Speaking at a fringe meeting of the Conservative Party conference the Social Care Minister Jackie Doyle-Price suggested that people should not expect that the houses they live in should be able to be passed on to the next generation as an inheritance. She said that it should not be seen as the role of the state to pay for our care in old age if we can afford to do so ourselves.

Her intervention has led to the start of a strident debate and media discussion. Language such as ‘dementia tax‘ has reappeared in the political lexicon. Inescapably, however, as I said on the BBC last week this is a discussion we badly need to have in Scotland.

Over the past year Scottish Care has continually articulated a message that the older peoples care sector in Scotland is at a point of real challenge if not crisis. We have a nursing shortage of 28% average vacancies; 9 out of 10 care at home providers are unable to recruit to key posts, and nursing care home providers have recently told me they are paying £1000 for one agency nurse to do a night-shift in some parts of the country. Pressures from growing costs, increased registration and regulatory requirements and increasing levels of clinical demand are pushing providers to the very edge.

Faced with such realities people can react in diverse ways.

There might be a tendency on the part of some to bury their heads and assume things will get better without any strategic intervention. They won’t!
There is an equal tendency to seek to do less for more – however, any short term financial gains achieved by such an approach will soon evaporate as individuals no longer deemed eligible for support become more and more unwell and are put at increasing risk. The reduction in the use of care home placements combined with a lack of adequately resourcing care at home and housing support is a game of care roulette with only one victim, the vulnerable older person desperately in need of support and care.

Another reaction is the desire to reform and change. This is undeniably necessary not least in the way we purchase care and treat older people in a discriminatory manner with regards to choice and control such as through the operation of self-directed support. Equally important is the desire to innovate and re-design but if ‘new models of care’ are viewed as some sort of panacea for our current ills we risk losing creative innovation and care entrepreneurship as fatigue and failure take root. Even with progressive use of technology we aren’t going to find a magic chic of gold at the bottom of the care garden.

Overarching all this is a response which says we are doing a lot anyway, we are doing better than others and that we are spending more than we ever have. All of these might very well be true as is the oft heard statement that we need to transfer resources from acute clinical delivery into primary and community health and social care.

But …
and it is a big but. The fact is we have not robustly undertaken an analysis of whether even with reformed, dynamic, localised, non- institutionalised interventions, there will indeed be sufficiency of financial resource it is difficult not to conclude that there is a substantial inadequacy of resource in social care. That is what frontline staff and providers are telling me up and down the country. In particular as we live for longer and with better health, how will we pay for increased dependencies and an even greater volume of care and health need?

Integration is part of the answer to that puzzle but so too is a serious debate about the mechanisms needed to be able to pay for health and care. We need to collectively have a debate about the ethics of being treated free at the point of care if you develop one condition such as cancer but if you live with dementia there will be a greater likelihood you will have to pay. We need to have a debate about the ethics of inheritance and contribution. We need to start to shape the nature of decisions around personal insurance, income tax, separate taxation for care etc.

And we need to do so urgently. This goes way way beyond our politicians. In no way should the care and support of the most vulnerable be used as a party political football. We deserve better and need to find political and societal consensus, agreement and collective resolve.

The debate is urgent. The decisions are necessary. The desired resolution desperately needed.

In our capital city you can now earn more from being a dog walker than supporting the old in their home to live independently and with dignity.
I’m not sure that is the sort of society most of us would want but that is what is our real inheritance unless we act to change it.

Donald Macaskill

@DrDMacaskill

Last Updated on 18th October 2017 by Scottish Care