There is a cost-of-care crisis in Scotland and the scale of it is beginning to emerge.
When The Herald asked every council for the facts on their social work spending as part of the NHS: Time for Action campaign, more than half said they had burst their budgets, with Glasgow predicting an overspend of £9.7m this financial year and Fife £10.7m.
What the figures demonstrate is that across Scotland, the funding available to care for the elderly and vulnerable is stretched to, and in many cases, beyond capacity. This has serious consequences for those who rely on social care - and in some cases the consequences are already with us. Edinburgh City Council, for example, says its waiting lists for care packages for pensioners and the disabled have doubled, leaving hundreds of people without the care they need.
There are a number of social, economic and policy reasons for this crisis. The ageing population is an important factor, although as the Economic and Social Research Council pointed out earlier this month, an increasing number of old people can expect to live longer but also healthier lives. Age does not necessarily mean dependency.
When it does, it is often because of the entrenched poverty which the Convention of Scottish Local Authorities has also identified as a cause of the stretched budgets. Poverty often leaves many elderly men and women needing complex, expensive care for long periods, and is something which the west of Scotland and Glasgow in particular have wrestled with for generations.
However, these social and economic factors do not tell the whole story on social care budgets. Just as important are the policy decisions which have been made at national and local level, some of which are having unintended consequences.
The first is the council tax freeze, which not only offers the biggest savings to those in the biggest houses, it has forced councils to cut back on services for the most vulnerable. The policy must be reconsidered urgently.
Secondly, the personalisation of community care - which was designed to give people with disabilities more control over the services they use - has been combined with significant budget cuts, although several councils say self-directed support is still a major cause of budget over-runs. The personalisation programme must be properly funded.
The third factor which is putting pressure on social care budgets is the integration of health and social care services. Again, the principle may be good, particularly the aim of keeping unnecessary hospital admissions down, but there is a gulf between the vision and the reality. The necessary funds have been slow in making their way to where they will be most effective.
These issues - and possible solutions - will be discussed today at an event which is being hosted by The Herald. Clearly, one possible solution would be to increase social care budgets, but equally there has to be realism about the cost and sustainability of other policies, such as free prescriptions. Longer term, a shift to preventative policies is also needed and specifically community-based initiatives that help prevent elderly people ending up in hospital.
What is also clear is that councils cannot cope with this crisis simply by being clever with their budgets - the problem is much too big for that. The shape of society is changing, and that means its social care must too. But it must be properly funded and efficiently run. Otherwise, it is the poor and vulnerable who suffer.
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