Date of prep: December 2020
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Talk of creating a national care service is a “distraction” from the larger problem of an inevitable rise in numbers of older people needing social care over the next two decades, according to a Scots economist.
Speaking to members of Holyrood’s Health Committee recently, Professor David Bell warned MSPs that local authorities would not be able to cope without “significant” additional funding and called for a public discussion about what taxes would need to rise to pay for this.
Between 2020 and 2040 the number of people aged 80 and older in Scotland will increase by around 68%, while a 74% increase in the number of Scots with dementia is also expected over the same time.
Addressing the Committee, Professor Bell said the Scottish government “hasn’t done much strategic thinking” after the move to providing free personal care for over 65s in 2002, and this “has been exacerbated by the austerity we have seen over the last decade.”
“Social care is bigger than the NHS in terms of the people employed but yet it gets a fraction of the attention the NHS does,” he added.
“It is a hugely important sector and a very complicated one as it includes private, public, unpaid carers, third sector partners and others.”
In a paper submitted recently by the University of Stirling academic in response to the Committee’s social care inquiry, Professor Bell highlights how local authorities – the bodies responsible for delivering social care – have had their budgets cut in real terms by 13.9% between 2012-13 and 2018-19.
Professor Bell, who as well as being a finance and devolution expert has advised a number of care and ageing review groups, explains the reduction was partly due to the UK government’s austerity policies but also the Scottish government ‘largely following the UK government’s budgetary approach by increasing the NHS funding at the expense of other spending priorities.’
‘There is now little scope for local authorities to divert more funding to social care at current levels of funding,’ the paper states. ‘Scottish local government is not able to meet the inevitable increase in demand for social care during the next two decades.
‘It has squeezed the care home sector: the 2017 national contract for residential care paid £558.77 per week, while self-funders paid £648.92. Self-funders are cross-subsidising those who are supported by the local authorities, and the number of private-sector care home places only increased by 7% between 2007 and 2017.’
He adds: ‘Growth in social care provision of less than 1% per annum during a period when current and future demand can reliably be predicted to rise at a much faster rate, does not suggest that the private sector feel this is an attractive sector in which to invest.
‘This may reflect their recent experience with the level of charges that local authorities are able to bear.
‘If the private sector is unwilling, and instead the public sector is expected to make the investment in social care a strategic priority, it is not clear which budgets might be raided to support this priority.
‘The alternative of increasing taxes or user charges tends not to be discussed. This must be part of the policy agenda going forward. Part of this discussion must be how paying for increased investment in social care can be organised fairly.’
The recent meeting marked the start of the next phase of the Health Committee’s inquiry into social care which was supposed to take place in April but delayed by the pandemic.
That deaths in care homes related to covid-19 were proportionally higher in Scotland than elsewhere in the UK reflects the difficulty the sector faced, Professor Bell told MSPs recently.
He said social care was left without the resources for adequate PPE and testing, and that the system “buckled under the strain”.
“We are left with an issue around, it seems to me, discussions of a national care service which are somewhat of a distraction,” he said.
“Since local government is the main funder in this monopsony this puts huge pressure on the ability of local government to fund the sector.
“At what point do you set the floor above which people are expected to contribute to their care or do you do it through a general increase in taxation?
“Or targeted taxation of people more likely to benefit from it? Or do you go use some sort of a system of insurance? But the record of insurance systems around the world is not a happy one.
“Scotland does need to address this strategic question because there will be increases in demand. Whether that is met in care homes or care at home, there will be an increase in demand for care services for older people going forward.”
by Sarah Nimmo
Pharmacy in Practice is a UK pharmacy publication with its roots in Scotland.