To call it daunting would be an understatement.
Changing the way older people are cared for so that large numbers are looked after in the community instead of in hospital, is the public policy equivalent of trying to shift Ben Nevis a few feet to the left.
It means that decades of tradition, habit and received wisdom among hospital staff, social work departments and voluntary agencies will have to be overturned to make way for new ways of operating. Jealously guarded NHS budgets will have to be shared with social work departments. To persuade those who plan services locally to change the way they allocate resources, clear proof is required that looking after people in the community improves the care they receive and helps prevent hospital admissions.
Unfortunately, problems on all these fronts mean that there has been slow progress towards improving care for the elderly population.
A report by Audit Scotland today finds that there is limited evidence of money being moved to community-based services, and away from institutional services such as hospitals and care homes. The Scottish Government's 10-year plan Reshaping Care for Older People has no clear national monitoring system to show that it is being implemented successfully and what impact this is having on older people.
There is evidence that the Change Fund has brought together different sectors to agree joint plans to improve care, and some small-scale initiatives are under way, but the report has found that not all of them are evidence-based or monitored properly, and few of the health and social care partnerships responsible for spending the money could show their work meant fewer old people in institutional care.
This is not a problem of tomorrow, but of today. The Herald's NHS: Time for Action campaign has highlighted the way in which the growing elderly population has been putting pressure on hospital services since last winter and, doom-laden as it may sound, the problem is only going to get worse. Theresa Fyffe, director of the Royal College of Nursing Scotland, has highlighted a "massive gap in workforce planning", encompassing the NHS, local authorities, care homes and the voluntary sector. Her remarks echo The Herald's call for a review of hospital and community services to ensure they are geared up to cope with caring for the elderly population in future. Audit Scotland points up the need for strong local and national leadership to drive forward change, leadership which is currently lacking.
The Scottish Government knows this is a challenge, but this report underlines starkly that efforts so far are falling short. Unless the way elderly care is delivered is changed, the cost to the NHS will simply spiral out of control and elderly people will lose out. Change must happen promptly because Scotland's demographics are changing quickly. The Scottish Government was right to launch Reshaping Care for Older People, but must now look again at the pace of progress and the need at all levels for better information to help managers make decisions and better monitoring of what works and what does not. There is no more time to lose.
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