Audit Scotland's new report must quicken the pace of change for older people write Ian Welsh and Calum Irving.
How to support our older citizens is an increasingly pressing question in Scotland. Last week’s Audit Scotland report on Reshaping Care for Older People could not have been clearer about the need to quicken the pace of transformation. This is not only a matter for local authorities and health boards – it is a matter for all of us and the third sector, as well as older people themselves and unpaid carers, have a significant role to play.
Audit Scotland is clear this agenda is not simply about improvement; it is about transformational change. There is perhaps a question of how much change will be driven by the 1.5% of spending on older people that the Reshaping Care for Older People Change Fund represents. It is therefore key that we spread and sustain the gains that are being made, and the new models of care that we know have been developed in some areas of Scotland. Achieving this requires not just leadership, but shared leadership in which the third and statutory sectors work effectively together and with older people and carers. Investment in supporting this cross-sector, co-productive approach has been patchy and short term in most areas and this is a key deficit that needs to be addressed if we are to stand a chance of increasing the pace of change.
The third sector provides over a third of formal social care and a wealth of community-based support that is often the linchpin in enabling people to stay well, remain active, involved and in their communities. We often forget that older people are not simply recipients of care, they are valuable contributing citizens and must have a stronger voice in this agenda. Older people are significant providers of support with Scottish Government figures suggesting that around 3,000 over 65-year olds receive more than 20 hours of care each week, while over 40,000 over 65s provide more than 20 hours of care.
Audit Scotland highlights the success of Reshaping Care in fostering greater partnership and notes that the third sector is now more involved in planning services. To support this the ALLIANCE, with partners, run the ‘Reshaping Care for Older People – Enhancing the role of the Third Sector’ programme, providing essential support to the local third sector support organisations known as ‘Third Sector Interfaces’ which act as third sector strategic leads for Reshaping Care locally. A recent scoping exercise carried out by this programme reinforces the view that the sector is more involved and that partnerships are stronger. However it also reveals that some of these relationships are ‘fragile’. In the vast majority of areas relationships still do not enable difficult and contentious issues to be discussed openly. Supporting these cross-sector relationships to strengthen and mature requires mutual trust, respect and understanding. This requires significant investment of time and energy. We have no doubt that the level of investment in the capacity of the third sector to play its role in Reshaping Care was significantly underestimated and this must be addressed as we move towards the wider health and social care integration agenda.
While third sector involvement in Reshaping Care partnerships is mandated, that of older people and unpaid carers is not. Some partnerships benefit from their knowledge, skills and experience, however this is far from universal. Effective involvement of older people and carers must become the default if we are to achieve effective, well designed services that deliver the best possible outcomes.
We welcome Audit Scotland’s recommendations and hope they provide added impetus to the pace of change and to effective planning to embed and sustain the shifts already achieved. We welcome the emphasis on evidence based practice, although that evidence must be sensitive to lower-level, community based support that older people consistently report as having a substantial positive impact on quality of life. Evidence must also take account of the complexities of health, wellbeing and quality of life and the impacts of a myriad individual, social and environmental factors along with the cumulative impact of a range of supports or services. A key message from the third sector is the challenge of measurement approaches that do not sufficiently value precisely the holistic approaches that are often key to the very shifts Reshaping Care seeks to achieve.
Above all we support Audit Scotland’s reinforcement of the importance of community assets. This agenda is too important for us not to garner our collective assets and bring them to bear in shaping a future in which all of us are well supported and positively valued in our old age.
Aberdeen City Befriending Partnership (ACBP) demonstrates Reshaping Care for Older People’s ability to foster successful partnerships which improve services. It supports people over 65 who face isolation; disconnection from their community and loss of independence.
ACBP partner Living Well Befriending Project and befriender Christine Coutts support people such as Sheila McLaughlin, 77. Sheila says weekly visits have made ‘a huge difference’ to her life.
“Just having the chance to talk, to set the world to rights or to actually get out and do something, a lunch club or even just shopping, has added a whole new side to my life. It’s about fellowship.”
“The company is great and it makes you feel so much better in yourself.”
Christine, a retired nurse, talks about the ‘precious time’ she spends with Sheila saying
I’m just happy to be making a difference.
The establishment of ACBP was facilitated by ACVO and has brought together the TSI, local third sector organisations, the local authority and NHS to create a service which builds support around the person and makes the most of people assets. It serves to embed third sector activity in local strategic planning, including Community Planning and local ‘joint commissioning strategies.’