues are quite rightly getting plenty of attention and coverage elsewhere.

Staffing
Nurse bursaries (non-income-assessed) in Scotland are currently £10,000 per annum, paid monthly throughout the course (£7,500 in final shorter fourth year) with other further possible financial assistance available depending on individual circumstances. The current annual tuition fees in Scotland are officially £1,820, although most Scottish nursing students do not seem to have to pay for tuition fees, unlike in England where the tuition fees are also much higher. In England, the equivalent maintenance grant figure is £5,000 per annum, but there is a possible extra £1,000 per annum if you plan on working in an area suffering from severe shortages, which include mental health, and there are also some possible childcare allowances and there’s also a small additional means- tested element.

In Scotland, we have the Scottish Carers Living Wage (first introduced in 2016) which is paid to all staff in a caring role who are aged 18 or over. It is currently £10.50 an hour (likely to go up to at least £10.90 in April) as opposed to the current National Living Wage for 23-year-olds and above which is £9.50 an hour (excluding London) and which is going up to £10.42 an hour from April. In
addition, the (Scottish) National Care Home Contract (more about this shortly) states that all staff aged over 18 employed in whatever role in a care home are paid a minimum rate of £9.90 an hour – another rate that will go up in April.

Funding
We have free personal care in Scotland (first introduced in 2002) where free personal and/or nursing care is available to all adults over 65 years old who have been assessed by the local authority as eligible for these services. You can generally get this support regardless of age, income, capital assets, or marital or civil partner status once you are deemed eligible by your local council.

The National Care Home Contract (NCHC) in Scotland was first
established by COSLA (the Scottish local authorities organisation) in
2006/07 as the model contract (updated and renewed annually) where all the detailed terms and conditions are set out and this is used by all Scottish local authorities for the purchase of care home places for publicly funded clients throughout Scotland. The current NCHC nursing care fee rate is £832.10 a week and the residential care fee rate is £719.50.

However, it’s worth noting here that absolutely no ‘top ups’ to these fees are allowed by the NCHC, except in exceptional circumstances.
(A recent freedom of information request showed that Scottish local authorities’ owned care homes were costing the taxpayer an average of 50% more in weekly fees than the figures outlined above – and we’ve been campaigning long and hard for many years for a ‘level playing field’ on fees between sectors – and for private owners to be paid nearer to the true cost of care.)

Dark storm clouds
In addition to the impending Scottish Covid-19 public inquiry, the Care Inspectorate recently tried to introduce some changes to maximum care home size. Its plan was that the maximum care home size allowed would be 60 registered beds, for new registrations and on the sale of existing registered homes. It also planned to increase minimum bedroom sizes significantly and increase other general requirements. These changes seem currently to be parked, but probably not for long, despite the combined impact of these changes making over 90% of Scottish care homes non- compliant and difficult to sell or even to refinance.

The Scottish government’s plans to introduce a National Care Service are not all bad in principle. However, they have rightly hit huge opposition and objections from practically every stakeholder involved as the plans remain very short of detail on the likely costs and practicalities, so it’s not yet possible to give a fair and reasonable opinion – watch this space.

Another dark storm cloud to watch
out for is a planned Scottish Workplace Parking Levy (similar to that operated in Nottingham for several years) largely courtesy of the Green Party which is currently in coalition government with the SNP. NHS and hospice premises will apparently be exempt, but not it seems care homes – another sad example of NHS first and social care second.

Bed-blocking is a UK-wide problem affecting our sector and the Scottish government recently announced £8 million extra funding for NHS Scotland to directly fund hospital discharges to care homes or for home care packages – a good start but much more will be needed to make a real impact in this vital and problematic area for both NHS Scotland and Scottish social care.

In conclusion
As an avid Scottish rugby union supporter, I am ever the optimist and am generally a glass half-full person about most things in life, including the future of our great social care sector and the amazing staff that work tirelessly round the clock at the front line caring for their ‘second families’, so it isn’t all bad. And to end on a positive note – at Renaissance Care where we currently operate 16 care homes throughout Scotland with close to 1,200 staff, our number one priority continues to be the health, safety and wellbeing of all the vulnerable elderly in our care, as well as of all our incredible hard working and dedicated staff – truly our greatest asset.