The Health and Social Care Alliance Scotland Alliance have produced a booklet asking people across the sector to look ahead at the future and discuss what we need to do to shape a fairer, better Scotland. Our CEO Brian Sloan talks about rethinking the existing concepts around ageing.
We know the future for health and social care in Scotland will be, and must be, different. There is a ferocious bustle of reform activity – reshaping care, integration, self-directed support, joint strategic commissioning – but it isn’t yet clear how these will all work together. There’s a broad consensus on the direction of travel, but it’s not yet clear where we’re going; or if the gears are working as well as they should when we face sharp bends or bumps in the road.
The Christie Commission issued a clarion call for more preventative services, and there are some excellent examples across Scotland, from lunch clubs to walking groups. But if everyone who needs such support in later life is to get it, no matter where they live or what their income, there must be a more sustained investment in such services and a more robust means of recognising and measuring their value. Too often, we hear from our member groups delivering preventative services that, as demand increases, their income is falling or less certain. The desire to protect core services in a time of austerity means prevention struggles even more for resources, with the Change Fund seen as little more than a temporary sticking plaster.
“Social prescribing” – one of the latest buzzwords – will be meaningless if the community services aren’t there to refer to. Often the people who need preventative services most are stymied by lack of access to transport. If you are remote from or unable to use public transport, your free bus pass will be of little benefit. Following years of underinvestment, the community transport services people need are wholly inadequate. A recent injection of £1 million by the Scottish Government for community minibuses is welcome, but falls far short of a sustainable strategy to expand community transport to meet growing demand. Minibuses and social clubs might not seem at first glance like vital components of a sustainable 21st century health care system. But, without them, isolation and loneliness, ranked twice as damaging to health as obesity in a recent study, will continue to diminish the wellbeing of our older population.
There have been genuine efforts to personalise services, including the recent legislation for self directed support. The priority now must be to ensure such measures translate into meaningful improvements in people’s experiences, and are not hollowed out by smaller budgets or higher charges for service users, and that they have the information and support they need to make effective choices about their own care.
The concept of personalisation should also inform how we develop preventative services. One example of how this can be done is Men’s Sheds. These began in Australia, following recognition that many older men find mainstream older social and activity opportunities unappealing, and consequently become either isolated or overreliant on the pub for social support. Age Scotland is now supporting the establishment of Men’s Sheds across Scotland, places where older men can enjoy camaraderie as they work together on projects that interest them, and that are very often of wider community benefit too. If we want people to lead active and healthy lives as they age, and increase their chances of a high quality of later life, such tailored opportunities must be readily accessible across the country.
With the Default Retirement Age gone and the State Pension Age rising we must also rethink the concept of retirement, to ensure that more of us find the later stages of our careers fulfilling and enjoyable. Stopping work should be seen less as a cliff and more as a process of gradual change from productive employment to active later life.
“Whatever the future of Scotland what matters most is that our citizens and communities are recognised as our biggest asset, both in meeting the challenges we face and in shaping how we do that. The ALLIANCE is founded on the strength, value and power of lived experience and we look forward to continuing to work with our members and others to ensure we apply our collective energies to shaping the fair, inclusive future we want.” – ALLIANCE Chief Executive Ian Welsh
Download the full ‘Small country, big ideas’ report.