Alex Matthews: Different thinking needed for social care

Audit Scotland says that current approaches to social work services will not be sustainable in the long term. Picture: Esme Allan
Audit Scotland says that current approaches to social work services will not be sustainable in the long term. Picture: Esme Allan
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Social care services are under renewed pressure this year. They are caught between increasing demands, as more people are living for longer with more complex care needs, and decreasing budgets.

As a result, every Scottish local authority has social workers ­trying to meet more residents’ needs, but with fewer homecare hours and residential care home beds, leaving gaps to be filled in by unpaid carers.

In response, councils have adjusted eligibility criteria for services, passed cost reduction requirements on to third party providers, and responded to one-off government initiatives. Each of these are ­worthwhile and have reduced costs in the short term, but they do not address the root causes. More ­worryingly some councils are ­considering passing extra costs on to service users, requiring them to purchase care equipment privately.

A report by Audit ­Scotland, Social Work in Scotland, ­concluded, ­‘current approaches to ­delivering social work ­services will not be ­sustainable in the long term’. Indeed, 15 of ­Scotland’s 31 ­Integration Joint Boards – the organisations that sit across ­Scotland’s health boards and local authorities and commission adult health and social care – predict an overspend this financial year.

However, there are ways to make a real difference.

One is to make better use of ­technology. Telecare devices which provide remote care and ­reassurance to people in their own homes are already used but are not deployed in a systematic way to reduce the uptake of other care services. The evidence from ­Argenti, a ­telecare service that PA Consulting Group delivers in ­partnership with Hampshire County Council demonstrates its ­benefits. Over three years, the ­number using the services has grown from 500 to more than 6,200 and £4.7 million of net savings have been made. Overall, the service has received positive feedback from ­residents and social workers.

Another approach is to improve support for older people after they have been in hospital. Even after a very brief stay, elderly patients can lose their independence and require increased care.

The hospital wants to avoid a delayed discharge, which is expensive in the short term, while social care teams will want to avoid the person having to go into a ­residential care home – expensive in the long term.

What’s needed is short term intermediate care, like that provided by a third sector organisation such as Erskine – a Scottish nursing, residential, respite and dementia care provider. This will reduce the pressure on hospital and social care teams and help to develop the essential role of the third sector in the health and social care system.

However, these are complex changes that require councils and health boards to think differently about the way that they deliver care.

They also require investment in the short term to deliver better quality care at lower cost in the long term. Making the decision to invest requires strong leadership and support at local and national levels.

Alex Matthews is a health and social care expert at PA Consulting Group. www.paconsulting.com/publicsector