The health care sector in the Highlands suffers from inflationary pressures, especially in medicines and staff costs, an ageing population and a lack of younger healthcare professionals in more rural areas, while at the same time seeing a considerable increase in the overall population of Inverness.
These issues combined require a major increase in funding for our healthcare sector in the Highlands. Not only is there a massive budget gap in annual running costs but major investment is required to replace or upgrade hospitals and care homes.
My comments do not reflect any unhappiness with people in the health and care sector in the Highlands: my travels around care homes and hospitals have demonstrated to me again how lucky we are to have professionals of the quality we have.
The Highland Health and Social Care Partnership (HHSCP) finance report as of August 30 confirmed there remains a budget gap of £98 million for the year 2023/24. Cuts of £29.5 million have been proposed. No funding source has been identified for the residual gap of £68.7 million.
All the way through the report the difficulty of hiring and retaining staff is repeated. There is a single line on costs which really stands out: locum and agency staffing in the four months to end July was £22.6 million.
Highland councillors recently received the Strategic Plan on adult services. The scale of the challenges makes harrowing reading.
Largely due to staffing issues, seven care homes have closed permanently or temporarily since March 2022 in Cromarty, Grantown, Portree, Ullapool, Stontian, Mallaig and Invergordon, with a combined loss of 161 beds. A major care home company has exited from their three Highland care homes – the remaining outstanding issue being the future of Moss Park, their largeish Fort William care home which is for sale. In April of this year the HSCP took over an independent sector care home in Newtonmore.
To generalise, independently owned care homes are losing money and the regulator Care Inspectorate Scotland has introduced new facility upgrade requirements for licensing which are frankly unaffordable. Unless an independent care home gets relicensed it cannot be sold as a care home. The necessary upgrade is unaffordable, ergo it cannot be sold as a care home.
We all want our parents in care homes near where we live. A local doctor tells me Lochaber has half the care beds it needs. Anecdotally, care home residents from Skye are being sent to care homes in Nairn and Aultbea.
Care home staff get paid less than staff in hospitality businesses – no wonder hiring is difficult. In terms of carer payment rates, they vary between providers, but the minimum of £10.90 per hour applies. Though the First Minister in his ‘Programme for Government’ announced an inflation matching increase of 10 per cent to £12, it is not clear from when, and in any case remains uncompetitive with the hospitality sector. If care home staff were paid, say £15 per hour, then there would be less staff turnover and the massive agency bill reduced.
A care home manager told me that her staff resign, sign up with an agency for the care provider who then pays three times the amount to get that same staff member back.
We read of the importance of care at home…but the report said there was a “reduction in available commissioned services” of 1300 hours per week.
Because we don’t have enough care/respite capacity then we are getting delayed discharges in hospitals with appalling consequences. That is explained in detail in the latest Performance and Quality Report. A week in an acute hospital bed costs £4,500, whereas a Care Home costs £700 and Care at home £350 for the same period. Clearly having a hospital bed taken up due to no available care home beds is financial madness, not to mention the negative impact on hospital waiting lists etc.
Plenty of carers and care home capacity spread across the Highlands, with well paid staff, would solve a lot of problems.