Reform of care for Scotland's older people needs to accelerate according to Audit Scotland.
As the Public Bodies (Joint Working) Bill moves towards the end of its legislative journey, Audit Scotland's report 'Reshaping care for older people' is a timely reminder of the challenges. Moving the managerial deck chairs around is only a small part of the solution.
The report reviews progress three years into the Scottish Government's ten-year plan to improve health and social services for people aged 65 or over. It is one of Scotland's biggest and most complex programmes and involves NHS, local government, voluntary and private bodies. The Government is supporting it with a four-year, £300 million Change Fund.
The report says:
• Improving care for older people and joining up services has been a policy focus for several years but progress has been slow, and monitoring of its implementation and impact needs to improve
• The Scottish Government needs to work with its partners to clearly plan how resources will move from institutions such as hospitals into the community. They also need to better understand why activity and spending on services for older people varies across Scotland
• The Change Fund has brought bodies from the different sectors together to develop and agree joint local plans to improve care, and a number of local initiatives are underway
• The information needed to make decisions and assess their impact on older people is not nationally available. Bodies need to improve and maintain data on costs, activity and outcomes for health and care services.
As usual with Audit Scotland reports, they are strong on analysis, bringing together the available data in a presentable format. This info graphic sets out the key data very helpfully.
The weakness is that the recommendations focus on getting public bodies to produce more data. Important though this is - it misses where the key focus needs to be.
For example, the funding of additional community care is almost entirely missing from the financial memorandum to the Bill. It has been assumed (Christie Commission) that the funding is coming from reducing unplanned admissions to hospital, calculated at £1.5bn. However, health boards are now arguing that far from reducing beds, they need more, and the Health Secretary has said he agrees.
The next problem is that care for older people in the community is little short of a national disgrace. The big numbers in this report do not reflect the problems facing home care staff in particular. Many are paid well below the living wage, employed on zero or nominal-hours contracts and given insufficient time to provide a quality service. The BBC File on 4 programme covered the cost of delivering care in England earlier this week. The same problems are all too evident in Scotland.
Numbers in this report are useful, but quality outcomes are more important.