Unmet needs continue to grow
Audit Scotland has issued a draft of its annual audit on Cùram Is Slàinte nan Eilean Siar, the Western Isles Integrated Joint Board (IJB). The Report details an underspend of £8.7 million in 2021/22 across health and social care services.
In his report, the Auditor said: “Service underspends continue to arise primarily from vacancies that have not been filled, particularly to higher grade posts in Community Nursing and Allied Health Professionals, and other staff vacancies in Mental Health and Home Care & Reablement.”
At its December meeting, the IJB published an overview of ‘unmet need’, which stated that 84 people had been identified as needing or requesting a social care assessment but had not yet been assessed. A further 103 people had been assessed as requiring social care, but had not received it as there was no provider in place. The IJB says the service delays account for a total of 781 hours of unmet need across the Western Isles.
The Unmet Needs Update report stated: “Regarding the increasing demand for services the Health and Social Care Partnership has been awarded a recurring sum of monies from Scottish Government under the heading of winter pressures (alongside all Partnerships in Scotland). The funding is aimed at improving the current system challenges as evidenced in unmet need alongside other performance indicators. Locally, an investment plan has been developed (as previously approved by the Integrated Joint Board). The plan outlines a key area of service development, notably the expansion of the START service.
“The planned expansion START service will provide geographical cover for the whole of Rural Lewis as well as continuing to provide a service in Stornoway/Broadbay and in doing so reduce the length of hospital stay and number of delayed discharges and unmet care needs.
“The investment is in the order of £477,000.”
Concerns raised as waiting lists for care and support grow
The extent of unmet care needs has been set out in shocking detail in a set of reports put to the Integrated Joint Board for health and social care in June.
The reports reveal growing pressures in social care delivery, with 109 people seeking support still waiting for an initial assessment of their care needs, 11 of whom are in hospital waiting to be discharged, and a further 122 overdue a statutory review of their needs.
The number of people who have been assessed as needing care but have no delivery in place is 58.
These shortfall figures account for 477 hours of undelivered care each week, down from a peak of 731 hours per week in March. The report recognises that the figure for undelivered care would be considerably higher if it were to include those waiting to have their needs assessed: “Of particular concern is the hidden ‘need’ associated with those individuals requiring assessment. Until this gap is closed as a system we cannot truly understand the totality of unmet need.”
The figures come as a result of continuing resourcing issues in care, with 47 vacant posts within homecare and re-enablement alone, and a sickness absence rate well above the national average, running at up to 14.2% in some areas.
For those looking for support, the service shortfall can be catastrophic. Am Paipear spoke to one family carer who asked not to be named: “We are already at breaking point but have no option other than to carry on. Not having the care we need in place has left us depressed, exhausted and fearful for the future. We are desperate.”
Tagsa Uibhist delivers some of the allocated care hours through its dedicated care at home service. CEO Chris MacLullich explained the impact that the situation has on both his staff and clients:
“The staffing crisis in care is particularly acute in the islands where we face a desperate situation that is getting worse, month on month.
We have done what is in our power to recruit more staff; we have increased the rates of pay to well above the National Living Wage, increased our employer’s pension contribution to 5%, offered full time working hours, increased our mileage rate to £0.56, gained key worker status for incoming workers in partnership with the Hebridean Housing Partnership and we continue to offer training, and continuous professional development, from entry level to managerial level.”
“Our Managers are caught between a rock and a hard place – doing all that they can to respond to on-going and unmet needs for care whilst also trying to look after the wellbeing of our Care Assistants, who cover the length and breadth of Uist.”
“There is a real risk this crisis could deteriorate into a full blown emergency. In Tagsa and in other agencies such as the Western Isles Community Care Forum, we have huge concerns about the strain that unpaid carers are under with these levels of unmet need and waiting lists.”
The Disability Advocacy Collective (DAC), a campaigning support group for people needing care, has cautioned that shortfalls in service provision is having an impact on mental and physical health. Cathy Anne Dunn, Advocacy Western Isles Manager and DAC Facilitator, told Am Paipear: “DAC represents a number of people at the sharp end of the care crisis. Every undelivered hour of care means more pressure on family carers, who are already struggling. We know that care services are stretched and we recognise there is no quick fix, but we are heartened to have the support of Uist councillors, including Paul Steele, who pledged his commitment and support to DAC members when we met before the election.”
A Comhairle spokesperson said: “Health and Social Care is utilising the additional resources provided by Scottish Government to enhance frontline services. The first phase of increasing the social work team capacity is nearly complete and when all posts are operational this will assist in addressing the outstanding assessments. This has included an additional FTE post based in Uist and enhanced Team Leader capacity to support the frontline workers across the islands. The additional payments to care providers have been facilitated to enhance the renumeration of their workforces, supporting their endeavours to recruit and retain.”
“In addition, the Integration Joint Board has approved the development of new posts to support existing services. This was subject to a Report to the last meeting of the IJB. This investment will include services to supplement and extend the reach of existing services in relation to unscheduled care and hospital at home, as well as providing proactive support to sustain or retain independent living skills.”
Council candidates asked to consider care
The Western Isles Community Care Forum (WICCF), a registered charity representing Third Sector care providers across the Western Isles, has written to candidates to set out the financial pressures that local care groups are under.
The letter details an average 66% gap in funding, with some organisations receiving as little as 10% of their funds from the statutory bodies responsible for social care delivery in the Western Isles.
WICCF Chair, Morag Munro, said: “While members are grateful for the financial support they receive from the IJB, Comhairle and NHS, the gap between this support and their expenditure has increased dramatically over the years. This is due mainly to the fact that there has been no uplift to the amount received since 2013. In the meantime costs have increased and demand continues to increase due to our ageing population, more people being cared for in their own homes, an increase in the number of people with dementia, a reduction in the number of family carers and extended family and a lack of workforce in the care sector.
Organisations are finding it increasingly difficult to access funding to close the gap. We are very dependent on the generosity of our community, but they are also struggling. Funders are generally reluctant to fund core costs or services which they perceive to be the responsibility of statutory services and are often only interested in new initiatives.
Fundraising puts a great deal of pressure on organisations and involves staff in spending a large proportion of their time in trying to make ends meet – time which could be better used for the benefit of the vulnerable in our communities.”
Mrs Munro also raised the issue of funding cycles, highlighting the difficulty of forward planning when funding allocations are delivered on a year to year basis.
Another local group, the Disability Advocacy Collective (DAC), has invited candidates to a series of ‘zoom hustings’, to share their members’ concerns and to hear for themselves what prospective councillors have to say on cuts in social care service delivery, respite services and assisted transport.
The DAC is made up of the Speak Out Group (18 adults with a learning disability), Advocacy Western Isles, Autism Eilean Siar, Enable WI Branch, Harris Disability Access Panel, carers and service users. In its letter to candidates, the Collective highlighted the significant underspend in social care, stating: “In the last reporting period, there were 444 care hours undelivered every week as a result of carer shortfall, leaving desperate families across the WI without the full support they need.”
The IJB’s own meeting papers state: “…projected underspend of £217k in the homecare services. This is mostly due to the level of vacancies held, net underspend of £614k, offset by projected agency costs of £342k. The budget already assumed a £250k saving from vacancy so the underspend in staffing is actually £864k less the agency cost.”
Both groups have addressed their pleas direct to the candidates standing for office in the hope that if elected, they will prioritise the needs of the most vulnerable in our society.