Audit Scotland review shows ‘slow progress’ on elderly reforms
A major Scottish Government programme aimed at improving care for Scotland’s elderly population has made slow progress so far, a report has found.
Audit Scotland has reviewed progress three years into the Government’s 10-year project to reshape health and social services for people aged 65 and over.
It found there is limited evidence of money being moved to community-based services, and away from institutional services such as hospitals and care homes.
The report has called for more funding to be focussed on preventing or delaying ill health and supporting people to live in their own homes.
The move is necessary due to increasing spending on health and social care for older people, which Audit Scotland said is not sustainable.
The Scottish Government predicts that spending in this area will need to rise from around £4.5 billion in 2011/12 to nearly £8 billion in 2031.
The programme is one of Scotland’s biggest and most complex projects, involving NHS, local government, voluntary and private bodies, and is supported by £300 million of funding over four years.
But Audit Scotland said that, three years in, it is yet to demonstrate how “significant changes” will be achieved.
It said: “There is no clear national monitoring to show whether the policy is being implemented successfully and what impact it is having on older people.
“Strong national and local leadership is needed to take this challenging agenda forward.”
The report went on to state that the Scottish Government needs to work with its partners to clearly plan how resources will move from institutions into the community. They also need to better understand why activity and spending on services for older people varies across Scotland.
Auditor General for Scotland Caroline Gardner said: ” While there has been progress, particularly in bringing bodies together, change has been slow.
“Our report makes recommendations aimed at helping accelerate change, particularly given the growing pressure on services and the integration of health and social care.
“In particular, we want to see better information for making decisions and assessing impact, and the Government and its partners to be clearer about how to move resources from institutions, like hospitals, to community-based services.”
Conservative health spokesman Jackson Carlaw said: “It is welcome that people are living longer and healthier lives, but with that comes a monumental fiscal burden.
“The job to change services to cope with this is a complex one, but this report clearly highlights areas where the Scottish Government has to do much better. “
Hugh Henry, convener of Holyrood’s Public Audit Committee, said: “It is disappointing that the Audit Scotland report notes that progress in improving care for older people has been slow, and that monitoring of the impacts on older people needs to improve.
“As £4.5 billion of public money was spent on care for the elderly in 2011/12, the Public Audit Committee will want to know why there hasn’t been more significant progress in improving the care of older people when it hears from the Auditor General for Scotland at its meeting on February 19.”
Councillor Peter Johnston, council body Cosla’s health and wellbeing spokesman, said: “We in local government welcome this report from Audit Scotland.
“It highlights that more needs to be done to shift resources to community based services.
“While this has happened in a limited way through the Change Fund, we think that the integration of health and social care services will allow local partnerships to really focus on investing money in preventive services and moving away from institutional care.
“We recognise that more needs to be done to monitor cost, activity and outcomes and we are working with key partners to improve this situation.
“Our view more generally is that the reshaping care programme has consolidated partnership working, it has allowed local partnerships to innovate and it has helped to support more older people live independent lives.”
Brian Sloan, chief executive of Age Scotland, said: “Reshaping care to prioritise preventative and anticipatory services in the community, shifting away from expensive and unnecessary hospital treatment, was never going to be easy, but it is vital.
“This report shows that we need both to do more and do better. Most importantly, we need greater national and local leadership to drive through this change with more urgency. This has to start with a proper monitoring system so we know precisely how money is being spent around the country and what is working and what isn’t.
“Without this we’ll continue to see the patchy, slow progress which Audit Scotland has highlighted today.”
The Audit Scotland report found that delayed discharges from hospitals remain an issue, although progress towards targets have been made.
In 2012/13, the equivalent of 837 hospital beds were occupied for a year by patients aged 75 or over who are clinically ready to leave hospital.
Liberal Democrat MSP Jim Hume said: ” Despite the continued warning signs over bed shortages, rising emergency admissions amongst older patients and real problems with continuing care, these figures confirm that older patients are still being left to languish on hospital beds even though they are clinically ready to leave hospital.
“Integrating health and social care is important if we are to build a health service fit to cope with the challenges of an ageing population, but it should not be done in a way which compromises patient care and safety.”
Commenting on the report, a Scottish Government spokeswoman said: “The Scottish Government is absolutely committed to ensuring that our older population get the support they need to stay in their own homes for as long as possible.
“Services must evolve to meet the challenges of this ageing population. That is why this Government is investing £300 million in the reshaping care for older people programme – not as an end in itself, but as means to realise our ambitious vision for a fairer and more prosperous Scotland.”
The spokeswoman said that the Integration of Adult Health and Social Care Bill, which will bring the two services together will ” focus on improving anticipatory care for people in communities and help to reduce inappropriate use of acute and institutional care”.
She added: “This report looks at the first two years of a 10-year programme and does not fully reflect some of the excellent work happening in local communities, which the recently published report from the Joint Improvement Team has already highlighted.
“Local partnerships are already developing robust systems for assessing progress locally and are using this information to help inform how they commission services in the future.”