Scotland’s ageing population combined with a decreasing overall annual Scottish Government budget will make progress in shifting care for older people from hospitals to the home more difficult, according to a Holyrood parliamentary report.
Published today, the Public Audit Committee’s report on reshaping care for older people notes that spending on health and social care for older people will need to rise from approximately £4.5 billion in 2011/12 to nearly £8 billion by 2031 to meet increasing demand. This comes at a time when the overall annual Scottish Government budget will continue to decline until 2015/16 and is not expected to return to 2009/10 levels until 2025/26.
The committee report follows the ‘Reshaping care for older people’ report (February 2014) from the Auditor General for Scotland (AGS) and the Accounts Commission, which noted that the current arrangements are “not sustainable”.
During evidence to the committee the Auditor General for Scotland reported that “limited progress” had been made in shifting care from hospitals and care homes to care at home or in the community because finances are reducing and the number of older people is increasing.
Other findings from the committee report include:
- In relation to the Scottish Government’s and COSLA 10 year programme Reshaping care for older people (RCOP), the AGS explained that "there is a big gap in national information on needs and the appropriateness of services.” The Scottish Government confirmed that the data is “not yet collected consistently enough to give the right level of confidence about the national picture, or to enable meaningful comparisons between localities.” The Committee therefore welcomed the Scottish Government’s commitment to report back on work to ensure that national data supports the RCOP programme.
- The Committee has recommended that the Scottish Government regularly publish information on the progress made towards increasing the proportion of the total health and social care budget spent on care at home.
- The Committee acknowledges the range of innovative projects which the £300 million Change Fund has supported, two years in to this four year Scottish Government programme. However, the Committee has sought further information on how the effectiveness of this fund will be measured.
Public Audit Committee Convener Hugh Henry MSP said:
“The Committee recognises the long term policy of governments to shift care from hospitals to home or the community continues to be a significant challenge. This is made all the more difficult by rising demand from Scotland's ageing population and budgetary pressures.
“This challenge is one of the biggest facing Scotland today. It means it is vital that progress is made in the reshaping care for older people programme as it involves changing the way care is provided whilst continuing to meet current and future demands within the budget available.
“The Committee recognises that we are only four years into a 10 year reshaping care programme during which time some progress has been made. However, for there to be a step change in that progress it is vital that NHS Boards, Councils and partners fully exploit the data available on local services.
“It is therefore imperative that the impacts of these changes can be effectively scrutinised. Given the concerns regarding data gaps at a national level, we have asked the Scottish Government for an update on their work in this area.”
The Public Audit Committee’s recommendations include:
Since 2004 the Scottish Government has had a policy objective to ‘shift the balance of care’. This means shifting from institutional services such as hospitals and care homes, to care at home or in the community. It also means having a greater focus on services that prevent or delay ill health.
In 2010, the Scottish Government and the Convention of Scottish Local Authorities (COSLA) launched a ten-year change programme, Reshaping Care for Older People (RCOP). This aims to improve the quality and outcomes of care, and to help meet the challenges of an ageing population.
Scotland's population is ageing, with the percentage of the population aged 65 or over projected to rise from 17% to 25% between 2010 and 2035. Many will enjoy good health and will not need to access intensive or long-stay health and care services. However in 2012, 9% of people aged 65 or over received care at home or as a long stay resident in a care home or hospital. This percentage increased to just over a third for people aged 85 or over.
The length of time people live in good health has not increased in line with life expectancy. In addition, the number of long-term health problems that people have increases with age. In some areas of Scotland, higher levels of deprivation and ill health mean that people need more access to health and social care and at an earlier age.