The Care Reform (Scotland) Bill has been passed, but can it fix a broken system?
The Care Reform (Scotland) Bill was passed unanimously in Holyrood yesterday. The bill introduces changes to existing procurement law, including provisions to make it easier for the third sector to compete for contracts. There are provisions for ministers to produce guidance on ethical commissioning and for greater rights for workers in the sector. While it waits to be seen how this will work in practice, hard working staff in homelessness, one of the most overburdened parts of the sector, are clear about what needs to change.
Procurement
Local authorities have a duty to provide social care. Since the 1980s, this has mostly been outsourced to private companies and third sector organisations. A policy of competitive tendering for public services means councils become the buyer of the service from the care provider who submits a bid (also known as a tender) to the local authority, making their case for why they should be picked and how much it will cost.
If they win, they will have the contract for a period of time before it goes up for tendering, and they need to go through the process again, with the risk of losing to a rival provider.
A recent study of the voluntary sector’s experience of procurement found they believe that price still trumps service quality and outcomes for service users, and processes are often inefficient, not person-centred and risk averse.
“It feels like you’re fighting fire”
Jessica* is a community link worker in a building where homelessness, healthcare and social work services are provided in the same building on the Cowgate in Edinburgh. She loves her job, and her employer: “I absolutely love it. I love the fact that they are such a great organisation.”
The organisation she works for supports her person-centred approach, which means she can get an understanding of what her client needs: “As long as I’m doing something to help somebody in their journey then, and I can justify it then, and it’s legal, I can do absolutely anything, which is great.”
The flexible approach pays off. She says that they get stats back to assess the impact of the service, and community link workers in traditional GP services, who are confined to the office all day, have a higher rate of non-attendance than for her outreach service.
Although she loves her job, Jessica is frank about how hard it is: “There’s a lot of cuts unfortunately, so we’ve lost a lot of our services that people would refer to. It feels like you’re fighting fire.” She blames the competitive tendering processes, when things are working well, they end up getting cut to save costs: “You see it all the time, this is why I love my employer, because they have integrity, and they don’t just say, ‘oh, we’ll do that service’ to the Council just and then undercut everybody and give a really poor service. That’s what happens”.
“Unfortunately, they often go with the lowest bid. And there’s a reason why it’s the lowest bid, because they’re going to pay their staff less and cut the service. So, the potential is there, but with all the cuts, it’s just impossible to give the best service”.
Jessica has worked in homelessness for twenty years and she has seen this repeated again and again. One example she gave was with the Housing First service, the revolutionary service that received a lot of press and media attention, and has a strong evidence base of successfully ending homelessness in groups with severe addiction and mental health issues.
The service went up for tendering in 2021 and underwent cuts. She saw people who had been in a flat with Housing First support lose their tenancies: “It’s a drain on housing and the NHS again. You’re making a saving by picking a service that undercut everybody, but then there’s more attendance in A&E as these people are in crisis without the right support. So you’re not actually saving money as a city overall.”
“It costs less money to properly support people than to react to unsupported people”
Competitive tendering also has the effect of stopping frontline staff from speaking out, for fear of their service losing funding, which is why both interviewees have asked to remain anonymous.
Grace* has worked in homelessness in Dublin, Canada, Brighton and now in a Glasgow homeless hostel.
She is worried by a creep towards lower standards in care provision due to lack of funding in Glasgow: “I saw it deteriorate in Dublin where those things are really not well funded. And then I moved to Canada where it was the polar opposite.” Grace explained that Canada’s provision of social care is backed up by evidence that funding services properly leads to savings in the long run: “Systems in Canada, Finland and Scandinavia, they are all based on the idea that it costs less money to properly support people than it does to react to unsupported people in all ways. The science is there and it just doesn’t make sense that we’re not following it.”
Grace explains that the service she worked in Brighton deteriorated significantly after a large care provider undercut the service provider that had successfully provided a home for people with addiction and mental health problems for the past ten years and then pulled out, leaving the service without funding allocated: “It never fully recovered.”
Grace believes homelessness is one of the worst affected, as cuts to other services increase the likelihood of people becoming and staying homeless. Lack of support for mental health means clients are inappropriately placed in homeless hostels when “they need support with their medications, remembering appointments and meeting their therapeutic needs… They seem to have just been dumped there for being too much trouble. That impacts everybody within the service, not alone themselves.”
Sarah*, a council worker who refers cases into the services echoes Grace’s sentiment, that homelessness is increasingly becoming a catch-all category for people whose needs aren’t met by services that would be more suitable, particularly for clients with high support needs involved in offending behaviour: “Due to the level of risk linked to the offending behaviour, accessing appropriate supported accommodation providers via mental health or learning disability commissioning services can be challenging. This often results in homelessness services having to take responsibility for sourcing suitable permanent accommodation for clients with complex needs.”
Grace is clear that more funding is needed to address the issues: “They’re set up to fail in so many ways. And it’s just so not right. I say these things are an easy fix because it’s obvious what the fix is.”
*Not their real name.
