National Care Service - social care support and service provision: evidence

4. Examples of factors that influence different service type/provision

There are several factors which influence service type/provision as shown in Figure 4. Scotland’s demography is a leading factor as discussed further in the paper Scotland’s Health and Demographic Profile. The recent Audit Scotland Social Care Briefing^[18] states that “by 2038, forecasts suggest that nearly a quarter of people living in Scotland will be over the age of 65. Scotland’s increasingly ageing population means that the demand for social care services will rise, and more resources will be required for social care over the long term. Around a fifth of the population of Scotland define themselves as having a disability and disability is more prevalent in older people. As our older population rises, the number of people with a disability, as a proportion of the population, is expected to increase too”.

Other factors include resources, both financial and workforce. Further information on the workforce is available in the paper on The Adult Social Care Workforce in Scotland. The Independent Review of Adult Social Care^[19] and the Audit Scotland Social Care Briefing^[20] discuss the sustainability challenge for services. Audit Scotland reports that “the 209,690 people working in social care are under immense pressure, and the sector faces ongoing challenges with recruitment and retention. Staff are not adequately valued, engaged, or rewarded for their vitally important role. The workforce is predominantly female and poor terms and conditions for staff contribute to recruitment difficulties, rising sickness absence and high vacancy levels. This puts the capacity, sustainability, and quality of care services at a considerable risk”^[21]. Some of these challenges may have been exacerbated by the Covid-19 pandemic.

Figure 4: Examples of factors that influence service type/provision

• Social care services
  • Demographics
  • Policies
  • Commissioning and procurement
  • Workforce
  • Financial resources

Decisions about services are currently made locally by each Health and Social Care Partnership. To date, how services have been commissioned and procured locally has varied, which has impacted the types of services and provision in local authorities. An Audit Scotland report published in 2016 stated that “councils have a challenging task to manage the market for providing services in their local area. There are potential tensions around making savings while ensuring high-quality services at a fair cost in an environment of increasing demand and financial pressures. There are risks to the quality of services if councils continue to drive down costs at the rate they have in the past without changing how they provide services”^[22]. Both the more recently published Audit Scotland Social Care Briefing and The Independent Review of Adult Social Care discuss the need to improve the commissioning and procurement process.

Finally, policy decisions can influence service provision. In the Independent Review of Adult Social Care, as an example, it cites the introduction of the Free Personal and Nursing Care policy and the increase in use of services. A study published by the Joseph Rowntree Foundation in 2007^[23] found that following the introduction of the Free Personal and Nursing Care policy in Scotland, there had “been a Scotland-wide increase in demand for care at home:

• Between 2002 and 2005, the overall number of local authority care at home clients rose by 10 per cent.
• Within this group, 62 per cent more received personal care”^[24].