Do we need to drastically rethink social care provision in Scotland?

Given the ongoing impact of austerity-driven cuts, and the growth in demand, services may be headed for dramatic change.

The Scottish Government's living wage for care workers comes in in October. At the same time new integrated joint boards overseeing health and social care are beginning to wrestle with their budgets.

In the third sector, and private sector, charities and companies which provide care are waiting to find out how - and how much - of the £250m provided to Scottish councils by the Scottish Government to support the change will find its way to them.

The Convention of Scottish Local Authorities tells me this is already sorted - with local arrangements in place. I must say that's not the picture I've heard from the employers themselves.

In some areas councils have been warning disabled people that cuts to services they are provided may be necessary to help pay for the living wage.

Care workers don't just work with disabled people. Much of the cost of care, and the increasing demand, is driven by meeting the needs of older people who may have disabilities or other health needs.

But there is considerable concern in relation to disability services. The Independent Living in Scotland project (Ilis) recently felt the need to publish a "statement of ambition", calling for an independent commission to look at the way £3.9 billion a year is spent on social care support.

Ilis and 15 other supportive organisations say underfunded social care causes isolation, poverty, illness and indignity for many disabled people and carers.

One significant concern is that an emphasis on health will squeeze out concepts of social care as a means to participate in all aspects of society. The Ilis coalition fears powerful health factions on the joint boards responsible for bringing health and social services together, see social care primarily as an extension of health care and a means to cut health budgets - by reducing hospital delayed discharges for example.

That is plainly important. But health and social care integration will also lead to a rethinking of what care is, and is for.

The charity Cosgrove Care is among those thinking about the consequences. It has just appointed Heather Gray, former director at the Princes Trust, Who Cares? and the National Deaf Children's Society, to be its new chief executive.

The disability charity, which works with people aged from three to 83, is already looking at ways in which it can adapt to a new funding environment where even more is demanded for even less.

Ms Gray says answers could include new service models - more self help and building of community capacity, for instance, better use of technology and increased work in partnerships. Cosgrove is looking at how it can find new funding sources and protect front line staff.

Anecdotally I hear increasingly of people with disabilities whose care packages have been reduced to the extent that their ability to live independently is significantly reduced.

We were moving away from a situation where the best day out a disabled person could expect was a wander round the local shopping mall in the company of a carer. In some parts of the country we are now back to that terribly limited view off what constitutes involvement in meaningful activity.

The reshaping of our expectations of social care may be already underway.