A SENIOR councillor who oversees care in the Capital has admitted that the city is being failed by contractors and admitted he’d be “frantic” if his elderly mother was stuck in hospital.
In an open and frank discussion, Ricky Henderson, chairman of the Edinburgh Integrated Joint Board (EIJB), told the Evening News he understood the toll the social care crisis is having on loved ones and their families.
He outlined the measures the board – made up of council and NHS Lothian representatives – plan to take to deal with the situation, despite a proposed £3 million worth of savings due to be made in the care budget for 2018-19.
In their most recent papers the EIJB admits that Edinburgh ‘regularly has the highest number of delayed discharges [from hospital] of any Integration Authority in Scotland’ with local contracted providers reporting high turnover rates of care staff in the region of 30 to 50 per cent in some instances.
The Capital is in the midst of a care crisis with, according to the latest figures available, 1,836 people still waiting to be assessed for provision, including 700 who have not yet received care packages and 169 people delayed in hospital.
Mr Henderson said: “I think the situation is challenging, we are in a difficult place.
“We know that our performance is not good enough and at the end of the day we will be judged on the numbers and the graphs and the trajectory of whether we’re meeting targets.
“Every single statistic is a person and usually an elderly frail person who needs a bit of care and support.
“Personalise it for a moment, my mother is 89, she’ll be 90 next year – now if she was stuck in hospital and couldn’t get a care package I’d be frantic about that. So, I understand how every family must feel about that and that’s what we need to focus on.”
A scathing Care Inspectorate investigation last May into the quality of care provision found five out of nine factors of care that were rated “unsatisfactory” or “weak” while the projected deficit for health and social care costs rose to £9 million in September. Although Mr Henderson said health and social care in the city was “not performing well” he was at pains to stress the good work that is being done by staff but often gets overlooked.
He said: “There’s a lot of good work gets done, a lot of people working really, really, hard and doing some great stuff which sometimes gets forgotten about – but we’re not performing well. People are in hospital for too long after they’ve been told to go home. There are people waiting in the community for services for far too long. There are people waiting in the community for assessments for far too long and these are areas that we’ve got to improve.”
He spoke about the problems with private contractors not being able to fulfil the contract they signed up to and feels the marriage of public sector and providers from the private sector is not working.
The current contracts with 12 private care providers have been in force since around April 2016.
He said: “They are contracted providers, we have a legal contract with them and they have a legal contract with us and currently they’re not providing what we need them to provide.
“I don’t think it’s working in the way that we need it to work.
“We had the same issues with the previous contract and the contract was refreshed and the payment rate was increased. I think it went from £16 per hour to £16.50 per hour if they’re reaching certain targets, so that was a step forward in terms of the pay rate. For council [care per hour] I think it works out as roughly double.”
The failure of the contracted providers to deliver on their promise means the EIJB often have to look elsewhere for care provision.
He added: “There are still parts of the city where we simply can’t provide a package of care. It’s not a case of these big bad private companies not bothering their backsides.
“I think they would dearly love to be able to fulfil the terms of the contract and deliver on everything they’ve committed to but they’re coming up against a number of challenges.
“What we do is if we’ve gone through the providers in that area and they’re not able to source a package of care we then go to what we call the ‘off contract’ providers. So, that’s a whole bunch of other people who are not signed up to the contract as they weren’t prepared to accept the terms, but they will provide a care package at a higher rate.”
Recruitment into health and social care is an acute problem in the Capital with competition from retail, tourism and call centres.
Mr Henderson said: “It is a fact that you can be paid just as much for stacking shelves in Tesco as you will be for providing intimate care for elderly frail people and all the responsibility that goes with that and that’s not everybody’s cup of tea – that’s not what everybody wants to do. The difference of 50p an hour on your pay rate means that people who work in that end of the economy will quite rightly make decisions based on that if it means taking home more money at the end of the week.”
He added: “Recruitment and retention of staff within the contracted providers is a problem.
“A number of years ago there was a split 50 per cent of domiciliary care services where delivered by council staff and half were contracted out to the external providers.
“I think the council administration between 2007-2012 changed that proportion from 50/50 to 75/25, so 25% is internal in the council.
“So the staff are better paid, they have better terms and conditions and they tend to be more experienced. The turnover in council staff is much lower than in the private sector.
“But it costs twice as much – I wouldn’t say I support the decision as it’s left us in a difficult place but they took the decision to contract out more of the service in order to get more for their money.”
Mr Henderson believes a number of things need to be done to solve the problems in care but admits that there is no “magic solution” which will make thing better overnight.
He added: “One of the recommendations that come out of the Care Inspectorate report was to have a workforce development strategy – so that is being worked on.
“There will be a whole range of things, there won’t be a magic solution – there isn’t a magic solution to any of this to be honest.
“Anybody who comes along and says you’re doing it wrong, if you did it this way it would be sorted is talking nonsense.”