DR DONALD MACASKILL: Care has to be local and close, and we need to be willing to pay for it


It was with both personal and professional sadness that I learnt of the recent announcement to close Budhmor Care Home in Portree.

Personal because with Skye roots my own family have been among the thousands who over the years have benefitted from care home provision on Skye.

Professional because it is yet another closure of an excellent rural care home in a year which has seen too many and which I fear will see many more.

Staff and Relatives on the steps of Budhmor in Portree. Pic, Willie Urquhart

My day job is as chief executive of Scottish Care which is the representative body of independent care providers – that includes charitable, employee-owned and private care homes.

It is a job which seeks to advance and improve the care and support of older people and adults in Scotland, and which increasingly is about highlighting the critical state the care sector is in after years of neglect and under-funding.

The Covid-19 pandemic has been especially hard for residents, families, and frontline workers in our care homes but in some senses the next few months and years may bring even greater challenge.

There is much talk about the National Care Service, but the problem now is that that is a future dream.

The care crisis is immediate, and it feels like the care sector is standing on a burning platform and unless urgent issues are addressed then many care homes and homecare organisations will simply not be around in two-or three-years’ time to walk into the promised land.

There are many challenges, but I want to mention three – lack of resource; the need to value the workforce and the need for a new vision.


Unlike in other parts of the UK in Scotland for well over a decade care home fees have been set by what is called the National Care Home Contract, which is this year being re-designed.

it is a contract between local authorities and care home providers and as well as setting standards of quality it also determines through an annual national negotiation what the rate of fees (the National Rate) should be.

Over the years the gap between what some consider to be a reasonable level of fee charge and the National Rate has widened.

Some have argued that the failure of public authorities to pay adequate fees has led to those who pay for the care home place themselves – known as self-funders – to effectively be subsidising the shortfall from the state.

Others have pointed to the disparity between what it costs a local authority or the NHS to run their care homes (a rough average of £1,300 a week) and what they pay independent (private or charitable) care homes at just under £800 a week.

Independent analysis has recently suggested that the average weekly fee rate should be between £1200-1400. Now while mention of finance can be off-putting, to ignore the realities of cost and resource means that we are never going to sort issues out and will continue to try to buy care on the cheap as well as making it impossible for homes to invest in improvements.

One of the major problems with the National Rate is that it fails to take into account the very different costs of delivering a service in Portree compared to Pollok.

The last few months have seen a saddening demise of some high quality rural and remote care home services simply because they are no longer sustainable or are unable to attract staff to work in them.

Care has to be local and close, and we need to be willing to pay for it or we will lose it forever.

People need to be supported in the places they belong to and have connection with. Yet we are in danger of people having to travel dozens of miles in order to visit residents and family because there is no local care home. That is wholly unacceptable.

We urgently need to do something. Skye has lost too many homes over the last decade because they could not make ends meet.


One of the major issues in rural communities is attracting nursing and care staff at pay levels they are willing to work for.

Unless we can attract the right men and women to work in the sector, unless as a whole society we start to value the work of social care, then we can keep the buildings open but there will be no-one to staff them.

We need to adequately reward and value the workforce in our care homes in a way that recognises them as individuals who are gifted and skilled.

The work of supporting someone living with late-stage dementia or who is on a palliative and end of life care pathway is skilled and professional and those who do it are gifted in compassion and humanity.

Yet we rarely value them and recognise them. That simply must change. 


Care homes have been hammered during the pandemic – often at the hands of ill-informed media and career minded politicians.

The recent High Court ruling from England has a lot of resonance for Scotland.

It is sometimes said that care homes are God’s waiting room but, in my experience, they are places where it is possible for people to grow, to come to a new lease of life and to thrive and flourish until the end of their days.

Anyone who has visited a care home in the years before the pandemic will know that they are vibrant, active and lively environments, with loads of activities and celebrations.

We need to change our negative image of the places which care for some of our most valued and valuable citizens, part of that means changing our view of older age in general.

People who are in their later years have so much still to contribute, to create and to share with us all.

They have the same right as any one of us to have their voice heard and to be active citizens in their communities. It is time to urgently change our view of care homes.

There will be more stories of closure and the devastation of hurt that is caused by losing your home, unless as communities we take this crisis seriously, invest the necessary resource, value the workers, and change our negative image of care homes.

We cannot continue to lose places like Budhmor because we are unwilling to pay the true cost of care.

Dr Donald Macaskill is chief executive of Scottish Care and his parents both hailed from north west Skye.