Communities have high expectations when it comes to health and care services
The message from the last COSLA conference before the local elections was a pragmatic one: in the current straitened economic climate the public sector is facing diminishing resources and so expectations have to be managed.
“I think we have to recognise the challenges that we are faced with in local government with a shortage of finances. We can’t absolutely do all things for all people. We just don’t have the resources to do that,” COSLA’s health and wellbeing spokesperson Councillor Douglas Yates told Holyrood.
“If people come to us thinking there will be a great pot of money without a bottom, that is delusional. We have to be pragmatic and realistic and that is where the responsibilities have to come in.”
Councils’ responsibilities are great and growing. Last month the Scottish Government published its Social Care (Self-directed Support) Bill, which seeks to lay the foundations for self-directed support to become a mainstream choice and will enshrine in law, for the first time, the right to choose for everyone eligible for social care. Speaking recently about the Bill, Public Health Minister Michael Matheson acknowledged the difficult financial situation but added that “no matter how challenging the context self-directed support is here to stay” and said the Bill, which is expected to be passed by the end of the year, will ensure the choices people make must be given effect by councils.
Self-directed support has the potential to help harness the best of what care and support should be about, says Yates. While COSLA didn’t agree that the strategy needed to be underpinned by legislation and indeed counselled against it, Yates says it will engage constructively with the process.
“When you put layers of bureaucracy on top of existing practice it is sometimes not a good thing and has unintended consequences.
“But we are where we are with it and we will see the progress of that Bill as it goes through Parliament and what comes out of that,” he says.
While he argues that the introduction of self-directed support is a “great opportunity”, he says it also presents “huge challenges” for local authorities in terms of how it will be implemented.
“We hope it will be implemented sensitively and thoughtfully so that the outcomes for individuals receiving self-directed support would be much improved from where we are at the present moment and time,” he says.
“At the end of the day it is all about improving outcomes for people and using more of a pooled resource to achieve good outcomes for people. That is at the core of it.
“There will be various challenges along the way,” he continues.
“I don’t think there is any doubt about that because individuals will have their own peculiar problems so it is not a one size fits all. I think that is where the sensitivity will have to be employed at local council level so that we can ensure fairness but also try to deliver realistically the best outcomes for individuals.”
While the financial climate cannot be ignored, there is much that local government can and is doing to improve the health and wellbeing of individuals. Each local authority has its own priorities and responses, but the various local manifestos for the upcoming local elections reveal some common themes that will be ongoing focal points for councils.
Supporting carers to manage their caring responsibilities with confidence and in good health features prominently in many of the party manifestos. The Scottish Conservatives express their deep admiration for the work of carers across Scotland and argue that they want to see councils develop closer working relationships with carers and local carer organisations, adding: “We recognise carers as equal partners in care and are committed to providing appropriate respite hours, in partnership with the voluntary sector, to support them.” In its manifesto for the city of Glasgow, Scottish Labour pledges to appoint a carers’ champion to ensure the voices of the 60,000 carers in Glasgow are heard. Support for kinship carers – grandparents and relatives who look after a child because the parents are unable to – will see payments rise by 25 per cent, it says, while the party also proposes the introduction of a new carers’ discount card for council-run and private services. Meanwhile, an SNP-led council in the same city would take steps to repay the debt owed to carers by establishing a Carers’ Council, and will also introduce a Disabilities and Carers’ Champion to ensure decisions reflect the needs of these groups. In addition, the party said it would introduce a “Caring for Carers” kitemark for employers in the city to recognise those employers offering the best support and flexibility for carers, and it would also work with schools to ensure that child carers are given the support and understanding they need to successfully combine caring and learning.
Responding to the increasing care needs of an ageing population will also be an ongoing challenge for local authorities. In the Highlands, where the integration of adult services across the council and NHS Highland has been piloted, the Scottish Liberal Democrats pledged to continue its “pioneering” work to help older people stay in their own homes, avoid unplanned admissions to hospital and, when they need hospital care, get back home as quickly as possible. The party also plans to support older people by making better use of telehealth and telecare.
Meanwhile, the Scottish Conservatives point out that they have consistently argued for health and social care budgets to be merged and remain committed to. “Rather than a centralisation of these services, we see this as an opportunity to devolve power and choice to service users through a further expansion of individual budgets, so that patients can commission their care from providers of their own choice and in a way that meets their individual needs,” the party states.
And in Fife, Scottish Labour has announced that former First Minister Henry McLeish will head up a review of health and social care in the area if Labour is successful in the May elections.
McLeish, who was responsible for introducing free personal care in Scotland, said that care of older and disabled people “cannot simple be left to market forces”.
He said: “We have the opportunity to shape the future of health and social care by removing the false barriers that exist between the NHS and social services to create a health and social care service based on the principle of high quality provision free of charge at the point of need.” Last year the Scottish Government set out its own plans to integrate adult health and social care. Speaking at the time, Health Secretary Nicola Sturgeon said the “radical reform” proposed by the Scottish Government is “badly needed to improve care for older people, and to make better use of the substantial resources that we commit to adult health and social care”.
Yates agrees this is a step that needs to be taken but admits that, for some, there is still a nervousness about relinquishing control.
“Human nature directs that people have a problem relinquishing power and control, it just seems to be a natural element in individuals. But that is what we have to do to have a more holistic approach to things and we need to get people to be more mature about it to look to whole arrangements within a locality, to look at pooled budgets and how those would best benefit communities.
“Now, that is a big change from what we have currently and it is not something that is going to be easily achieved and we recognise that it is going to be a bit of a struggle to try and wrestle some of the power and control from some people. It is easier with some individuals than others, I think!”
A consultation on the Scottish Government’s plans to integrate health and social care is expected to be launched next month and Yates says COSLA will continue to work with the national government to bring NHS healthcare and local government-run social services more closely together. However, he stresses that a one size fits all approach will not succeed.
“It has got to be flexible and it has got to meet the needs of the local communities. That is where local authorities will have that opportunity to be innovative and bring in local solutions. You need to retain localism and the flexibility to be able to best treat those individual aspects within communities. If you have a one size fits all you wouldn’t be able to do that. It would be too rigid. You wouldn’t be able to adapt to local circumstances.”
While that creates an additional challenge for local authorities, Yates believes it is “definitely the right direction of travel” and says councils are showing that they are “up for that particular challenge”.
“It is actually quite exciting because if you can do that that is a great prize because that will deliver and that will deliver far better, integrated services and it will save the public purse as well,” he adds.
“It is a great prize because you will get better services delivered more economically so it presents better value for money for everyone.”
Katie Mackintosh
Katie is Holyrood magazine's Health Correspondent and has been with the magazine since 2005. She has an MA in Sociology with Gender from Edinburgh University and a post graduate diploma in Journalism from Napier University. Katie has twice been named PPA Scotland Feature Writer of the Year, in 2008 and again in 2009, and was shortlisted for magazine writer of the year at the Scottish Press Awards in 2012. She is an Aberdonian by birth, a Glaswegian by nature, who now lives in Fife with her...