'It is apocalyptic': Scotland's entire care service faces collapse

The Herald Scotland

11 hours ago

The crisis could see swathes of the country's sick, disabled, elderly and mentally-ill left abandoned. It is, charities say, 'apocalyptic'.
There are warnings that vulnerable people will die, suicides will rise, families will be placed under intolerable burdens, and the health and social care sector will become unsustainable causing the NHS to buckle.
In total, 240 third sector organisation have signed an open letter to First Minister John Swinney warning that 61% of charities providing health and social care support fear that they 'will no longer be a going concern within four years'.
(Image: Sara Redmond, Chief Officer of Development Health and Social Care Alliance Scotland. By Colin Mearns)
The letter is published exclusively in the Herald on Sunday today. Between them the signatories provide services for hundreds of thousands of vulnerable Scottish people.
Charities are paid by the state, including local authorities, to provide care for elderly, sick and disabled people. Demand is now so high, and funds so tight due to cuts, that they can no longer make ends meet, they say.
The letter calls for 'immediate action to address the profound crisis threatening our sector', and says 'the well-being and rights of Scotland's people and the sustainability of the third sector and wider public services are at immediate risk'.
The charities warn that without them, the public sector cannot function. Claims by the Scottish government that it wants to improve social care 'cannot succeed if we are not here to help you deliver', signatories say.
They add: 'Our organisations face increasing levels of demand which simply cannot be met within available public funds. Services and support are facing severe funding cuts. Many organisations are scaling back services significantly; others are looking at the possibility of closure. The sector, and the people it supports, have been pushed to breaking point.'
A recent poll of 'not-for-profit providers' found that '67% said they were budgeting this year on the basis of reaching financial balance through reserves … Of these, 91% reported that they will no longer be a going concern within four years'.
The head of one charity said their organisation had a '65-70%' chance of closure within 'two years' unless the government intervenes.
The letter tells Swinney that '81% of charities and voluntary organisations face financial challenges that put essential services and support they deliver at risk … We are now at tipping point. Unless action is taken, the health and social care sector will be pushed over the edge of sustainability. The impact of this will be felt in communities across Scotland, including by some of our most marginalised individuals and families.'
Unless the government invests, 'the consequences of inaction will be felt in every community. It will increase crisis interventions, deepen inequalities, build pressures on the wider public sector and leave lasting scars on our country'.
The Herald on Sunday spoke to 12 chief executives of major charities, plus the heads of the two main umbrella organisations representing third sector groups in the health and social care sector: the Coalition of Care and Support Providers (CCPS), and the Health and Social Care Alliance Scotland (known as the Alliance).
(Image: Rachel Cackett is chief executive of the Coalition of Care and Support Providers in Scotland)
Between them, CCPS and the Alliance represent the bulk of Scottish health and social care charities providing services to people in need of care.
The signatories to the open letter - organised by CCPS and the Alliance - range from relatively small community organisations to charities running major care homes.
INSTITUTIONS
Angela Bonomy is chief executive of Sense Scotland, which provides care for people with complex disabilities. She fears the crisis in the care sector will lead to the return of disabled people being put in institutions run by local authorities.
(Image: Angela Bonomy) 'The people we support would typically have been locked up in institutions in the 1980s,' she says. 'Many of the people we support are those who were released from that institutional care. My worry is that's where we're going to end up again.'
Bonomy added: 'We currently support people on a shoestring.' If local authorities had to take over their care directly 'it would cost so much more than what they currently give us, because they don't give us enough.'
The government needs to 'respect' the third sector. 'You don't feel valued, you don't feel a partner, you don't feel understood or respected. I think [the government] genuinely thinks we make cups of tea for people. Actually, the complexity that my staff deal with, and their responsibility, is off the scale.'
Care staff, she explains, earn £12.60 hourly, paid for by state contracts. Bonomy adds: 'And we're supposed to tug our forelock and thank local authorities for the crumbs from the table.'
She called the process 'absolutely ludicrous'. Bonomy says hikes to national insurance by the UK government mean additional staff costs of £750,000 annually. 'It's existential. I can't put up a price. I don't have a price to put up.'
She added: 'The majority of the people we support haven't got families around them. We're their family.' Without organisations like Sense Scotland 'they are left to languish, and therefore die'.
Charities providing essential care are 'victims' of 'poor decisions' by the state because of 'the lack of understanding, and the lack of value, for what we do. If we stop doing what we're doing, I don't know where these people go because the majority don't have families, spouses or carers, they've only got us'.
Like all charity heads, she worries for her organisation's future. 'People think we're staffed by volunteers, we're not. I've got 1068 staff.' If her charity closed 'they wouldn't be contributing to the economy'. The crisis in the sector means 'human costs' for both staff and the people they support.
SCHIZOPHRENIA
Jim Hume is director of policy with Change Mental Health, originally known as the National Schizophrenic Fellowship. It supports 11,000 people across Scotland.
Hume is frustrated by the fact that the Scottish government says it wants 'early intervention and prevention' whilst public bodies responsible for health and social care 'are looking at cuts' and 'blind to early intervention and prevention'.
(Image: Jim Hume) 'Where will people go?' Hume asks. The only real alternative is into hospitals, but hospitals are 'struggling for mental health beds'.
He adds: 'That leaves people in crisis point. We support people with suicidal ideation daily. You can see the implications of that. People with mental illness average lives 20 years less than others and need support.
'There's a risk of people not being supported when they have suicidal ideation. That obviously can have drastic consequences … We're going to very quickly see people either facing suicidal ideation and the consequences of that, or ending up in hospitals where there's no room for them, or being isolated and separating themselves from society and becoming lost to society.'
He notes that academic studies show that for every £1 spent on prevention £7 is saved. Yet cuts to just one mental heath project now mean 'more than 4000 people in Edinburgh not having support'. Hume adds: 'Something is drastically wrong.'
Ewan Aitken is CEO of Cyrenians, the homeless prevention service. Unless the government changes tack, his vision of the future is this: 'People will get sicker and sicker. Eventually not just we will disappear, but state services will crumble.
'Because so much of what we do stops things getting worse before crisis happens - those crises will happen more often. There will be increased pressure on state services. State services across the board will be overwhelmed and unable to manage.'
(Image: Ewan Aitken) He adds: 'I hate taking an apocalyptic approach, but recent times suggest we're much closer to that set of circumstances than we've been for a long, long time.'
Charities which provide care are on short-term state contracts which make planning for financial stability very difficult. 'Give us long-term contracts,' says Aitken. 'Why can they sign ten-year contracts with IT firms, but only give us a year on the basis that somehow they don't have money for us, but they do for them?'
To make ends meet, Cyrenians reduced staff by 'about 15%. That means a whole bunch of people won't get support'.
Aitken gave an example of 'what happens to individuals when things go bad': a lunch club for elderly people was being attended by a woman who began showing signs of dementia. Staff 'couldn't cope' and alerted 'statutory services. But they kept saying 'we can't deal with it'.' Staff were asked to 'keep going'.
Eventually, staff had to take the drastic step of banning the woman in order to force the 'the local health service' to act. 'It was awful, they felt crap about it, but it was the only way to get the services to step up.'
CHURCH
Viv Dickenson runs Cross Reach, the Church of Scotland's social care arm. It supports children in care, children affected by disability and poverty, as well as services for homelessness, learning disabilities, mental health and recovery programmes. It also runs residential care homes for the elderly.
(Image: Viv Dickenson) Dickenson says the Scottish government 'needs to stop passing the buck because all we hear is it's either the UK government's fault or local government's fault. Somebody needs to take accountability for the situation we're in because this is about all our lives, not other people'.
Everyone, she stresses, may need care at some stage in their lives, or have loved ones who need care. 'If social care crumbles we cannot live life to the full.'
She says the sector has been an 'absolute shambles' since the Scottish government scrapped the National Care Bill. 'There's no Plan B. They need to understand the risks.'
She adds: 'Like everyone else, we've had to make cuts in services.' Preventative work has 'been hit really hard'. Around 1000 people in Kilmarnock alone 'have been affected because of cuts to mental health services'. Her organisation now uses fundraising to keep those services going rather local authority money.
Other services affected include projects linked to criminal justice, dementia, children affected by parental drug and alcohol abuse, and daycare.
'These are cuts that have come through grants being cut and local authorities trying to make savings. They might be making financial savings, but there are real human costs.'
She says that the government will try to claim it has invested in the sector because of the rise in earnings for third sector care staff - contracted by the state - due to the real living wage.
'So while we might be seeing cuts to services all over the place, the government will be able to say they've invested in the sector,' Dickenson says.
She notes that most care workers are women. So fundamentally all the government is doing, she says, 'is recognising women deserve a living wage'.
Dickenson adds: 'We've got a perfect storm happening, where the government will say 'we're investing' yet those of us trying to deliver on the frontline just see cuts and lives destroyed every day.'
AUSTISM
Dorry McLaughlin runs Scottish Austism. It provides support to about 10,000 autistic people or their carers throughout Scotland.
'If I had one request of government it's 'be brave',' she says. 'You can't fix the NHS unless you fix social care. Invest in prevention because crisis intervention costs much more.'
(Image: Dorry McLaughlin)
Her next national insurance bill is an additional £1million. Cash reserves are keeping the charity going. 'We provide services that aren't funded by anybody at the moment. Some of the preventative services we provide we fund ourselves. They will stop if we don't get that bill paid.'
Janet Haugh is CEO of the charity Right There, which works to keep families facing homelessness together. It runs 500 properties in Glasgow and offers temporary accommodation. It works with 3000 people annually.
She fears for her organisation's future. The word 'charity' troubles her as it has 'fluffy connotations'. Many members of the public think of charities as small groups of volunteers shaking collection tins in the street for good causes.
(Image: Janet Haugh) That's not what health and social care third sector organisations do. 'We're a national charity, supporting thousands of people,' Haugh says.
Organisations like Haugh's are doing essential work 'because of poor state services'. Yet grant funding 'has all gone'.
Local authority funding was so low that in some cases Right There had to 'hand back accommodation-based services we delivered. We couldn't afford them. We were running at a deficit for years. We had to dig into reserves. That's not sustainable'.
She added that the crisis 'is going to result in deaths, in people dying. Today, an example would be: I received an email where a young person was going to [complete suicide]. We prevented that'. In other words, if her charity wasn't there, 'that young person is likely to [complete suicide]'.
MORALITY
Sam Smith, CEO of C-Change Scotland, which works with people with additional support needs, said government behaviour 'makes no economic sense, let alone the morality of it'. Without charities providing health and social care, the public would have to rely on the NHS, at greater taxpayer cost.
Smith adds: 'If we only look at the economic cost, we miss the moral cost of the damage we're doing to our fellow citizens.'
(Image: Sam Smith) In terms of what the government says and what it does, 'words aren't being met with actions … the words are good, but the reality is not. At the moment, it feels more expensive to do the wrong thing'.
Any return to 'institutional care', Smith adds, 'isn't safe. We know institutions aren't safe for people. Look at the historic child abuse inquiry. These vulnerable people are our neighbours, sisters, brothers, parents - they're us'.
Good social care creates 'a web of connections and relationships which sustain us. It's to our shame that we'll only understand that when it falls over'.
Social care isn't just about helping the sick or disabled. It means their families are able to work 'because their loved ones are receiving support'.
Jenny Miller runs PAMIS, which works with children and adults with profound learning disabilities. She mocks claims by the government that 'we're all in it together'.
(Image: Jenny Miller) Miller adds: 'We're at the stage where family and carers - who aren't the ones disabled, but are being disabled by the lack of services - will end up taking their own lives because they're so desperate … There's nowhere else for them to go.'
She accused the public sector of 'gaslighting families'. She said mothers are being told they have to exhaust themselves 'before we'll give you any help. Why can't we just be honest and say this is wrong … The system is utterly broken in some areas'.
Like all the charity heads, she fears for the health and wellbeing of those who depend on her services if the government continues on the current trajectory.
Naini Mihas, director of Networking Key Services, which represents carers, says her organisation risks 'disappearing because of our funding'. She suffered a '100% cut from the council'.
(Image: Naini Mihas) The charity once received £100,000 in 'core funding' from the state. 'It's all gone.' She now depends on other sources of income like the lottery. 'We nearly closed down,' Mihas adds.
The collapse of social care charities will 'disadvantage the whole of society', she says.
SUICIDE
Mark Hoolihan is CEO of the Thistle Foundation, which supports thousands of people with disabilities and long-term health conditions. Many of the people they support are 'unable to work, their relationships break down, they lose friendships and social connections, some become housebound, some have suicidal ideation'.
(Image: Mark Hoolahan) He says: 'We need to see social care as an investment, rather than cutting social care.' Only investment will 'reduce the reliance on services that cost more money', like the NHS.
One of their contracts was cut by 25%. 'That's 300 people we wont be able to see in one geographic area.' They will have to turn to the NHS. 'The quality of their life will be diminished.'
Shubhanna Hussain is from the Coalition of Carers, which represents unpaid carers and local care centres. There are 700,000 carers in Scotland.
The state assumes, she says, that if 'services are reduced or stopped that family members will step in'. The result is that unpaid carers - mostly women - 'give up work'.
(Image: Shubhanna Hussain)
The situation, Hussain says, 'is already catastrophic. The largest level of care is delivered by women aged 45 and over. They provide almost 50 hours of care a week to their loved ones'.
She adds: 'Over the last six months, I've heard numerous carers say they've thought about ending their lives. I've never experienced this level of despair.'
Roseann Logan, is director of the Community Links Worker Programme, which helps people facing poverty, loneliness, debt, abuse and housing problems. Her organisation helped 12,000 people last year.
One service lost 40% of state funding, leading to staff being cut in half. That caused 'an almost 50% reduction in the number of patients we'll see', Logan added. People are now waiting for two years for 'statutory trauma-related services. Where do they go? There's no other support. Many third sector organisation are closing their doors because of funding'.
(Image: Roseann Logan) One third-sector organisation in Glasgow providing trauma services 'had to close their doors as their funding stopped. We're being sent more and more emails from organisations saying that from such-and-such a date they'll not be able to receive any more referrals … It's devastating to see people's lives destroyed.'
ALZHEIMERS
Rachel Cackett is chief executive of the Coalition of Care and Support Providers in Scotland, an umbrella organisation which represents 85 not-for-profit organisations, the majority of which are charities providing social care.
They include Quarriers, Bernardo's, Alzheimer Scotland, the British Red Cross and The Salvation Army. Her members mostly receive 'public funds to deliver core public services'.
Cackett says her members are the 'cornerstone' of care in Scotland. 'If they're not stable, or sustainable, then the support people get will disappear.'
Annually, one-in-25 Scots and their families depend on social care, she explains. 'It's about giving people what they need to lead their best life daily. The level of cash coming in is woefully inadequate for the demand.'
People who need care and their families are currently 'being hit from all sides'. Often those in need of care require help with everything from going to the bathroom to walking.
'It could be any of us,' Cackett says. Social care isn't simply about 'putting mum in a care home', she explains. It can range from supporting teenagers with mental health problems to adults with learning difficulties, or helping people leave hospital so they're not stuck in 'really expensive acute wards'.
Social care is a 'Cinderella service', she says. Cackett adds wryly that she's waiting for 'Prince Charming'.
Even before the increase to national insurance, charities were 'working at the knife edge of what's possible'. The hike created a '£30million black hole which charities had no means to pay'.
She adds: 'Aldi has just announced their basic pay is £13. You can get 40p an hour more working in Aldi than in our sector doing crucial work to enable people to live a good life. What's happened to the social contract in Scotland that we think that's okay? Why aren't people more angry? It's a scandal.'
Most work is through public sector contracts, she explains, with rates set by government. 'There's no headroom, there's nothing left. Most of our providers are making public sector contracts work by eating up their reserves. You can only do that for so long.'
The big question for charity leaders now is 'can I maintain quality at this price? And too often the answer is no. We're increasingly seeing [providers] handing services back and saying to local government 'if you think you can deliver at that price go and do it, we cannot maintain quality'.'
Funding has been 'cut to the bone. You can't keep the quality of what you're delivering, and that's not safe for anyone. It's an absolute mess out there'.
Cackett adds: 'People who are the most in need are the most forgotten in terms of how the government - national and local - are spending cash. That will impact on families right across the country. It will impact on all of us. As a country we're not upholding the rights of people to live good lives. And that's not getting the political traction it should.'
An adequately funded sector would help the Scottish government achieve its aims, she says, by reducing hospital numbers and waiting list times. 'We work cost effectively, we do good return on investment.'
Some members warn 'of a return to much more institutionalised ways of thinking about care'. Decent funding, therefore, will ensure people aren't 'incarcerated far from home in unsuitable accommodation, but can live in the community. Instead, we're facing cuts. That's the real disjunction'.
Simply accessing support is 'becoming harder and harder'. For someone with dementia, the criteria for getting support is so high it's a fight 'to access anything at all. People are really struggling'. That means families must step in. None of this helps the economy, she says.
Cackett doesn't believe government claims that 'there's no money. Of course, there's money. The government makes choices about how to allocate money and it's repeatedly chosen not to allocate sufficiently here, and now we're seeing the fruits of that. They've a choice.'
Cackett says the government 'cannot fail' with social care as the risks are too great to society. 'We've reached a real crisis point. No-one can hide from where we're at. That's why we're writing to the First Minister.'
For families experiencing dementia, cuts can mean 'nobody is there for you. That's horrifying'. Some 57% of care providers have 'seriously considered handing back contracts'.
If the 61% of providers who fear closure within four years do fold, Cackett says, then 'we're talking about thousands of people's jobs'. It would also be 'catastrophic for communities and families to lose that level of service'.
Due to the 'scale of fragility in the sector', the state 'must step in'. She's 'perplexed' by the level of funding from the UK and Scottish government and councils.
'We're at a crunch point. They must put the money in the budget this year, because without it, we're not there and everything they say they want to happen can't happen because we wont be around at the same scale to help them deliver it.'
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CLOSURE
Sara Redmond runs the Health and Social Care Alliance Scotland, representing hundreds of organisations and more than 3500 members, including Chest Heart and Stroke Scotland, the British Heart Foundation, Macmillan Cancer Support, Age Scotland, Carers Scotland and Cerebral Palsy Scotland.
She says 'demand is going up' while simultaneously 'services are having to close or not accept any new referrals because they just don't have the money to continue running them or the funding has been cut. They just can't afford to continue delivering what they've been delivering, let alone take into account growing demand. We have a huge problem with unmet needs'.
Increasingly, 'we're waiting until people are in crisis before we can actually respond'.
Redmond says of the government: 'The social contract isn't being upheld. People's health is worsening.' Care providers are being asked to 'deliver more with less'.
The time for 'warm words' from government is over, she adds. 'We must recognise the growing crisis.' Redmond says 'moral injury' is being done, and we need to consider 'the kind of society we're creating'.
As all of us may at some point need social care, 'you can't plan to protect yourself against this unless it's privately financing [care] from your own pocket. The majority of people can't afford that'.
Redmond adds that 'even organisations providing support for people affected by cancer' are starting to 'think about whether they can continue. We're at a point of crisis now. We need political leadership'.