Harriet Dempster and Nigel Henderson: Reform of services needs to realise that care begins at home

The financial outlook which faces us in the years to come is the most challenging for decades; the gap between current and future demand is huge; the expectations of health and social care services are growing; and the resources available in future years are declining.

In light of this, we must change the way we do things. The Public Services Reform Bill is designed to ease the burden of scrutiny by reducing duplication, streamlining operations and focusing on promoting service improvement. While these changes are welcomed, we would argue there is a need for a more fundamental look at public service reform that goes beyond simply reforming some public bodies.

When we consider health and social care services, much of the attention to date has been on structural change with the aim of bringing them closer together to deliver seamless services. All the feedback from people who use services confirms their wish for a single system approach. How this is best achieved is debatable, but what is clear is that structural change alone will not deliver sufficient efficiencies or economies.

This realisation has prompted discussions about the continued viability of certain flagship policies. Some would argue there are now real questions about the affordability of, for example, free personal care. It may be time for a review.

However, before firm conclusions are drawn, we would suggest it's time to reflect and perhaps redraw the relationship between the individual, the family, the community and the state.

As baby-boomers reach old age, their aspirations will differ from earlier generations'. The 21st Century Review of Social Work, published by the Scottish Government a few years ago, anticipated some aspects of this in that it advocated a shift towards what we refer to as more personalised services, where people are able to exercise more choice and control over their lives and the support they receive.

But this is just one strand of the move to promote more active citizenship. It is partnered with another shift towards social care services actively promoting interdependence, independent living and enhancing mobility. In some cases, this has been translated into providing very intensive services to people. Recent evaluations of these approaches are positive and show that people are able to live active and more fulfilled lives, for longer, in their own homes and in their own communities.

The ultimate success of these approaches will depend on the extent to which people feel valued and involved in their communities and the capacity of these communities to include them. We believe it is in this area that attention, energy and resources should now be focused.

Moves to encourage new ways of doing things in the face of tight financial circumstances can often be met with resistance. People feel restricted by finances and so prioritise those things they must do, not the things they should do, and services that provide a little help early and so often make a big difference to someone's life can be sacrificed for fear of failing to meet statutory obligations.

Rather than seeing the future challenges as a threat, we believe it is an opportunity to be grasped, one which sees the skills of social workers being directed beyond individuals and families to empowering and enabling communities. We look forward to working together, and with others, to build broader alliances and a momentum which can make the most of this opportunity.

Harriet L Dempster is president of the Association of Directors of Social Work. Nigel Henderson is convener of Community Care Providers Scotland