SCOTLAND’S health and social care system is already under serious strain. But according to the country’s leading expert on dementia, the gaps could be about to widen further – with serious results for all of us as we get older.

Without extra investment, says Professor June Andrews, the system could be reduced to three tiers: great care for the rich, decent care for the middle classes if they sell their homes and cash in their savings and, at the bottom, sub-standard care that is under-funded and under-staffed. It is a grim prediction that could signal the end to the principle – already under serious strain – of a good standard of care for everyone.

Professor Andrews is predicting the dark future partly because of the changing demographics of Scotland. As part of the Grey Matters series looking at the issues affecting Scotland’s ageing population, The Herald has reported on the latest research showing that the number of over-85s is expected to increase 110 per cent by 2034 - and an older population means more of the problems associated with ageing: heart disease, frailty and dementia.

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All of this will demand more of the care system, but Professor Andrews believes it is simply not ready and that those who cannot afford to top up their own care will be doomed to an elderly life of neglect and poor care.

One obvious way to prevent this from happening is to improve community health and social care and keep more people out of hospital for longer - something which the Scottish Government is tackling through the establishment of Health and Social Care Partnerships, which are a good idea in principle. Hospitals can often make elderly people frailer and more confused and accelerate their journey into care, while caring for people at home, on the other hand, can leave them stronger, less likely to return to hospital, and, most importantly, much happier.

But the problem is funding. The Government says the aim of the partnerships is to improve community health and keep more people out of hospital, but from the start, the policy has been beset by a lack of money. There is some extra funding, but it is not enough, and many Scottish care homes also say the national agreement on funding offers only a one per cent increase at a time when they are facing an eight per cent rise in their costs.

Professor Andrews very reasonably points out that the only answer is for the Government to pay what care actually costs. Speaking in The Herald, the expert on healthcare for the elderly, Professor Ian Philp, also suggests that Scotland should double spending on community-based help.

This is not the answer the Government will want to hear, but it is ultimately a fairly simple equation: Scots will need more care and that care comes with a price. We could carry on believing that our care will be paid for by somebody else; the Government could also try to convince us it can handle the situation with only a marginal increase in funding. But at some point everyone – the Government and the elderly themselves, and especially taxpayers – is going to have to accept the truth: building a social care system that can care for people when they need it will require more funds.