What price dignity?
The flagship policy of Health and Social Care Integration which was established, from April 1, created Integrated Joint Boards bringing health and social care together for many services.
Like many I saw the logic of closer working, pooling resources, placing the patient or citizen at the heart of clinical and social care. With others I heard the words ‘partnership’, ‘collaboration’ and that frequently used and rarely understood concept called ‘co-production’.
So how has it been on the ground?
It’s early days but the signs have not been positive in many areas if you are a care at home or housing support provider.
The first real test came in the form of dispersing £125m Government funds to frontline care staff to ensure they were paid the Scottish Living Wage.
This has the potential of creating real change in a sector which employs thousands of workers who daily deliver care and support to some of our most vulnerable citizens. But over the years public authorities have sought to buy quality care from providers, whether charitable or private, by paying lower and lower rates.
Such a process cannot continue if we are to attract and hold onto staff who are required to be increasingly skilled, whose work is demanding and emotionally draining.
But even if we move into calmer waters the recent experience of negotiation has highlighted a deeper issue. Namely, the relative priority given to older people’s care and support.
Successive governments have trumpeted Free Personal Care and this has been a laudable policy. But one cannot dine out on a single initiative forever.
Year on year as an ageing population increases and lives for longer we are spending per capita less on older people’s care and support. By 2022 the number of over 75s will increase to 530,000 in 2022, reaching 780,000 in 2037 – an increase of 86 per cent in just a quarter of a century – 360,000 more than today.
Hard decisions must be made sooner rather than later and these in large part will determine how much we truly value older people in modern day Scotland.
The cake is getting smaller and smaller – but have we had a proper debate about the equity of cutting that cake? I think not.
This goes beyond party politics to the heart of who we are as a society.
It necessitates the real hard collective work of determining the true cost of care now and for the next decades. It is more than negotiating a decent set of terms and conditions for workers. It is about negotiating the price of dignity and the value of old age.
Dr Donald Macaskill
This article first appeared in The Times on 27th September 2016