Equal Opportunities Committee, 01 Dec 2009

Meeting date: Tuesday, December 1, 2009

Official Report 189KB pdf

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“All Our Futures: Planning for a Scotland with an Ageing Population”

Agenda item 4 is evidence taking from the minister on a separate issue, which is the Scottish Government's strategy "All Our Futures: Planning for a Scotland with an Ageing Population". The minister is accompanied by John Storey, branch head of the older people and age team in the Scottish Government. Welcome, John. Minister, would you like to make an opening statement?

Yes, thank you, convener. I last updated the committee on 15 January. At that stage, the Scottish centre for intergenerational practice was in its infancy, and had not even received its first grant. Also, we were thinking about the national forum on ageing, and the see the person, not the age campaign.

Since then, we have implemented the major commitments of "All Our Futures" and we established the Scottish centre for intergenerational practice towards the end of 2007. It held a summer school in September and its first national conference in Perth on 1 October. We have set up the national forum on ageing: it has several manifestations, including the national forum on ageing futures group, which held a successful launch in the Scottish Parliament on 15 June.

We have run the see the person, not the age campaign to combat ageism, which I hope that many of you saw. It was about promoting positive images of older people, and its third phase was begun to coincide with UK older people's day on 1 October, using the fairly innovative and eye-catching wrinkly billboards. We have held seven regional stakeholder events, and we held a further event with older people from black and minority ethnic communities on 6 October, at which the Minister for Housing and Communities, Alex Neil, spoke. Finally, we made a commitment to report to Parliament, which we did last December.

That is a condensed version of our progress. I am happy to expand on anything that members want to hear more about.

Thank you for your opening statement, minister.

Can you outline the main suggestions for change and improvement that were raised at the older people stakeholder events?

I will let John Storey say a little more about that in a moment. I will just say that 900 people—quite a healthy number—attended the events, which were held in Glasgow, Inverness, Galashiels, Perth, Aberdeen, Dumfries and Galloway, and Edinburgh. The reports of the individual events, and a single report that covers the issues from all seven events, are on the Scottish Government older people website, if people want to examine the results in more detail. I am sure that John will give a flavour of the issues that came out of the events.

A number of points came out. There was nothing terribly new or different that people have not heard before, but we heard about the need to simplify forms and procedures. The cry from a number of the events was the need to put things into simple English. We heard that benefits and pensions should be paid as a right rather than having to be applied for and claimed using complicated claim forms. People wanted continuing action by the Government to tackle pensioner poverty, and they wanted working and learning opportunities to be available. Older people wanted to live life to the full, and they wanted to live in a safe environment without fear of crime, and with good lighting and pavements. Those were some of the main issues that arose from the seven events and they are the type of things that you might have expected to hear.

I understand that the poor provision of information was raised during the events, along with the issue of transport difficulties, particularly for people who live in rural areas. How is the Government addressing those concerns?

Those issues have been discussed at the older people's consultative forum, so they are not a surprise to me. We are keen to continue to do what we can to ensure that information is out there, and we are encouraging service providers to make information available. There have been a number of initiatives to ensure that people are aware, for example, of the energy assistance or the benefits to which they might be entitled. It is partly about getting the information out there, but also about how the information is provided. That brings us back to John Storey's point about the gobbledegook that you sometimes have to work your way through to understand what is being discussed, which I think we can all appreciate.

I ask John Storey to say a little bit about transport, which is an issue that we have picked up from the older people's consultative forum.

Transport is always an issue, particularly in rural areas. The concessionary travel scheme provides free bus travel to people who are over 60, but it is not much use to someone who lives on the road between Dundrennan and Auchencairn, for example, if no buses pass along it. That is a difficult issue to deal with, although when I spoke to the Scottish Government's bus adviser just the other week, he pointed out that in any area there are probably quite a number of resources and there might be a need to co-ordinate them. As well as established bus services—the commercial bus services—there are local-authority-supported services, school bus services and NHS provision of one kind or another, which takes people to hospital in particular. In addition, there are community transport facilities such as community group minibuses, which are often funded by the lottery. The bus adviser pointed out to me and one of my rural policy colleagues that in any area, there is probably rather more provision on the ground, including demand-responsive services, than one might realise. The interesting question that he threw out was whether there was some way of bringing those services together at local level.

Is the Government taking any specific action to bring that issue to the fore and focus minds on it?

We could examine whether we can do more. The issue was identified as a priority area for action in "All Our Futures", and we might be able to have another look at it as we take forward our work on reshaping provision for older people. At the moment, we are dealing with the high-level stuff, but we might be able to address that in the context of practical considerations such as how people get about in their communities and some of the barriers to their being able to access services. I am happy to take that away.

That would be appreciated—it is quite a big issue.

I welcome much of what the minister has said and the work that has been done on the Scottish centre for intergenerational practice, the anti-ageism campaign and other areas. I may have missed some of this and perhaps should have paid more attention, but to what extent are you trying to implement all of "All Our Futures" rather than just selecting bits of it and rejecting other bits?

All of "All Our Futures" is being taken forward and, by and large, implemented. Within that, there are the six priority areas for action that we touched on earlier, including the establishment of better links between the generations. We have tried to focus on the biggest priorities and those on which people want action to be taken. The see the person, not the age campaign was a response to the need to break down barriers, reduce age discrimination and change how people view older people in society. The feedback from older people has been pretty positive. A cultural change must take place, which will not happen overnight. Challenging how some people view older people is part of that process.

Quite a big emphasis was placed on older people being able to continue to work for as long as they want to and on promoting flexible approaches to enable that to happen. Given the employment situation, that is particularly difficult to do at the moment, but to what extent is it being emphasised? A recommendation was made that the Scottish Executive—or the Scottish Government as it now is—should have a no-retirement-age policy. Can you say anything about that specifically or your employment work more generally?

John Storey informs me that a no-retirement-age policy is in place. Otherwise, people would need to apply for permission to continue working after 65. I do not think that the UK Government has any intention of changing the statutory retirement age. I understand that the UK Government will look at the issue next year—by the sound of it, that will be post the election—so we will need to wait and see whether that happens. As things stand, all that we can do is to lead by example. I suppose that the Scottish Government having a no-retirement-age policy is as good an example as we can get.

My only observation, I suppose, is that it would be unfortunate if making such a change resulted in further pressures during the current economic recession. Certainly, some companies—I will not name them, but we all know which they are—have been rather good at promoting the benefits of having an older workforce to interface with the public, who often find that they have a more positive experience. However, we will need to wait and see whether any changes to the law emerge in future. As I said, that will not happen before the general election.

Obviously, the challenge is to mainstream older people's issues throughout the whole Government. For example, older people should also be able to participate in learning activities. To what extent are the issues on the agenda of each of the Government's directorates? I am told that recently—I do not know whether this has happened yet—responsibility for older people's issues was moved into the equality unit. Will that encourage the issues to be mainstreamed more than if they continued to sit in the health directorates, or is that not the reason for the shift?

I think that it will help to ensure that every part of Government plays its part. In health, we need to ensure that our policies deal with age discrimination and promote equality. I have indicated some of the big challenges around that, such as in screening services. For example, we need to ensure that we have medical evidence on why a screening programme should have a particular age-related cut-off date. However, age equality is important for all parts of Government, so I hope that that will be an outcome of moving responsibility for age equality into the equality unit.

John, do you want to add anything on that?

Time has moved on since "All Our Futures" was published almost three years ago. The Scottish Government is focused on its single purpose of creating an economically prosperous Scotland from which all Scotland can benefit, including older people and people with disabilities. If the different directorates are asked about their focus, they will say that their focus is on the single economic purpose rather than on "All Our Futures" or other policies.

Further to John's comment about how things have moved on since "All Our Futures" was published, the Government now talks about its priorities as involving five strategic objectives. More and more, we are trying to ensure that the objectives within "All Our Futures" are aligned with those. Therefore, when officials are talking within Government, they think not necessarily in terms of "All Our Futures" but about how that policy relates to the five strategic objectives that they are working towards. We want to ensure that the policy is synchronised with those objectives. I hope that moving responsibility for age issues to the equality unit will help to do that.

If it is possible, I will comment a little more on the issue of employment. It is interesting that anecdotal evidence in the business press suggests that, in the current recession, older people are not the first to be made redundant. In previous recessions, by comparison, older people tended to be the first to go. In addition, West Midlands Regional Observatory recently produced statistics that showed that older people are being retained in employment.

Another issue is the Heyday case, which Age Concern brought against the UK Government in the European Court of Justice. Age Concern argued that the setting of specific retirement ages by companies contravened equalities legislation. The European Court of Justice referred the case to the UK Supreme Court. That court opined fairly recently—in September, I think—finding against Age Concern and saying that companies could set a particular retirement age. However, its view was predicated on its awareness of the Government's review of the retirement age policy, which was originally going to happen in 2011 but has since been moved forward to 2010. I will be interested to see where that review and the review that the minister mentioned go next year, but one certainly gets the feeling that the ground is shifting on the current retirement age of 60 or 65. One has only to read the financial press to realise that companies simply cannot afford to pay out pensions to everyone who retires at 60. After all, everyone is living much longer. When the retirement age was set at 60, people were dying at 62 or 65; now that people are living to 78 or 80, you cannot afford to maintain a retirement age of 60 or 65.

Does the Scottish Government support the call for older people to have more control over health and care needs?

Absolutely. We have introduced the concept of mutuality into the health service—although, given my earlier comments about jargon, I suppose that I should clarify what that means. It means that people, whatever their age, have to be true partners in their care; of course, with children, there will be parental involvement. Patients will be very much involved in decision making; there will be mutual respect between the patient and the health professional; and the days of simply telling people what to do and then sending them away should be long gone. People want more information and expect to have a say and to be given options. That is all to our benefit; given the older population that John Storey referred to, it is in society's interests for people to remain healthy as long as possible, and self-care and looking after one's own health represent one of the most effective ways of doing that. I absolutely subscribe to that concept.

We must ensure that the system sees that through. Of course, that will be a challenge to people who have worked in a particular way, in the medical profession or in some other profession. It is difficult to change to a different way of delivering services but, without a doubt, it needs to happen.

You have presented a very good case for why it should happen, but my second question, which you have partly answered, is about what it actually entails for the Scottish Government. What kind of message do you need to send out, and how do you send it out?

My comments do not apply only to the health service, but it provides a good example. Training front-line health professionals to see the patient as a partner in care is a good investment in time and effort, but we must ensure that when the person leaves the consulting room, the general practitioner's surgery, the nurse or wherever they have a lot of information about their condition, have a point of contact to discuss issues further—because, as we know, when someone gets a diagnosis, it might not be until the next day that they have 110 questions to ask—and are empowered and supported through self-management courses to be able to manage their condition.

The health service must see itself as helping to make all that happen, and the self-management fund in which we have invested has allowed a plethora of organisations supporting people with long-term conditions to set up self-management courses. Of course, most of the people who will take advantage of such courses will be from the older population. When one speaks to people who have been through the process about what they were like when they were first diagnosed and their situation now as a fully informed patient who knows how to manage their condition, it is like night and day. That has to be good for health professionals, because when the patient comes back to see the health professional there can be a better quality of discussion than would be possible if the patient was not informed. That is a concrete example of how the health service is changing to support the older population.

That was helpful.

There has been a 4 per cent increase in local authority expenditure on free personal and nursing care for self-funding residents in care homes, and there has been a 15 per cent increase in local authority expenditure on personal care for home care clients. Given those statistics and the recent predictions on population, what are the implications for free personal and nursing care?

First, we are absolutely committed to the free personal care policy, as I am sure is the Parliament. The policy is one of the flagship policies that have stood the Scottish Parliament in good stead, in that it has demonstrated what the Parliament stands for.

Secondly, services and how we deliver them cannot stand still and must change, for example through far closer integration of health and social care and through new models of support, in which home care services are based on reablement. Reablement means that someone who comes home from hospital gets a package of services and support that changes as the person changes. We have been bad at that. A person can come out of hospital and two years down the road be receiving the same package of support, with no effort having been put into enabling them to recover the independence that they enjoyed before they went into hospital.

There is suddenly a realisation that by focusing on reablement we can help people to get back to where they were—perhaps not 100 per cent, but pretty close to that. People want to be able to do as much as possible for themselves and can be helped to make their meals and do other things that they used to take for granted. The feedback suggests that people want to do that and that services should provide the bits that people cannot do for themselves. That change in philosophy makes a lot of sense. The approach will mean that there is capacity to help more people and, I hope, do more preventive work with people—we are touching the edges of some of that. Reablement is a core theme of our work on reshaping older people's services.

If we can get all that right and redesign services to make them work far more effectively for people, as I believe that we can do, the free personal care policy will be more affordable, because we will use our resources more effectively and efficiently, as we need to do, given the financial backdrop. It is in all our interests to get that right, so that we can not only provide services that people need but sustain free personal care, which is a must.

Thank you for that answer. What impact will the Equality Bill have on the Scottish Government's approach to planning for Scotland's ageing population?

I will not get into consultation timescales again. [Laughter.]

We are working our way through what the bill means, to ensure that we have thought through its implications. It does not take much to make us think that the bill will potentially have an impact on any area of service delivery—and not necessarily just the obvious areas. I am closer to the health service, because of my portfolio, so it is clear to me that screening is one such area. It is clear that compliance with the Equality Bill will have pretty profound implications for how services are delivered.

The work is on-going. A lot of thought and attention is being given to what the Equality Bill will mean for each part of Government and what it will mean for service providers at local level, particularly health boards and local authorities. We need to work through all that at all those levels. It is a pretty profound set of proposals, I think.

How do we gauge the impact of campaigns such as the Scottish Government's see the person, not the age campaign? Do we test whether public perceptions are changing as a result of such campaigns?

Yes. The attitudinal surveys give us a stark picture of how some people see older people in society—the views are not all positive. However, if interventions such as the see the person, not the age campaign are successful—as I hope that they will be—in challenging attitudes and changing minds, over time we will see a shift in attitudes to older people reflected in the attitudinal surveys.

It is interesting that, in some societies, older people are regarded differently, with deferential respect, because they are the elders in society. Children are brought up to think in that way, and that is the backdrop and the culture. We have a different culture, unfortunately. In the mass media—especially television and films—older people are often the butt of easy jokes that are made at their expense. We have a lot of work to do if we are to change such attitudes. The see the person, not the age campaign was a way of getting underneath people's views and getting people either to put themselves in the position of being an older person on the receiving end of that treatment or to recognise that they held those views and think about the negative impact that such views have. They were encouraged to think about whether they would want that attitude to be held towards one of their loved ones—a relative, or someone whom they knew.

The campaign was not the end of the story; it was a start in challenging the strongly held views that people have developed as a result of our cultural backdrop. It remains to be seen how we will be able to measure its success. John Storey may want to say something about how we may track some of the changes over time.

Before we did the first advertising, we carried out survey work, which involved telephone interviews of around 1,000 people across Scotland and some focus groups, which were conducted by our advertising agency. That work suggested that ageism is not high among people's priorities—there are much more important issues—and that we should take a soft approach in our work. It suggested that we should not be telling people, "You must stop doing this"; rather, we should be encouraging people to see the person, not the age. That is where the campaign—in particular, the television advertisement—came from.

We have now completed three phases and have done some tracking after each phase. I hope to get the results of the final phase later in December. There is good buy-in. People recognise "see the person, not the age" as a slogan. We can measure that there has been some shift in attitudes, although it is fairly small. We recognise that, as the minister said, it will take time to change attitudes in this area—it will not happen overnight after one campaign.

I am sure that we could share those results with the committee once we have the whole picture.

That would be helpful, thank you.

John Storey talked about the legality or otherwise of age discrimination in work. The Scottish Government's equality statement said that, in the context of the recession, older men are among those groups that are most at risk of becoming long-term unemployed or inactive. What impact is the recession having on older people in employment and those who are not working? Does the Scottish Government have specific support programmes for older men?

What John Storey said about the recession was interesting—in some ways it might be counterintuitive, although welcome nevertheless. However, there might be some evidence that the younger people in the workforce are the first out the door. That could point to a problem elsewhere that is equally as concerning.

On support for older men, a number of programmes—from Jobcentre Plus in particular—have focused on getting people with long-term limiting illnesses, who have been out of the workplace for some time, back into employment. Some of those programmes have been around for a while, although I do not have figures to hand to demonstrate how successful they have been. Many of them are run through UK Government departments.

Initiatives that are further upstream include keep well, which delivers a service in the most deprived communities that targets the 45 to 64 age group of men who are less likely to engage with the health profession about their illnesses. It is a good and effective intervention. People are called in proactively for a health check and at that point are signposted to numerous services that can help to deal with their fitness level, smoking, alcohol intake and debt issues.

Part of the service is about identifying employment opportunities, which can help to build confidence in someone who has been out of the labour market and has a range of other issues in their life. The first stage is building their confidence so that they are able to consider going back into the labour market, and providing training opportunities. Keep well is a good way of getting in contact with the people who are the hardest to reach and other things can then flow from the health check. I have spoken to people who used to have no confidence in their ability to do anything, and it is remarkable to see the transformation in them after they have been through the process. The programmes put confidence back into them.

Several things are happening in a variety of settings, but I highlight the keep well initiative, through which the health service is making a difference in reaching people who would not otherwise be reached.

At the Scottish older people's assembly that was held here in October, 300 participants compared their experiences. Will you give us an insight into what the assembly achieved and how you see it being used in the future?

The Scottish older people's assembly was organised by the older people's consultative forum and supported by Age Concern and Help the Aged, which were involved with the mechanics of making it happen. Although we provided the funding, I was keen to allow those organisations to structure and give flavour to the event. It was very much for older people and they set the agenda.

The report of the event was discussed yesterday with officials. I have not discussed it yet, although I will at my next meeting. It was important symbolically to have older people coming together to talk about their issues of interest. The next question is where it should go from here. What were the outcomes? What type of future events might be useful? We have talked about some specific issues today. Any future events that take place might be more focused on specific issues, such as transport—which has been mentioned—age discrimination and access to public services. There are a range of issues that could give focus to such an event. Although, by its nature, the first event was going to be broad, there was a feeling that we would want future events to be more focused on specific themes. I am happy to write to the committee to keep it informed of my discussions with the forum and its conclusions about where it wants to go.

We very much welcome that. Is there anything you would like to add?

I do not think so.

It remains for me to thank you on behalf of the committee. The session has been long, but we are grateful to you for giving evidence on the carers strategy and "All Our Futures".

Thank you.