One of the biggest challenges facing Scotland, regardless of the outcome of the referendum, is how to ensure the nation's ever-growing number of older people are well cared for.
This is not a newly discovered problem, but one that politicians and civil servants have been wringing their hands about for at least 10 years. New figures, however, provide further confirmation of its sheer scale. They show that, while the number of households in Scotland is projected to increase for all age groups, the greatest increase is for households headed by someone aged over 65. These are predicted to rise by 50 per cent in the next 25 years, while the number headed by over-85s is expected to more than double; compare that to an increase of just three per cent in households headed by someone aged under 65.
Alongside this phenomenon is a dramatic projected increase in the number of very elderly people living alone. This highlights the need for urgent thinking about how to prevent loneliness and depression in the ageing population. Innovative thinking will be required to prevent a situation developing where thousands of older people have only their television sets for company.
At the same time, the figures emphasise the importance of the merging of the NHS and social care services to maximise efficiency.
Because older people are more likely than working-age people to have care needs of various kinds, agencies providing those services are going to come under ever greater pressure. And this is not a far distant prospect; it is happening now. The Herald's NHS: Time for Action campaign has been calling for a wholesale review of health and social care services to ensure the right resources are in place to be able to cope with the large-scale change that is taking place.
These services are already under pressure. It is apparent from the complaints made by nurses about overwork and understaffing and, more recently, the latest figures on NHS waiting times and bed-blocking, that have shown Scottish Government targets are being missed.
The fundamental question is: how is Scotland going to pay for medical and social care of the elderly in future? Will taxation have to be raised?
Councils have pointed to the growing need for families and friends to share caring duties with the state; that is a fair and legitimate expectation, especially given the pressures caring services face. At the same time, health and social care professionals from across Scotland have called for an honest debate about how to fund the NHS, including the possibility of raising taxes.
That is an issue politicians will have to face whatever happens on September 18; in the event of a No vote, it will be critically important that the Scottish Parliament acquires substantial revenue-raising powers in order to have the economic levers to deal with this problem as it sees fit.
It is time politicians engaged the public in a serious debate about how best to manage the growing care needs of the ageing population.
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