Martin Sime: It's up to all of us to care for each other

Published on Tuesday 28 June 2011 16:03

An ageing population and the unsustainable costs involved for Scotland's public services mean we will have to learn to do more and expect less

YESTERDAY'S launch of the Christie Commission report into the future delivery of public services left many frustrated. It failed to deliver a magic wand to fix our public services. There was no soundbite, no simple headline recommendation that would be straightforward to implement.

But what Christie does do is provide a framework and a set of actions which could genuinely transform the way we think about, deliver and pay for Scotland's public services. It makes it clear that there can be no more excuses - that we must change the way public services meet the needs of Scotland's people and we must start changing now.

The report estimates that it may take until 2025-26 for the Scottish budget to return to its 2009-10 levels in real terms - an adjustment period of 16 years. At 2010-11 prices, the shortfall over that period is around 39 billion. Rapidly rising demand and falling resources could be a toxic combination. The Commission estimates that 40 per cent of current public spending goes on tackling problems that are avoidable if only we shift to a preventative spending agenda. As the commissioners have said, unless Scotland embraces radical reform, both budgets and provision will buckle under the strain.

The major factor in the projected demand is our ageing population. The Commission says that between 2008 and 2033, the number of people over 75 will increase by 84 per cent. Unpublished research suggests the strain this will put on health and social care will cost an extra 2.5bn every year by 2030 and that's only if we radically change service models to reduce demand. If we do nothing, that cost will rise to nearly 7bn extra. To put that in context, that's between 9 per cent and 20 per cent of the entire Holyrood budget.

When the SNP came to power in 2007, 4.5bn was spent in total on health and social care for people aged over 65. Unplanned admissions to hospital alone accounted for about 1.4bn - as much as the entire GP service and prescriptions combined.

And on a global scale, the IMF estimates that, for developed industrialised countries, the fiscal burden up to 2050 will be made up of 10 per cent from the fiscal crisis and 90 per cent from ageing.

But what does all this mean for the way we think about older people?

How we look after our older citizens is the singular benchmark of our civilisation. If we aspire to be a 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, and health and social care have had years to get their act together to provide the seamless service that people deserve.

Caring for our older population is the single biggest challenge facing Scotland in the decades ahead. And we need to start addressing this now.

This is not something that our politicians in Westminster and Holyrood can solve on their own. It involves us all - young and old, frail and healthy - because we'll all get old some day and the consequences could be dramatic if we don't get it right.

Lots of things need to change, and change fast, if we are going to cope. Let's begin with our collective mindset. Everyone needs to pay more, do more and expect less. Taxation and pension contributions will have to go up just to sustain what we have. We'll have to think hard too before we resist hospital closures if there's a proper plan to get the staff out working in the community, helping people to live independently where they can. Increasingly, we can't have both.

However the biggest attitudinal challenge goes deeper than that. We need to learn to become good neighbours and citizens again, since we'll only get through this together. Of course, many do volunteer - 45,000 voluntary organisations and 1.2 million regular volunteers are testament to that.

But we need more people helping themselves and each other, since social isolation is the biggest threat of all. There are many good schemes and projects all over Scotland - lunch clubs, community transport, befriending, the sterling work of the WRVS - but they are at the margins of our health and social care systems when they need to be at the centre of reducing demand for hospitals and care.

We must do more to integrate services. One of the key phrases in the Christie report is "competitive neutrality" - not pitching voluntary organisations against local authorities on the basis of who can provide the cheapest service, but on who can provide the best service to meet the needs of individuals and communities.

One way forward is to view the challenge from a different perspective. Instead of seeing the changing demographic as a problem, why not find ways to make the fact that we are living longer part of the solution? Let's get older people involved and even leading the programmes of change.What better advocates, planners or volunteers could there be than active older citizens? We forget at our peril that only a tiny proportion of 65 to 75-year-olds come anywhere near hospital or care homes, and with the right encouragement and support they could make a huge difference in meeting the needs of their older and frailer counterparts.

All the evidence suggests that more people will be willing to do more if the support and structures are there to help them, which is exactly the opposite of what is happening with the implementation of Cameron's Big Society gamble.

But for a fraction of the cost of a new care home, we can help people to do their bit, and those that do get so much out of it too.

Supported self-help is the only practical way of reducing demand for care. Helping people to spend their last days at home rather than in hospital is a crucial issue, as is giving more people the resources to make choices about their own care. This builds on the assets and resources they already have - friends, neighbours, family.

Evidence in the Christie report indicates that such self-directed support programmes for long-term health conditions can reduce visits to GPs by up to 69 per cent, reduce hospital admissions by up to 50 per cent and more than pay for themselves through savings.

There are some exceptional organisations working with these new models and making a big difference. The hospice movement and Alzheimer Scotland aren't motivated by profit but by a mission to care, and put people at the heart of all they do. They mobilise thousands to support their efforts and raise millions in public donations. Yet they too remain at the margins of the system and the billions it consumes in institutionalised provision. That has to change.

As for the rest of it, the turf wars between health and social care, between central and local government must stop. We should expect that not one penny is wasted on duplication, bureaucracy or professional vested interest. This isn't, after all, about the doctors, nurses, social workers or care workers. Every resource we have is needed for the front line if we are going to meet the challenge head-on.

The sheer urgency of the crisis facing Scotland's public services has been ignored, not just by our politicians but by the rest of us for years. The need for investment in prevention, for much more efficient and integrated public services and for a person-centred approach is unavoidable. Christie has thrown down the gauntlet to the Scottish Government - but it's for all of us to pick it up and start changing now.

• Martin Sime is chief executive of the Scottish Council for Voluntary Organisations and an expert adviser to the Christie Commission.