By Councillor Peter Johnston, COSLA Spokesperson for Health and Wellbeing.

"Today sees the publication of a report by Audit Scotland which finds that a new care model is ‘not yet achieving its full potential’.  

"Self-directed support (SDS) is a model of social care and support which offers people new ways of having more choice and control - including by opting to take a direct payment of funds, in lieu of traditional services, and then deciding how they want to spend those funds to meet their social care needs – be that help with dressing and preparing meals, or help to live and work independently in the community.

"Social care is funded by local government and delivered through the new health and social care integration authorities and self-directed support represents a step-change in the way those services are provided and commissioned. Audit Scotland’s report quite rightly acknowledges that authorities are having to make these changes against a backdrop of increasing demand for social care, coupled with tighter budgets. It’s perhaps not surprising then that many areas are struggling to take forward this major transformation change at the pace many would like.

"The issues highlighted by Audit Scotland’s work are important, not least because they raise a number of questions about the wider context for social care which are often shied-away from in public debate.

"Scotland wants, needs and deserves a sustainable health and social care system for future generations; yet public debate tends to focus on the NHS – on the hospitals and health services that we have all used at some point and which are therefore very visible to us. I’m proud to be part of a country that fiercely values the NHS, but I think it’s time we devoted as much attention to the difficult questions surrounding social care – what we mean by ‘social care’, the value we place on it, and how much we, as a society, are willing to pay for it into the future.

"We’ve now seen almost a decade of real-terms reductions to local government budgets and the fact is this is harming the sustainability of our overall health and social care system. Some would argue that the Scottish Government’s recent ring-fencing of some of the resource allocated to local government, requiring that it must be spent on social care, amounts to a form of protection for those services.

"But it also masks two important issues.  

"Firstly, there’s the question of whether the ring-fenced amount is sufficient to meet growing demand. The answer to that is clearly no – councils and integration authorities are increasingly focused on the most urgent or severe needs as there simply isn’t enough resource to go around.

"Secondly, there’s the fact that this ring-fencing is against the backdrop of cuts to the overall local government budget and this impacts on other council services which our communities, including the most vulnerable, rely on daily.  Many of these services are key to supporting individuals and communities so that they don’t go on to require formal health and social care services, or only require them at a later point or to a lesser degree than they otherwise would have – whether that’s through support to stay active, eat well, get involved in the community, learn new skills, stay in employment, look after your mental health, or maintain a caring role.

"If we really want to protect the NHS, we need to re-think what we mean by social care and what that means for where we target limited public resources.

"Building community and personal resilience is critical to the long-term sustainability of health and social care services – we know that empowered local communities are the foundation upon which prevention and early intervention rest, and so building stronger communities needs to be a priority for all levels of Government. That means investing in community development, which in turn means investing in local government.

"Local authorities are the sphere of democracy which sits closest to our communities. Our local councillors live and work in those communities, we rely on local social care services to help care for our parents and grandparents – we know our local communities and strive to work with them to produce the best possible outcomes. That means strengthening community engagement and investing to build skills and capacity within our communities as part of a move to devolve assets and resources even closer to local people, so that support is truly designed from the bottom-up.

"Only by doing this will we create the conditions where ‘social care’ becomes not only a service that individuals and communities receive, but also something that communities engage in by drawing on the personal, social and physical assets we have but which are too-often neglected in a debate that focuses on ‘needs’ and an assumption that all of those needs must be met through traditional health and social care.

"This focus on empowerment, minimum intervention by the state, and viewing people as citizens with strengths and assets, as well as service-users with needs, is something that lies at the heart of self-directed support. It harks back to the values that underpin the social work profession – something we should hold fast to when looking to the future.

"If we want to secure a truly sustainable health and social care system for future generations, then it’s time we tackle the difficult questions about investment in local government, about how much we value our local communities, and about what this means for the way we think about social care."

Article published: 
Wed, 23/08/2017 - 23:01