Peter MacLeod: New care must let elderly choose own steps

SUCCESSFUL health and social-care reform will focus not on structure but on giving older people what they want, writes Peter MacLeod

Older people in Scotland deserve to live the life they want, how they want and where they want. For many older people that means living a healthy, independent, safe and social life in their own homes.

That has to be the aim of all organisations involved in helping to care for and support our older people. That is also the desire behind the Scottish Government’s proposals to “integrate” health and social-care services for older people. As a social worker with the best interests of people who need support as my only concern, I will stand up for that.

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And, as a professional with an experienced view of how to achieve it, I want to ensure that the proposals being consulted on by the government will achieve it. It is crucial that we focus on the right things and deliver the best we can for our older people.

The prominence of integration as a concept – the bringing together or merging of agencies, in this case health and social work – was heightened in the run up to the Scottish Parliament election in 2011.

By the start of the campaigning, it was clear that there was a consensus emerging across the three main parties that some form of health and social-care integration, on a national level, was desired. Their aim was to improve services to older people and make them consistent across the country and of a better standard; their method was to introduce new structures, creating new bodies or substantially altering existing ones.

The evidence actually points clearly to outcomes being the focus for change, not structural reform. This view is echoed by the Christie Commission, which reported to the government after the election, and the Statement of Ambition for community planning in Scotland.

The only way to improve services to older people is to focus on what they want: independence, being able to live at home, social interaction, and good health. That’s what’s key to success.

The new health and social-care partnerships must focus on improving outcomes and minimise structural change.

There are gains to be made here, but this is a significant change to the public sector: adult social care services represent about 70 per cent of each council’s social-work budget and about 18 per cent of their total budget. We have to ensure that we go about it in a way that preserves and builds on the successes we already have.

Democratic accountability, the consolidation of care and the prominence of social work are three things that I believe make social-work services the success that they are and will be crucial to the integration of health and social-care services. They deserve prominence and recognition in the forthcoming legislation.

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Most areas of policy that deal with supporting people recognise the huge benefit in allowing people more choice and control over the services they receive. Democratic accountability is an extension of this. The more we devolve decision-making to local people, the more chance we have of delivering the services that people really need. That’s what local government is good at. That’s why we have local government. That’s why the involvement of elected members is so crucial in the new health and social-care partnerships proposed by the government.

As we seek to integrate health and social care, we also must be mindful of not disintegrating the social-work care services we already have. Back in the 1960s, the Kilbrandon Commission reflected on the arrangements then in place: separate probation, child and adult welfare departments. The Kilbrandon report then formed the basis for the 1968 Social Work (Scotland) Act, which created community social work and integrated care.

Human problems seldom come singly and in order to help individuals we need to help families and communities. That’s the unique contribution social work makes. Any social worker will tell you that the most “challenged” families require support for many people, for example grandparents who care for children of parents with addiction or offending problems. The huge benefit at the moment is that these services are all linked.

The last issue, which is key to the success of integration, is the recognition of the unique contribution that social work makes. Social work and health are different. Of course they are. They contribute different things and both are essential to people who require care and support. In bringing them together, we need to ensure that neither is diluted or lost. That will require maintaining the leadership of each profession in any new arrangement.

Social-work services in Scotland work. The evidence of this is legion: from inspection reports, regulatory reports and, crucially, from people themselves. More than 80 per cent of older people rate the services they receive from social work positively and most people also feel that social work services help them live more independent lives.

Of course, there is room for improvement and we have seen things that have gone wrong. No one will have failed to have been shocked at the recent Panorama programmes on adult and older people’s care, or concerned at the collapse of Southern Cross care home providers.

There are opportunities to be grasped and gains to be made in integrating health and social care services, but we have to make sure our actions will have the consequences we seek and that we do not, in the process of solving one set of problems, create more.

We must focus on people: the people who deliver services and the people who need support; the way people live and want to live; the communities people are part of. If we can keep that as our context and keep improving the lives of older people as our ultimate aim, we will then be able to grasp success.

• Peter MacLeod is president of the Association of Directors of Social Work and will be addressing their annual conference Social Work: Innovation, Integration, Transformation in Crieff today.