Why social care outcomes in Scotland depend on LUCK!
The nature of people’s relationships with their social workers in Scotland is a topic which animates our subscribers. People should be able to expect these relationships to be positive and productive. But, increasingly over the years, the poor social care outcomes being delivered by social workers in Scotland have led people in desperate need of care to realise that social workers cannot be presumed to be on their side. And, never were, they find when piecing together and making sense of the delays, the unanswered questions, the unexplained pieces of what turned out to be grotesquely-bad advice. So profound are the mental health and financial impacts of this realisation that people are left unable to move on with their lives.
Our subscribers describe not sleeping since the day they discovered the awful truth that they were targeted at their time of greatest need by duplicitous local authority staff who had set out to gain their trust only to deceive them. They tell us of social workers bent on creating divisions within families. That nothing makes sense any more. That they have lost faith in Scotland’s social care system and no longer know whom they can trust. All made exponentially worse when they are told, in effect, by the attack-dogs employed by Council chief executives for the purpose, “You got what you deserved!”
People needing care in Scotland end up having to fight for their statutory rights when it becomes clear that the system doesn’t work – if they have the strength or appetite for a fight, that is! Many just give up. For the local authority, this is ‘job done’! They know that people do not challenge authority. That it wouldn’t even occur to people, who are no longer fully self-reliant and need care and support, to question their social worker in any regard, let alone about their motivation. Typically, therefore, realisation dawns only when it is too late for many.
But, there are some simple and straightforward things you can do. Things your social worker would do for you, as a matter of routine, if Scotland had a functioning social care system. In essence, this means keeping a record of everything and emailing your social worker with your understanding of what was discussed or agreed and asking for clarification of things about which you are unclear.
Your emails are unlikely to be acknowledged, since social care bosses in Scotland know that maintaining faithful records would leave them exposed when things go wrong, but don’t let the Council’s poor practices dissuade you. Treat the emails you send as insurance against the risk of the Council’s chief executive silencing you if things go wrong.
Facing the odds-on prospect of a poor social care outcome, according to the findings of the 2021 Report of the Independent Review of Adult Social Care in Scotland you have nothing to lose! You might even get your social worker on your side. A long shot, but worth a try!
So, why would Scotland’s social workers ever not be on your side?
We hear from social workers themselves.
Few of us would doubt that those who enter the social work profession in Scotland do so, in the main, in anticipation of being able to make a positive difference to people’s lives despite the demands and challenges they expect to face. This is a laudable ambition.
Scotland’s universities claim that their social work degree courses will prepare you for the challenging and rewarding role of social worker. But, the high attrition rate of social work staff, specifically those in their first six years in the profession, tell a different story: that this is not the reality, that something has gone wrong!
Information from a sub-sample of our subscribers – former social workers who chose to leave the profession or have retired, together with those still in-post – attribute the unsustainably-high staff turnover rates to the toxic work cultures which pervade Scotland’s social care system.
They tell us that disillusionment sets in within the first few weeks for new recruits who find their every move monitored by “psychopathic” line managers, “drunk on power”, who put their own self-interest ahead of the delivery of care by willingly accommodating management teams and social care bosses whose incentive is to save the local authority as much as possible which, translated, means paying as little as possible for care … driving down the quality of care for everyone in the process.
Feeling unsupported by their trade unions, those who bring their careers to a premature end do so fearing for the long-term ill effects on their mental health of bullying by co-workers, knowing that local authority whistleblower policies provide no safeguards against retaliation, having witnessed, first-hand, how ordinary members of the public are treated when they reach out to the Council with justifiable concerns about social care delivery or provision. These are the people best-placed to monitor and, therefore, to be aware of issues in social care. Who are, in effect, blowing the whistle. But, who, for alerting the Council chief executive or Head of Social Care to operational and governance problems find themselves stonewalled, silenced, ridiculed, blamed, threatened by the chief executive’s attack dogs – some wearing badges bearing the words “democratic” and “governance”. Even punished, by having care removed.
Perhaps, we should remind you that we are talking here of modern Scotland! Not, some Evelyn Waugh dark comedy!
Those who manage to bash on, despite the bullying, are troubled knowing that the generous pension they accrue is funded by the likes of the very people whose care they are required to delay or deny. The Department for Work and Pensions calculates that, in 2021, the average public sector employee had £7,370 paid into their pension compared with £2,110 paid into the average private sector pension.
All agree that stress is caused, primarily, by social care bosses requiring them to deprive people of the social care they need and not the workload itself. Female social workers say they feel degraded by male bosses, without social work qualifications, who occupy policy and leadership roles and expect the female ‘foot soldiers’ to empathise with the people needing social care in order to better exploit them. A vicious circle of state-enabled abuse.
One of our subscribers describes how the awful truth of what she had become dawned on the day that a vulnerable elderly gent, expressing a preference for a female social worker, was allocated to her but that her job was to find out what he was worth. Her advice to social workers in Scotland today is to take a long hard look at yourself every morning and question what you are doing and why!
It is no surprise that the level of discontent in the profession and drop-out rates are so high. Or, why BetterCareScotland’s subscribers describe feeling like imposters and confidence tricksters rather than social workers. Of being social workers in name only when the role involves processing people in ways that will save the local authority money instead of making decisions that will support the welfare of people needing care.
Against this backdrop, BetterCareScotland’s subscribers advise that people in need of care should expect their social worker to lie to them, to delay care assessments for as long as possible, to backtrack on assurances they’ve given, to fail to involve them in decisions and, instead, present, as ‘faits accomplis’, care plans that will not meet their needs, to provide conflicting advice, to present themselves as legal experts in order to intimidate, to create rifts between family members, to override people’s express wishes, to fail to put anything in writing, to advise family members to apply for the carer’s allowance as an alternative to statutory free personal care – the list is endless – enabling the local authority to find no evidence in support of complaints when people reach out.
THREE TIMES WHEN YOUR SOCIAL WORKER WAS NOT ON YOUR SIDE
Feedback from our subscribers reveals that there are many commonly encountered situations where the social care policies of a local authority, with incentives that are not aligned with the interests of people needing care, create moral dilemmas for social workers.
Social workers in Scotland should be incentivised only to act in the best interests of the service user but, by design, as the three cases we outline here illustrate, are persuaded to act in their own self interest.
Here, we outline just three times when your social worker was not on your side. In each case, click on the heading to EXPOSE THE PERVERSE INCENTIVES AND MORAL DILEMMAS IN SOCIAL CARE POLICY. And the risks to which people are knowingly exposed by their social worker. Risks their local authority would prefer remained hidden.
CASE #1: WHEN YOUR SOCIAL WORKER IS UNDER THE NHS MICROSCOPE
You are in your mid-nineties and have been treated in hospital for a respiratory infection … hospital staff have assessed you as medically fit for discharge into the community but in need of long-term support with personal care … despite your age, there is no community care plan in place … hospital staff contact social services to arrange a discharge assessment … four weeks later, a community social worker is assigned who calls you and tells you, before meeting you, that you need 24 hour care which only a care home can provide … you wish to be cared for in the community but the social worker says the only option is residential care.
Many people in Scotland will identify with this case.
Hospital clinicians will not discharge vulnerable people unless it is safe to do so even if they are medically fit for discharge.
The hospital clinician who treated you spoke to your son and said you are well for your age and can return home but that you cannot be discharged until a Community Care Plan is in place and that hospital staff will inform social services.
The hospital’s self interest is perfectly-aligned with yours in order to minimise the risk of your readmission.
Hospital staff declared you medically fit for discharge. Your age alone would indicate entitlement to Free Personal Care and the ready delivery of a standard Community Care Plan. But it takes some local authorities an average of at least two months to process a Community Care Plan with funding in place for basic personal care.
Self Directed Support (SDS) would provide you with the funds to employ a carer and tailor your care to better meet your needs. But local authorities, for reasons of economy, are reluctant to deliver SDS even if resource constraints mean they cannot deliver a Community Care Plan.
In the circumstances, the social worker has no incentive to discuss these social care options with you and your son. The social worker is sensitive to being under the NHS microscope and the perception of NHS staff that your hospital discharge may be delayed by local authority inefficiency.
The social worker, therefore, tells you point-blank that you need 24 hour care in a residential home. If the social worker can persuade you, your discharge could be organised within days and the social worker saves face. You are determined to return home.
The social worker is incentivised to save money for the local authority rather than deliver the care plan that best meets your needs.
Key to the social worker’s incentive to act contrary to your wishes and best interests is that you own your home. This could be sold to cover residential care fees. In such circumstances, we find social workers will use whatever means necessary to persuade people to be discharged to a residential care home – for all the wrong reasons.
And will be incentivised to class your admission to the care home as a ‘private arrangement’ – even though the social worker brokered the deal – making you liable for the care home fees in full while saving the local authority over £800 each month in the Personal Care Allowance to which you would be entitled.
The most recent HM Land Registry House Price Index shows that the average price of a house in Scotland in Quarter 1, 2022 is £180,822.
Family members and friends of anyone living in their own home in Scotland today who may need social care should know that this is an amount your local authority wants to get its hands on. Any way it can! Even if it means violating your right to family life!
Your social worker holds a meeting with nursing staff at the hospital to determine your long-term care plan. Neither you nor your son are invited and find out about it by chance after the event.
We suggested to your son that he might voice his concerns that your right to respect for your family life under Article 8 of the Human Rights Act, 1998 would be compromised if the social worker should override your wish to return home as soon as a Community Care Plan can be delivered.
The social worker responds to this by agreeing to process SDS funding which your son believes would better meet your needs. You currently remain in hospital awaiting delivery of SDS so that you can return home.
When local authorities in Scotland deny people the care they need or deliver poor social care outcomes, they create the risk for the NHS of crisis hospital admissions and the associated risk of delayed discharge of people who are medically fit for discharge from hospital but who cannot be discharged until a Community Care Plan has been delivered.
BetterCareScotland finds that, when making discharge arrangements for people needing care and support in the community, NHS healthcare professionals expose the NHS to the operational risks of local authorities if they take on trust that social workers’ incentives are fully-aligned with theirs and patients’ when there are no safeguards in place on which to base such an assumption.
CASE #2: WHEN YOUR SOCIAL WORKER BECOMES A SOCIAL VISITOR
You are 87 years of age … since your husband’s death two years ago, you have suffered five mini strokes each of which required emergency hospital admission followed by a period of convalescence in an NHS unit … your most recent admission to hospital saw you there for eight weeks and, when hospital staff declared you medically fit for discharge to the rehabilitation unit, they assessed you as a falls risk, as physically weak and needing support with personal care, and contacted the local authority … you were discharged for a period of convalescence in the NHS facility … when you returned home, someone from social services rang and said that, until a social worker was allocated to your case, you would have to pay for any care you need … a month later, a social worker organised walking aids and the fitting of grab rails in your bathroom and a panic alarm … over the next five months, the social worker made frequent visits but has not delivered a Community Care Plan.
Hospital staff declared you medically fit for discharge to the rehabilitation unit to regain mobility and stamina. This was arranged on the assurance from social services that they would deliver a Community Care Plan for you on your eventual discharge but with no apparent safeguards in place to ensure that a Care Plan would be delivered.
Your circumstances would indicate entitlement to Free Personal Care and the ready delivery of a standard Community Care Plan by the time you returned home and yet your social worker failed to deliver a Care Plan or explain the delay.
The hospital had alerted social services to your care needs. Social services should not have told you to pay for your care if you were entitled to Free Personal Care.
There are long waits for Community Care Assessments in some local authority areas but, in the circumstances, a standard Community Care Plan should have been fully operational by the time you returned home. You should not have been discharged by the NHS when it was not safe to do so.
We find that people being denied the Free Personal Care to which they are entitled is par for the course in some local authority areas in Scotland. When challenged, the authorities’ ready response is that, people are not ‘entitled’ to anything until they’ve been assessed irrespective of their circumstances.
In your case, over a period of many months the social worker has visited, often at awkward times for you, and for no apparent reason. Your Community Care Plan should have been delivered before your discharge from the NHS convalescence unit.
If you suffer harm that is attributable to your local authority’s failure to deliver a Community Care Plan, it may be determined that the NHS discharged you before it was safe to do so, creating a legal issue for the NHS.
Our data show social workers are incentivised to expose the NHS to the operational risks of local authorities’ policies and governance issues. We find that, unlike the NHS, local authorities fail to acknowledge the risks of their operations but are able to cover-up their operational events.
The risks taken by your local authority in denying you a Community Care Plan is not aligned with the hospital’s incentive to discharge you only when it was safe to do so if there is any likelihood of your readmission or a risk of litigation.
You feel discomfited by the social worker’s frequent visits and wonder if the social worker is ‘casing the joint” for some reason but you are afraid to ask! You do not know if, over this period of five months, the social worker has even assessed your care needs. She is adept at failing to answer your questions. You have no immediate family or friends nearby who can help.
Predatory behaviour by social workers is a red flag. It concerns us that, since Free Personal Care is a non means-tested entitlement, the social workers should take an interest in your financial means. Every aspect of this social worker’s behaviour seems predatory.
Unsurprisingly, without a Community Care Plan, you found yourself struggling increasingly to cope with basic household tasks. At our suggestion, you asked your social worker why things are taking so long. You went one step further and asked if it would help if you were to contact the chief executive. Well done! You are now receiving four visits each day and find that this arrangement works well for you.
Now that the Community Care Plan has been delivered, you are no longer subjected to the social worker’s needless visits.
BetterCareScotland concludes that your social worker was incentivised to delay the delivery of your Care Plan. This created welfare issues for you and legal issues for the hospital. Our data show Care Plans being delayed by over a year, one for SEVENTEEN MONTHS for a BetterCareScotland member. We regard this practice as an infringement of human rights when it restricts your ability to exercise your rights.
The social worker’s visits are a cause for concern. They may have been information-gathering exercises since community social workers in Scotland today will needlessly direct people with the means to pay to residential care homes for reasons we will explore in a future blog.
CASE #3: WHEN THE SOCIAL WORKER MEETS THEIR MATCH
At the age of 84, your father was diagnosed with vascular dementia with a prognosis of three years … he is no longer self-reliant … after a fall at home, social services allocated a social worker to assess his care needs with you, his daughter … you are your father’s Power of Attorney … you live nearby and are, in effect, his unpaid carer … the social worker said that demand for community care exceeds supply, that your father is a low priority, that many others are much worse off than him, and that it is anyone’s guess when, if ever, he will reach the top of the list … the social worker concluded that there was, therefore, no point in assessing your father’s care needs … this conversation took place by telephone before the social worker had met you or your father.
When your father had difficulty performing basic routines and was no longer self-reliant, his GP referred him to a psychiatrist who conducted memory tests in your presence and diagnosed vascular dementia with a prognosis of three years. Your father’s GP contacted social services to assess his care needs.
The social worker showed no interest in your father’s care needs and failed to discuss social care options.
At your insistence, the social worker agreed to visit. The social worker reiterated the telephone advice that a Community Care Plan was not possible because two care firms had ceased trading. You asked about Self Directed Support to fund your father’s personal care. The social worker brushes off your suggestion without explanation.
The social worker proposes that, as your father’s main carer, albeit unpaid, you are entitled to a Carers Assessment entitling you, at the very least, to four weeks of respite from caring for your father during which time he would be cared for in a residential care home. You ask who would pay for the residential care over those four weeks. The social worker says without hesitation, “The Council!”
A week after this meeting, you send the social worker an email outlining your understanding you have from these discussions. The social worker does not reply to your email but telephones and tells you that you were confused and backtracks on everything that had been discussed previously.
You tell the social worker that you are recording the call. The social worker accuses you of breaching the Council’s Code of Conduct. You point out that you cannot breach a Code of Conduct by which you aren’t bound. The social worker then suggests that it is morally reprehensible of you to record the call without forewarning her. You say that there needs to be a record of whatever is discussed for the avoidance of doubt. The social worker relents. You thank the social worker for understanding your position.
You ask again about Self Directed Support. This time, the social worker agrees that SDS can be delivered and calculates a weekly amount, promising to achieve more if possible.
The social worker tells you “it would be better” if you were to care for your father in your own home instead of moving back into the family home which he occupies. When you ask why, you are told only that “it would be easier”.
BetterCareScotland finds that social workers expect family members to act as unpaid carers even if this means having to leave the labour market. In your case, you have taken early retirement. However, these facts do not permit the social worker to decide not to assess your father’s care needs. Your father’s care needs must be assessed. They may be more complex than you are aware.
You should not have had to insist on the social worker delivering Self Directed Support. It should have been discussed with you as an option from the start and certainly not ruled out when lack of resources meant a Community Care Plan could not be delivered.
We find that social workers will routinely rule out all options but residential care when people have the means to fund their care fund their care. In your father’s case, with no home to sell, the social worker ruled out care completely.
The social worker should not have proposed a Carers Assessment for you as an alternative to a Care Plan for your father. You were right to doubt the promise of free residential care for your father for four weeks at some future indeterminate date. Well done!
We feel that, if people are expected to take social workers on trust, Carers Assessments could become the social care equivalent of PPI mis-selling by banks.
The social worker proposed a care arrangement which could leave both you and your father homeless one day. Your father lives in a Council house. You rent a flat nearby from a private landlord. We cautioned that, since your father’s tenure is assured, you would be well advised to proceed with your original plan and move into the former family home. This will provide security and allow your father to continue to live in surroundings with which he is familiar.
It is odd that the social worker should provide such questionable advice after you had disclosed that you were recording the call. If, as seems likely, the social worker had forgotten that the call was being recorded, this lapse in concentration shows a social worker primed to act in a manner which would disadvantage someone in need of care and support.
This case illustrates that a third party may be less likely to be as easily deceived by social workers than the person in need of care. However, in general we find that family members are frequently taken in by social workers whose word, they assume, can be taken on trust.
BetterCareScotland’s data, derived from the lived experiences of our subscribers, show that Scotland’s social workers routinely deny people the social care they desperately need, and do so at the direction of social care bosses and, ultimately, their unaccountable local authority chief executives.
Our data suggest that, in one of the world’s richest countries, local authorities employ social workers for the express purpose of denying people the care they desperately need. And that social work practices, which do not reflect the statutory obligations of local authorities in letter or spirit but which are supported by social care bosses and local authority chief executives, represent social care policy in Scotland today.
The only people who seem to benefit are social care bosses and the local authority chief executives themselves but only by being able to avoid being held to account when things go wrong.
The fact that social care bosses are not required by local authorities to have qualifications or backgrounds in social work suggests that social care policy in Scotland today is primarily about spending as little as possible not providing essential services.
It should come as no surprise, therefore, that social workers’ morale is low, absenteeism is high, and there is an attrition rate which creates recruitment issues.
CONFLICTS OF INTEREST
It is clear that the incentives of a local authority in Scotland looking to pay as little as possible for care will be problematic when quality of care should be of paramount importance.
The generally well-regarded Nordic model of social care, to which Scotland would aspire, is predicated on the belief that quality of care provision is key and should never be traded off against cost. This approach should ensure that social workers are employed to do what social workers are supposed to do and providers of good quality care do not leave the market.
So, delivery of care should see good quality care delivered within cost constraints and not what we see in Scotland today – people being denied the care they need, providers of good quality care being driven out of the market leaving providers, which undercut the competition to accommodate their local authority, unable to cope. This drives down the quality of care for everyone and requires carers in the community and in commercially-unviable care homes, being kept in business by their local authority, to agree to working practices and conditions of employment that the local authority would not expect their own staff to accept. Nor should they.
We see people with modest life savings treated as cash cows by their local authority. One day, this aspect of social care delivery in Scotland could be the undoing of unscrupulous local authority chief executives and social care bosses who prey on Scotland’s most vulnerable at their time of greatest need yet face no sanctions when things go wrong.
It is a grotesque abuse of position for local authority bosses to expect social workers to knowingly act in their own self-interest and prioritise career progression over the the delivery of good social care outcomes. And controversial, since public sector pensions are funded by taxpayers some of whom are being denied care. It seems clear that local authority social care policies and practices are at the root of the high attrition rate in social work.
Some social workers take their grievances to their trade union and professional/licensing body but vested interests lead these bodies to be incentivised perversely to support the system not their members. Such a response not only perpetuate the issues that have become hard-wired into the current system, but enables them.
It is only a matter of time until local authority chief executives who look the other way and social care bosses who fail to supervise social workers are held to account.
BetterCareScotland’s subscribers would caution, NO MORE COVER-UPS WHEN YOU MESS UP!
THERE IS HOPE
Despite their experiences, BetterCareScotland’s subscribers are hopeful that, one day, everyone in Scotland will inherit a social care system that is revered, not feared! With social workers seen in the same light as our NHS professional health practitioners, our doctors and nurses who work to, and are held to, scrupulously high standards in challenging conditions. Standards that are not observed in social work and social care in Scotland today.
We look forward to a fully-operational National Care Service, which has been pushed back till 2028, untainted by the vested interests and perverse incentive structures of local authorities which have brought the current system to its knees.
WHAT YOU CAN DO!
Join BetterCareScotland and campaign to see people in Scotland and their human rights treated with respect at their time of greatest need.
Join forces with us and support people being silenced by their local authority.
Help us to hold local authority chief executives and social care bosses to account for the poor outcomes they deliver to people whose taxes pay their salaries and fund their pensions.
LET BETTERCARESCOTLAND KNOW
When did you start to question whose side your social worker was on?
Tell BetterCareScotland about the doubts you dare not express for fear of retaliation.
If you have concerns about the response you received from your local authority when you reached out after things went wrong for you or a family member or friend, let BetterCareScotland know!
We will protect your information and will not share it with others.
If you prefer to remain anonymous, you can tell us of your experiences by completing only the ‘Message’ box of the feedback form on our website’s Home page.
Love and Peace!
“There is no greater agony than bearing an untold story inside you.” … Maya Angelou
Help to ensure that the vested interests and perverse incentive structures in Scotland’s social care system can be be designed out of the National Care Service so that the Scottish Government can deliver on its promise of good care outcomes, as standard, for all people in need of care in Scotland.
If you have a story you need to tell and would like to discuss it with BetterCareScotland, please feel free to get in touch with us by email.
We will protect your information and will not share it with others.
If you prefer to remain anonymous, you can tell us of your experiences by completing only the ‘Message’ box of the feedback form on our website’s Home page.
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Love and Peace!
