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SASW responds to Health & Sport Committee Call for Evidence

SASW submitted the following response to the Scottish Parliament's Health & Sport Committee call for evidence into the potential impact of Brexit on health and social care in Scotland. Credit and special thanks to Ian Johnstone, former Chief Executive of BASW and current member, for this response and for representing the membership on this issue. 

Impact of leaving the European Union on health and social care in Scotland

1. How could the potential risks of Brexit for health and social care be mitigated?

The Scottish Association of Social Workers (SASW) is the British Association of Social Workers (BASW) national body representing practitioners, managers, academics and researchers in all social care settings across Scotland. BASW represents the UK in the International Federation of Social Workers (IFSW) and our members contribute to the work of the European Social and EU Fundamental Rights Platforms and the European Anti-Poverty Network (EAPN). Such activities ensure that health and social care personnel are aware of innovative developments in other European countries. 

Social work is a human rights discipline committed to challenging injustice, promoting equality and securing the protection and well-being of all citizens. Whilst the situation in Scotland is very much better than that in England it is fair to say that many social workers in the UK work in a “blame culture” perpetuated by the populist notion that there is a right and wrong way of doing everything and feel unsupported and undervalued.

The fact that the core values and principles adopted globally by the social work profession are enshrined in the EU founding Treaties may account for greater recognition of the importance of social protection and accessible social services evident in the European context than closer to home.

Many important EU Directives empower social workers to support the most disadvantaged and excluded members of society and we fear that following Brexit the UK may choose not to comply with these, with the result that the UK’s withdrawal from the European Union will have a significant negative impact on health and social care in Scotland.

Such fears are well-grounded.  Many of our members recollect the longstanding resistance to increasing the qualifying training for social workers in the UK from a minimum of 1 year to degree level that prevailed prior to the Bologna Process in 1999, effectively delaying progress on the mutual recognition of qualifications for social workers wishing to practice in a different EU Member State to that which they qualified in. And of course, we will not forget the 30-year campaign necessary to secure the regulation of social care which culminated with the enactment of the Care Standards Act for England and Wales and the Regulation of Care (Scotland) Act, at the turn of the century.

Whilst we are pleased that this issue is finally being addressed by the Scottish Parliament, the UK remains one of a handful of EU Member States continuing to defy EU and UN directives to afford children the same degree of protection from assault to that enjoyed by adults. We are therefore gravely concerned over repeated assertions by Westminster politicians that human rights legisation should be repealed and by the rejection of an Amendment to include Fundamental Rights in the EU Withdrawal Bill.

In addition to basic EU Treaties there are a host of target setting measures such as the Europe 2020 and European Disability Strategies, the Social Investment Package (SIP) and European Commission Recommendations on Parental Leave and Family Friendly Employment policies, all of which are of important to those requiring the support of health and social care services. Equally important are the Youth Guarantee, the Directive on the Right to Banking services and the Facilitation Directive which seeks to prevent the criminalisation of people providing humanitarian assistance to undocumented refugees. We refer to EU Directives on Procurement and the annual Country Specific Recomendations (CSR’s) in our response to Questions 3 and 4.

Current challenges regarding staffing of the NHS tend to be interrelated and centre around shortage of staff, working conditions and low morale. Within the UK, the NHS faces difficulties in recruiting and retaining permanent staff. The UK has a ratio of 278 doctors per 100,000 of the population compared to an EU average of 346 per 100,000. Similar problems can be seen in the social care sector not only in relation to vacancy rates but also high turnover. The health and social care sectors have long relied on EU and other foreign nationals in all parts of the workforce. Such staff plug the acute shortage of qualified and unqualified staff but also enable health and social care practitioners to more effectively engage with our multicultural society in the UK.

Studies suggest that social workers who have obtained their qualification overseas constitute up to 20 per cent of the UK workforce (Hussein, 2017) and children and family social work is identified as an occupation of labour shortage. The cessation of free movement is likely to make it more difficult to engage such workers to fill the existing recruitment gap. Children and dependent adults have a right to family life and are at greater risk of exploitation and abuse when they are separated from relatives. Undoubtedly repatriating them with other family members will prove more difficult when this change takes place. Less stressful working conditions and more imaginative recruitment strategies encouraging people from within the UK to pursue or resume a career in the health and social care sector would mitigate some of these issues. In many localities the NHS is the largest employer.

We are very concerned that Brexit will have a negative impact on the availability of research funding in areas such as public and mental health, rare conditions, dementia and pandemics. EU legislation provides a harmonized approach to medicines regulation across member states and common rules for the conduct of clinical trials.  We would suggest that the Scottish Parliament takes steps to ensure that financial support continues to be provided to research projects (Horizon 20/20 - 80 billion over 7 years) and that valuable partnerships that civil society organisations in Scotland have developed with key EU funded organisations such as the Fundamental Rights Agency, the European Social Platform and the European Anti-Poverty Network (EAPN) whose membership is restricted to organisations from Member States, are sustained.

It is imperative that the Scottish Parliament secures the devolved power to control immigration and puts in place systems necessary to ensure the mutual recognition of professional qualifications for health and social care staff coming to Scotland or moving to other European countries. It will also be essential to ensure that Scottish people visiting or living in EU countries and incomers to Scotland from other European countries continue to be eligible for free health care.  

Expenditure on health and social services and welfare benefits in the UK has been reduced despite increased need on account the austerity measures that have been adopted since the financial crisis. This constitutes false economy as failure to provide support and assistance at times of crisis, not only results in avoidable suffering and distress, but invariably gives rise to greater future expense.

The need to ensure a more appropriate balance between investment in social rights and economic development and eliminate the poverty, homelessness and the other social ills that continue to blight the lives of so many was acknowledged in the package of proposals contained in the EU Social Pillar Proposals which was approved by the EU Council at the end of last year.

We urge the Scottish Parliament to bring forward a set of national proposals that address the need for radical redistributive tax proposals to finance long-term investment in the high-quality social infrastructure and services that are required to ensure the future availability of quality, accessible care, social, health and education services, affordable housing and rewarding employment for all those residing in Scotland.

We would suggest that there continues to be scope to reduce the costs of care for people in Scotland suffering from chronic diseases, which accounts for 70% of healthcare budgets, by promoting good health for all and preventing the onset and progression of disease, especially among groups in vulnerable situations. Too often relatives and informal carers receive too little support to prevent predictable crisis prompting emergency admission to nursing or residential settings and investment in more effective respite care and support for relatives and informal carers would make financial sense.

We would also consider that more sophisticated research and statistical processes are required to more accurately forecast the service needs of people in all areas and sectors and assess the broad societal impact of long term investment in services and social infrastructure to enable accurate estimates of the costs and gains of these to be factored in to financial planning.

The Country Specific Recommendations (CSR’s) published annually by the EU provide useful comparisons between the UK’s performance and that of other countries in progressing their National Reform Programmes (NRP’s) to eliminate poverty and social exclusion, reduce unemployment and promote equality through investment in education and sustainable growth and development. The Scottish Executive need to consider what mechanism will be put in place to ensure that such comparators continue to be independently provided after Brexit takes effect.

Finally, we hope that the enormous potential for health and social care services to offer people quality employment that enhances their own well-being as well as those they are supporting will be fully exploited in Scotland in the future in conjunction with the expansion of social economy enterprises.

2. How could the potential benefits of Brexit for health and social care in Scotland be realised?

We anticipate that the costs to health and social care arising from the loss of the substantial benefits of membership of the EU will be far greater than any benefits derived from Brexit.

3.  In what ways could future trade agreements impact on health and social care in Scotland?

EU Procurement Directives exempting personal services from some of the competitive tendering requirements have limited the development of the private sector care provision championed by the UK, in most other European countries, where such services continue to be provided directly by the state. Whilst there are many excellent privately provided local care services that promote empowerment and self-directed care in Scotland, the necessity to generate profit and meet the demands of local authority purchasers for low unit costs have led to the development of institutional models of care which promote dependency rather than empower people to maintain their capacity to live independently. 

4. The Joint Ministerial Committee (EU Negotiations) has agreed definition and principles to shape discussions within the UK on common frameworks including enabling the functioning of the UK internal market. What implications might this have for health and social care in Scotland and what are your views on how these common frameworks are agreed and governed?

Bearing in mind our comments about private sector providers in the foregoing paragraph, we would suggest that further investment in prevention and local support services is urgently required to achieve the economies of scale and improvements in the health and well-being of service users and their carers that will be accrued from them being enabled to retain their independence and remain in their own communities.

Conclusion: 

These observations and recommendations have been compiled in the climate of confusion that currently surrounds the complex negotiations currently taking place on Brexit and SASW would be pleased to provide any additional information that may be required to clarify the views of our members.