Ministers urged to shake up care for elderly

A MAJOR Scottish Government commissioned report will today call for the break-up of the bureaucratic empires governing health and social care, having concluded that Scotland’s public services are “patchwork”, “outdated” and “producer-led”.

A final draft of the report by the Christie Commission on the Future Delivery of Public Services, obtained by The Scotsman, says patients and especially elderly people should no longer be shunted between hospital and councils as they seek medical and social support.

It says “substantial savings” – which could run into hundreds of millions of pounds – can be expected if health and social care are integrated, so that patients only have one place to go to receive help.

The conclusion is one of several recommendations from the commission, led by former STUC general secretary Campbell Christie, which publishes its full findings today, following a nationwide nine-month examination of the country’s public landscape.

The report is expected to play a key role in government decisions over coming weeks, as ministers prepare to handle reductions in their available budgets at the same time as multi-billion-pound increases in the costs of delivering health, social care and education.

In the 113-page report, the commission says the public sector is “in urgent need of sustained reform” to meet what it describes as an “unprecedented challenge”, criticising what it describes as a “fragmented, complex and opaque” system which actively hampers the ability of public servants to work together.

In a damning assessment of the post-devolution years, it concludes that despite public spending having rocketed since the onset of devolution, politicians have “failed” to turn around deep-rooted inequalities which, it says, still scar Scotland and have got worse in many cases.

It says the main reason is because far too much money is spent on trying to alleviate social problems rather than keeping an eye on the big picture and tackling them at source – a failure which, it says, is no longer sustainable in the face of tightened budgets. “A radical change in the design and delivery of public services is necessary to tackle the deep-rooted social problems that persist in communities across the country. A cycle of deprivation and low aspiration has been allowed to persist because preventative measures have not been prioritised,” the report concludes.

The commission calls for a complete culture change in the public sector to focus on prevention, and says all public bodies should focus on improving “outcomes” for patients, pupils and the public. This requires much more collaboration across different public-sector bodies which, at present, are too focused on their own work to see the bigger picture, it adds.

It concludes: “We call on the Scottish Government and local authorities together with all their partners and stake holders to initiate these reforms. The goal must be nothing less than a thorough transformation of our public services. The prize is a sustainable, person-centred system, achieving outcomes for every citizen and every community.”

The report stops short from any specific recommendations on costly Scottish Government policies, saying only that contentious issues such as “free” public services should be considered “openly and transparently”. Nor does it offer any recommendations on cutting the number of councils or health boards.

• Analysis: Culture of spending is now a distant memory

However, it does place doubts over key SNP plans to create a single police and fire service, saying that “a number of questions remain to be addressed” as to whether it will lead to improved outcomes for the public.

The report also acknowledges that the call for a shift to preventative spending will be “controversial” as it could lead to spending being cut on existing services, such as hospital care.

Although the report does not offer details on what these may be, suggestions by other reformers include plans to shift cash from “demand-led services”, such as A&E units, to community healthcare which may help elderly people stay out of hospital.

However, SNP ministers have pledged to maintain spending on hospital care, in the face of huge public support for the retention of local acute services.

Nonetheless, the call for more integration in health and social care is likely to be backed by ministers today, who have already said they want to see reform rolled out across Scotland.

The move is currently being piloted in the Highlands where, for example, GPs will soon be able to prescribe home help for an elderly patient in need of support instead of sending them to accident and emergency.

However, unions are still sceptical about the measures, while local government chiefs have already mounted their full-scale opposition, claiming that reorganisation costs could amount to between £300m and £500m.

Nonetheless, other experts argue that around a half of the annual £1.5bn cost of sending elderly people to A&E could potentially be saved if there was better treatment and care for them at home.

The Christie Commission was appointed by First Minister Alex Salmond last November to see how the public sector could better improve outcomes across Scotland. It comes after another review, led by former Scottish Enterprise chief Crawford Beveridge, also called for major reforms to public policy in the face of the slowdown in public spending and rising costs.

The Christie Commission took evidence from across the public sphere in Scotland, and concluded that there are “serious shortcomings” in the way the public sector is designed. Different bodies “work routinely to different objectives” and frequently duplicate each other’s work.

Government-led action “often results in top-down, producer and institution-focused approaches where the interests of organisations and professional groups come before those of the public”, the report says. Instead, there needs to be more work done to involve people in the way services are run.

The system also fails to empower people to do things for themselves, which fosters a dependency culture, it says. Ministers should ensure a fundamental rethink of the way the public sector works with voluntary and private providers, it adds.

It also warns that because politicians are constantly seeking election, there is rarely a focus on long-term issues.

To compel public bodies to work together, the commission recommends that ministers pass new legislation which forces them to concentrate on improving outcomes for people, not targets or on spending money.

Other specific ideas include beefing up Audit Scotland to crack down on profligacy; piloting a “single public authority” which looks after everything in a given area; and having an annual report costing the long-term financial problems Scotland faces.

John Downie, of the Scottish Council for Voluntary Organisations, said: “The focus on preventative spending is right and that is what the Scottish Government needs to focus on. Scotland has been talking about this for some time now, but we now need to do something about it.”