Martin Sime is director of the Scottish Council for Voluntary Organisations, and writes a monthly column for The Caledonian Mercury.
While news stories about Southern Cross, Elsie Inglis and interbourne View have caught the imagination, it’s a good time to remind everyone of two things. One is that how we look after our older citizens is the singular benchmark of our civilisation. If we aspire to be humane and fair society, then that’s how we should measure ourselves.
Older people have a right to expect better than to be pawns in a
leveraged buyout of Southern Cross nursing homes, health and social care have had years to get their act together to provide the seamless service that people deserve, and nobody ought to be exposed to the treatment
we’ve seen and read about this week.
But the second truth is even more uncomfortable. Caring for our older population is the single biggest challenge facing Scotland in the decades ahead. And we need to start addressing this now.
The numbers involved are well rehearsed. We’re living longer and the number of older people, as a proportion of the population is rising fast. The strain this puts on health and care ends up as a really big cash cost – a minimum of £2.5 billion extra every year by 2030, but nearly £7 billion if we don’t do something about it now. And to put it in context, that’s between 9 and 20 per cent of the entire budget of the Scottish government.
In a culture of cuts, these harsh facts make uncomfortable reading. Our new government can’t even buy its way out of the problem: there is no amount of additional hospitals and care homes that would be enough – and anyway, there won’t be enough people around to work in them.
So how do we address these issues? I’d argue that we need to do three things. We need to change our way of thinking around how (and how much) we pay for care, we need to re-learn how to be good citizens, and we need to empower people to make decisions for their own care based on what they need and what they already have.
Let’s begin with our collective mindset. Everyone needs to pay more, do more and expect less – a 20 per cent slice of government funding demands a change. Taxation and pension contributions will have to go up simply to sustain what we have.
We need to learn to become good neighbours and citizens again, since we’ll only get through this together. There are many good projects all over Scotland – lunch clubs, community transport, befriending and much else besides – but they are at the margins of our health and care systems when they need to be at the centre of reducing demand for hospital and care.
And we need to place much greater emphasis on supported self-help as a vital way of reducing demand for care. Giving more people the resources to make choices about their own care builds on the assets and resources they already have – friends, neighbours, and family – so the choices tend to be more personal and better fitted to sustain independence rather than the reverse.
Political leadership is needed to sort this out, to put the interests of older people and the most vulnerable at the very centre of our politics. The challenge then is for us all to respond.
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