Calls to merge Scotland’s health and social care services

By EDDIE BARNES
Published on 16/09/2012 00:00

A RADICAL overhaul of Scotland’s public sector, including a cut in the number of councils and a possible healthcare insurance scheme, is required to deal with coming cutbacks and escalating NHS costs, according to one of the country’s pre-eminent academic thinkers.

Lord Sutherland of Houndwood, whose Royal Commission on Long-term Care led to the adoption of free personal care for the elderly in Scotland a decade ago, describes the country’s political landscape of two parliaments – Westminster and Holyrood – and 32 councils as “mad” and said that a collective “failure of nerve” was holding politicians back from proper reform.

The “shibboleth” of the NHS also needs to be confronted, he declared, saying that doctors are already being priced out of new technologies and better drugs that could help to save lives, due to “vested interests” blocking reform.

Central to changes required, he argues, is to complete government plans to merge NHS and council social care services – with one chief executive and one budget – to end the current situation where, he argues, managers are fighting to hold on to their share of the public sector pot. He suggests that, under this new unified model, funding could then come from a new insurance-based system, under which people would be charged for health and social care costs up to a capped amount of money.

His call comes as SNP finance secretary John Swinney prepares to unveil his spending plans for 2013 this week, with intense pressure on the Scottish Government’s £30 billion budget. Union chiefs are threatening strike action unless he proposes that public sector workers get a rise of more than 1 per cent, the cap which Chancellor George Osborne has suggested.

Last month, it emerged that the cost of free personal care for elderly people had risen by more than 150 per cent in seven years, up to £342 million, prompting warnings that a range of so-called freebies handed out by ministers, including free prescriptions, free bus travel and free tuition, should be reviewed.

Sutherland, who will address MSPs this week prior to Swinney’s budget, said that the focus needed to go far wider, given the financial squeeze.

It comes with ministers pledging to integrate health and social care services, but keep in place the country’s 14 regional health boards and 32 councils.

Sutherland said he credited the SNP government for pushing forward, but he added: “There is a failure of nerve. This isn’t just Scotland. It is as bad in England. “It is professions digging in and it is local authorities and health boards protecting their budget.”

He said ministers should merge boards and council social care, putting “one chief executive” in charge of one budget. On the number of local authorities, he said: “We have 32 councils. It is mad. And that was not looked at when we set up the new parliament. That was just a failure.

“What we needed to look at “Scotland is in a much better place to do this,” he explained. “It is still chaos in England. We have learnt a lot in ten years here and it could be a revolution.” in Scotland was what is required in terms of political representation. It doesn’t need a parliament and Westminster and 32 councils. It means we have 32 directors of social care. It is daft.”

Swinney will present his spending plans to MSPs on Thursday. Last night, he said he planned to divert more cash into “shovel-ready projects” designed to help construction.He said: “I guarantee I will squeeze every penny out of the money we have available to us to boost the pace of recovery and to support the hard-pressed households of Scotland.”