As of March 2023 there were 1,037 care homes for adults in Scotland of which 792 (76%) were for older people, 146 (14%) were for learning disabilities, 52 (5%) were for mental health problems, and 33 (3%) were for physical and sensory impairment.
Over 40,000 people in Scotland live in care homes, of which 92% are resident in care homes for older people.
That figure is only likely to increase in the coming years, with 20% of Scotland’s population now over 65.
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Since October 2016, the Scottish Government and local authorities have committed to paying adult social care workers the national living wage during waking hours, with this provision expanded in 2018-19 to include those undertaking sleepovers.
The latest Scottish Government budget reaffirms this commitment, with the UK Government having increased the national living wage to £12.21 per hour from April 2025, and Holyrood has provided funding for local authorities to increase the rate paid to carers to £12.60.
The move was initially welcomed, providing care staff in Scotland with a ‘premium’ compared to the rest of the UK.
However, new analysis undertaken by the STUC has found that the estimated 64,000 residential care workers in Scotland are now earning less on average than their counterparts in the rest of the UK.
Residential care worker pay in Scotland has increased by £2.27 over that period but that is less than the increase in the minimum wage (£2.72), average earnings (£3.44) and carer pay in the rest of the UK (£2.76).
Because pay is tied to the national living wage, a greater increase in the minimum wage compared to that measure penalises those in the care sector in relative terms.
From April 2020 to April 2024 the median pay for residential care workers in Scotland rose by 21.6% but the minimum wage increased by 31.2% while median pay for carers elsewhere in the UK rose by 27.2%.
In 2020, residential care workers were paid 20% more than the UK minimum wage, by 2024, this had fallen to 12%, meaning any ‘wage premium’ carers receive is being eroded.
According to the STUC data, in the last five years residential care workers have seen a real-terms pay cut of 2.1% using CPI (consumer price index) inflation and 9.6% using RPI (retail price index).
The report concludes: “The Scottish Government’s policy of increasing pay in the social care sector in line with the real living wage is no longer fit for purpose.
“Residential care worker pay is being left behind by the minimum wage, inflation, average earnings in the rest of the economy, and residential care worker pay in the rest of the UK. Unchecked, these trends will only serve to exacerbate the crisis in Scotland’s social care system, with knock-on impacts on delayed discharge from hospitals.”
The STUC is calling on the Scottish Government to increase pay in social care to £15 per hour, introduce sectoral bargaining – in which agreements would by negotiated on behalf of and apply to the whole sector – and, in the mean time, increase pay in line with or above percentage increases in average earnings, the minimum wage, and residential care worker pay in the rest of the UK.
Sandra, a care worker, told The Herald: “One of the things that could sort it out is sectoral bargaining, so that everyone who works in social care has the same terms and conditions.
“We’re all providing local authorities with services, they pay for the contracts, so we should all have the same annual leave, the same pay – but it’s not that way.”
Increasing levels of privatisation are also impacting care workers.
A 2021 report produced by GMB found that, on average, pay was £1.60 lower in the private sector than the public sector.
Agency worker Tamara told The Herald: “I work predominantly in private care but when I do shifts in the local authority homes I do find the staff are happier and there are more of them.
“The local authorities are held more accountable by the Scottish Government than the private care sector is, because those homes are obviously just run for profit.
“Local authorities get funding from the government so they’re held more to account whereas the private ones don’t rely on that as much so they don’t face the same kind of accountability.
“There are also better training opportunities and better equipment, I find that things are better and more smoothly run.”
Issues within the private sector have been highlighted by trades unions for some time.
In 2021, a GMB survey found that nearly three quarters of care home workers felt that they did not have enough time to deliver safe and dignified care.
This is borne out in a new STUC report which uses Care Inspectorate data to examine differences in staffing resources across private, voluntary and public sector care homes for older people.
It found staffing levels were 20% lower in private care homes than in the public sector or voluntary sector.
The data compared the number of registered places in a care home to the number of full-time staff.
On average, private sector care homes had 1.3 places for each staff member, compared to 1.08 in not-for-profit care homes.
The STUC said: “Staffing ratios in residential care homes matter. They matter for patient care, for health and safety, and for staff wellbeing. This report shows that staffing resources in private care homes are significantly lower than in public and voluntary care homes.
“Yet to date, Scottish Government proposals for reform of the care sector have not given any attention to different staffing ratios in the private, voluntary and public sector.
“Given the plethora of evidence that the not-for-profit sector has better staffing ratios, less complaints, and higher pay, any meaningful reform to improve social care must propose substantive changes to who actually provides care.”
Concerns have also been raised about the potential impact of Britain’s decision to leave the European Union on the provision of health and social care.
A 2022 report by the Scottish Government found that around 6.2% of staff in adult care homes were from the EU, a total of 3290.
While there had been no statistically significant decrease in this number since the Brexit vote, of those studied 75% said it had become more difficult in the wake of leaving the European Union to recruit staff for care homes, while 30% said EU staff had left in the previous 12 months.
Decreases in immigration present a demographic problem for Scotland, which has the lowest population growth in the UK, with the 2.7% increase in the last census driven entirely by inward migration.
A Scottish Government spokesperson said: “We value the vital role social care workers play in delivering high-quality care to people of Scotland.
“We also remain deeply concerned about the impact the increase in Employers National Insurance Contributions (ENICs) will have across the social care sector.
“Our 2025/26 budget provides an additional £125 million to enable adult social care workers, delivering direct care in commissioned services, to be paid at least £12.60 an hour, in line with the Real Living Wage. This £125m takes our total investment in improving social care pay to £950 million.
“This is higher than the National Living Wages which applies to many social care workers in England and Northern Ireland.”