New arms-length company to deliver care in Edinburgh

Care services would be delivered by an arms-length company under the plans
Care services would be delivered by an arms-length company under the plans
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ELDERLY, ill and infirm residents will be forced to buy their own bath seats under plans which include the creation of an arms-length trading company to deliver care across the Capital.

The new organisation would be run along the lines of Edinburgh Leisure, the body which manages public sports centres.

Care leaders have also pointed to Cordia – the arms-length Glasgow City Council company tasked with providing home care – as a possible model for how services could be delivered here.

They said the company would allow them to move away from signing “numerous” contracts and agreements with private firms, adding that these often collapse when directors decide they can no longer make them pay.

Core services which could be provided through the new set-up include home and day care, and occupational 

Union bosses said proposals to make individuals with “low or moderate level need” buy equipment such as bathing seats and boards had sparked acute worry. And there are fears this could be extended to items such as walking frames.

The proposals are among a raft of measures contained in the city’s updated budget plan, which is aimed at helping council leaders secure at least £147 million in savings over the next four years.

They also come after it was announced last year that home care in the Capital would be restricted only to those with a “critical” or “substantial” level of need in a bid to plug a 
multi-million pound black hole. “Telecare” devices, such as personal alarms and remote health monitoring equipment, will increasingly be used in an effort to fill gaps.

It is hoped creating a health and social care trading company will reduce spending by £1.5m in 2017-18, with changes to equipment provision saving a further £125,000 over the coming financial year.

Councillor Ricky Henderson, Edinburgh’s health and social care leader, said establishing the arms-length company was aimed at ensuring “consistent and stable” standards of care.

He said: “At the moment, we have numerous contracts with numerous different private sector providers.

“In some cases, providing the service becomes unviable for them and they just pack up overnight and walk away.

“The council is left to put together packages that have been more or less abandoned. You can have a lot more chopping and changing of care workers, which is partly symptomatic of the fact recruiters have difficulty recruiting and retaining staff.

“My colleagues think there’s room in the market for a public sector provider, that’s not necessarily part of a council department, and which would provide the foundation for some of the those services.

“A trading company would be able to offer terms and conditions that would be attractive to staff. Because there would be a commitment to the city, there would be a longer-term future and a stability for those who are looking for the service.”

Cllr Henderson said the role of private companies and voluntary groups was likely to be limited.

“We are very early in the thinking about how it would work,” he added. “There are a number of different models we could follow. Glasgow has a standalone company that’s wholly owned by the council and they deliver a lot of social care, and other, services.

“Personally, I doubt whether our system would include voluntary sector and community organisations. They’re better placed to do their own thing under their own arrangements. I doubt whether the private sector companies would want to be part of it.

“I would see it more like Edinburgh Leisure. The council owns all of the assets but Edinburgh Leisure does the management, which includes people with different areas of expertise and council members. You could see how a care organisation would operate on that basis.”

Amid growing staff concern over how accountable an arms-length organisation would be, Cllr Henderson said every effort would be made to ensure the new system is 
as accessible and open as 

“There are absolutely legitimate concerns around transparency and I think we would have to address those,” he said. “Standards of service in the care sector are governed by very clear criteria and by the Care Inspectorate. The minimum standards are enforceable and scrutinised.”

Figures unveiled recently show that 95 people in Edinburgh died last year while waiting for the council to provide them with a care package.

Campaigners, unions and care companies all said extra cash was urgently needed to tackle a “cruel crisis”.

The figures also showed there were 400 people in the Capital waiting for care, nearly 4000 hours of unmet demand and one person who had to wait nearly two years for a package.

Unison bosses have criticised the council’s updated budget proposals and said they could end up costing more than they save.

A spokeswoman for Unison said arms-length organisations had been tried elsewhere in the UK for delivering health and social care, and had failed.

“The business plans are often not realistic, they will have set-up costs, their borrowing costs are higher than those for local authorities, they will be liable for VAT and state-aid restrictions,” she said. “All these things would need to be looked at.

“There is also an issue about accountability. If members of the public are not happy with the service from health and social care they can go to a councillor, who can speak to the relevant officers and managers and try to agree a way forward. How much influence would councillors have over an arms-length company?”

The spokeswoman said making people pay for equipment could create a false economy because it increases the probability of incidents and injuries which would be more expensive to treat or address.

“If you give someone the right simple bits of equipment it could well stop them falling over, which prevents a hip fracture and therefore a hospital admission,” she added.

“People often need several pieces of equipment – even if they cost £10 that soon mounts up. Are they expected to pay for all that from their Income Support or Disability Living Allowance?”

Political leaders said the latest budget proposals were cause for concern.

Sarah Boyack, Lothian Labour MSP, said: “Edinburgh is facing a perfect storm of a rising number of residents and an older population, underfunding, additional cuts from the Scottish Government, and a high turnover in care staff.

“The Scottish Government has faced a real terms cut of one per cent this year but it has cut £500m from our local council budgets, a five per cent cut.

“There are already huge pressures on care services and we need more, better paid staff.

“In addition to our growing older population, I am aware that there are many people already acting as full-time carers for their loved ones who have physical or learning disabilities or long-term conditions who will also need more support over time.

“We also need to invest more in care services because people are stuck in hospital ready to leave but don’t have a care package in place to support them.

“That’s not just an additional cost to our already hard pressed NHS, its bad for people’s health.”

She added: “We also need to see investment in our care workers. They should be paid a living wage. Given the cost of living in Edinburgh that needs to happen as soon as possible.”