Cost-cutting planned as Borders Council report reveals elderly ‘time bomb’

COUNCILLORS will hear today that health and social services in the Borders are sitting on a time bomb because of a dramatic predicted increase in the number of elderly people in the region.

A report signed off by Scottish Borders Council social work director Andrew Lowe reveals that, in just 11 years time, the number of residents aged over 65 will rise by 40 per cent, while over the same period those aged 85 and over will rocket by 57 per cent.

Significantly, the number of Borderers suffering from dementia is also expected to surge by more than 50 per cent by 2020.

And, at 2007/08 prices, the extra cost to cash-strapped SBC and NHS Borders will be £8.2million a year – up 39 per cent on the two organisations’ current expenditure on old people.

These are the facts which underpin a major review, entitled Transforming Older People’s Services (TOPS), which recommends a root-and-branch reform of the way the council delivers its care home and day services.

In essence, the report wants to reduce the number of elderly Borderers in institutional or hospital care and offer alternative services in the community “which promote rehabilitation and maintain independence”.

But Mr Lowe cautions of the radical, cost-cutting measures: “Any changes to services to frail older people generate a degree of anxiety for older people and their carers.

“It will be important to ensure there is effective communication with service users and the press to avoid any negative publicity to the council.”

But he warns: “There is a risk that not making changes … will lead to deterioration in the quality of the fabric and service provided.”

The TOPS review began in August 2007, with two of its key recommendations currently being implemented.

The most controversial of the pair is to increase the share of home care delivered by private providers from 30 per cent to 50 per cent or 5,000 hours a week. These contracts have already been awarded, although around 20 per cent of the 450 affected service users have opted to use direct payments and select their own care provider. At the same time, new shift patterns and have been introduced for SBC’s own more specialist home carers. The cost savings of these changes is expected to be over £380,000 a year by 2012. The council has also moved to remove the postcode lottery in the assessment and speedy access to appropriate services of elderly clients, particularly new customers, in SBC’s five local social work offices in Galashiels, Duns, Hawick, Peebles and Kelso.

“There is no consistency of service with the existing model,” admits the report.

At today’s SBC meeting, Mr Lowe seeks approval to put four other key elements of the review out to public consultation.

These include introducing a so-called telecare service to allow the frail elderly to remain in their own homes rather than ‘blocking’ beds in hospitals and care homes. When piloted last year, it was discovered the sophisticated system, which uses monitoring and measuring devices to remotely alert clinicians to changes in a patient’s condition, rendered 181 sleepovers by carers and 457 home checks unnecessary.

The report claims the system, also designed to accelerate discharge from hospital and reduce admissions, would save SBC £126,000 and NHS Borders £190,000 a year by 2012.

A reduction by the council in housing support, in excess of £100,000 a year, to a range of sheltered accommodation projects in the region is also proposed.

Mr Lowe stresses the financial imperative for change, revealing that last year the combined spend by the council and NHS Borders on long-term care arrangements for the elderly was £20.9million, comprising provision for 731 people in residential care and nursing homes, 90 in long-stay hospital beds and 294 in receipt of intensive home care.

“The balance is heavily weighted towards institutional settings with 83 per cent of the budget spent on care home and long-stay beds, and only 17 per cent supporting people in the community.”

Mr Lowe wants that ratio to become 68 per cent to 32 per cent by 2020, thus reducing joint additional annual expenditure from £8.2million to £5.6million.

The measures, which are currently being finalised, are due to go out to public consultation from July 13 to October 5.