Publication: A renewed focus on the sustainability of social care

At their best, social care services enable people to not just live the life they choose, but to thrive. The services provided by councils, private and third sector organisations, include personal and practical support, from help at home through to care homes and assisted living.

Social care services need to shift and adapt as our society changes too. In many communities people are now living longer but often that means living with increasingly complex health and care needs. The ageing population (sometimes called the demographic time bomb) and increasingly complex needs are all creating pressures on health and social care services.

These pressures have led to a crisis across our social care services. Service providers are struggling to deliver the help, support and quality of service people need.

Recruitment of care and support staff is an enormous challenge. Low pay, often long and demanding working hours make it difficult to recruit and retain staff. We know too that increasing costs are making it more challenging for many providers to continue to deliver services.

The Accounts Commission is keen to understand how the challenges social care providers face can be turned around, enabling those that need support to receive the best possible help. There must be sufficient time, staff and resource to look at the needs of individuals holistically and with a preventative focus.

There has been a lot of discussion about the issues facing social care since the review by Derek Feeley of adult social care, published in February 2021, and scrutiny of the National Care Service (Scotland) Bill (the Bill) has continued the public debate of the need for change in the sector. Quite rightly time needs to be taken over planning and implementing the scale of the changes proposed in the Bill but the sector simply cannot wait for the reform that this is intended to bring. Action is needed now to ensure the sustainability of the sector and improve the availability and quality of social care services.

Focus must also be given to the specific local pressures seen across different areas of Scotland, in particular our rural and island communities. An ageing population, coupled with depopulation and the significantly increasing costs of delivering services in these communities is of real concern.

Audit and reporting on social care

The Accounts Commission want to support improvement in the sector. That's why we’re making changes to how we report on social care issues.

We will continue to undertake detailed audits where we identify a specific issue that needs focused work, such as our current joint audit with the Auditor General for Scotland on the misuse of drugs and alcohol. We will produce national reports on these audits as well as briefings and blogs on other community health and social care issues that the Accounts Commission feels it is important to comment on publicly.

We’re developing how we report on Integration Joint Boards (IJBs). IJBs are currently responsible for planning and commissioning social care services, as well as primary and community health care in local areas.

We plan to develop our yearly bulletin focused on the financial position of IJBs into an annual report that also comments on how effectively IJBs are performing and responding to the challenges in the community health and social care sector. This will include a ‘spotlight’ on a specific topic each year. The first of these will be on the commissioning and procurement of social care services. It’s a really important factor for the sustainability of third sector and private providers of services, the capacity and wellbeing of the workforce and the availability and quality of the services people need. The first of these new reports will be published in Summer 2024.

Supporting this report, we will also host a stakeholder event, where we will discuss with and hear from those involved in social care about the challenges, risks and opportunities for the sector. Importantly, we also want to discuss these issues with people with lived experience of the services and reflect this in our work.

Together with my colleague, Malcolm Bell, I will be working closely with the Audit Scotland team developing the IJB report, as the Accounts Commission sponsors for this work. It is an exciting and important piece of work that will contribute to the conversations about reform and the difficult decisions ahead for the sector.

Feedback

We’re always interested in hearing your thoughts on the work we plan to do. If there are areas of social care, or the primary and community health responsibilities of IJBs that you think we should be considering as part of our ongoing programme of work please email the team at: socialcaresustainability@audit-scotland.gov.uk.