Health and Social Care Strategy for Older People

The Scottish Government launched its written consultation on a Health and Social

Care Strategy for Older People on 8 March asking a range of questions on the issues that mattered to older people and the organisations that support them, to assist in the development of a Health and Social Care Strategy for Older People.

Our consultation on a Health and Social Care Strategy took place March-July 2022 and as well as receiving 127 responses to the consultation we also carried out 30 online and face to face engagement events with older people and the organisations that support them.

We heard a range of views on what matters to older people, including access to GPs, accessible and affordable transport, accessible homes and preparing for palliative and end of life care.

The Scottish Government has been considering how a Health and Social Care Strategy for Older People links into a new National Care Service, and how the views that have been gathered through this consultation can best inform the development of a National Care Service.

We therefore propose to extend the timeframe for development of a Health and Social Care Strategy for Older People in order to take account of, and contribute to, the development of the NCS.  This is especially important since the National Care Service (Scotland) Bill proposes making provision for the establishment of area boards to carry out Ministers’ functions in relation to social care, social work and community health.

Ministers remain committed to developing a Health and Social Care Strategy for Older People informed by this consultation analysis, once we have fully considered  the implications of the National Care Service Bill.

However, in the meantime, work continues on many aspects mentioned in consultation responses.

Access to GPs

The pandemic has been the biggest shock our NHS has faced in its history. Unfortunately, COVID has necessitated the imposition of Infection Prevention Control measures in order to contain its spread, particularly in the earlier days of the pandemic prior to the vaccination programme being fully rolled out.

These Infection Prevention Control measures, which have recently been deescalated, changed the way GPs see their patients. The Scottish Government wants to see greater availability of face-to-face appointments and is working with the BMA and RCGP to ensure this happens as quickly as possible. However some precautions remain in place as COVID has not gone away. We are clear that where clinically necessary face-to-face consultations will always be available to those who need them. 

Ultimately what is most important is that appointments are agreed between GP and patient through shared decision making, balancing patient choice and clinical judgement.

My Health, My Care, My Home, is a new and transformative healthcare framework that sets out a series of recommendations to improve the outcomes for people living in care homes.  It has a strong focus on multidisciplinary team (MDT) working, with the person living in the care home firmly in the centre of their care and having constant support from their family, friends and the care home team.

We hope that the framework will enhance the health of people living within a care home, improving the way we assess, monitor and respond to their complex and ever-changing health and care needs through a collaborative approach involving health and care professionals, health and social care partnerships and care home providers. Evidence tells us that current health and care provision is sometimes fragmented, reactive and poorly coordinated. Teams across health and social care should pull together as one entity to improve the integration between health and social care. This can enhance the health and wellbeing of those living in care homes, and therefore, improve outcomes

The framework also aims to meet the needs of all people living in care homes by enhancing not only their health, but also their wellbeing. People who live in care homes have told us that the biggest difference to their health is the environment that they live in. Therefore the first section of the healthcare framework focuses on the importance of the nurturing environment for a person’s health and wellbeing. The importance of day-to-day meaningful activities for the health and wellbeing of those living in care homes has never been clearer.

Affordable and Accessible Transport

We are investing in the bus network to support long term growth, providing over £2.1bn for bus over the rest of this parliament. We are continuing free bus travel for older and disabled people to travel anywhere in Scotland by bus, for free. We are seeing more people travelling by bus since the pandemic and I hope to see passenger numbers increase further. The sector faces a range of challenges currently and I am convening the first meeting of the industry taskforce today to explore these issues and work together to find solutions to these.

Scottish Ministers recognise the important role community transport services play as part of the transport network in Scotland and that they play a major part in reducing isolation and increasing social inclusion.

Local authorities are provided with resources for the support of community transport services through the local government finance settlement.

The Scottish Government continues to provide grant funding to the Community Transport Association Scotland to develop the community transport sector in Scotland and to provide advice and support on issues affecting it.

Community transport plays an increasingly important role in supporting patients to access health appointments. This helps to ensure that patients across Scotland are able to access the right care, in the right place and at the right time.

Our Plugged in Communities Fund, which is funded by Transport Scotland and delivered by Energy Saving Trust, is providing £1.5m this year to help community transport organisations to make the transition to zero emission vehicles.

The Scottish Government is also helping community transport organisations to decarbonise their buses through the new Scottish Zero Emission Bus Market Transition Scheme launched in August. 

Community transport organisations are also able to receive support through the Network Support Grant.

Housing

We want older and disabled people in Scotland to have choice, dignity and freedom to access suitable homes, built or adapted to enable them to participate as full and equal citizens.

Wherever possible, all new affordable homes are built to Housing for Varying Needs standards to help them achieve a degree of flexibility to meet people’s needs. In 2020-21, where information was returned, 95% of new build homes delivered by housing associations and councils met those standards.

We have flexible grant funding arrangements ensuring that specialist housing provision, identified by local authorities as a priority, can be supported.

We are introducing a Scottish Accessible Homes Standard from 2025-26 which all new homes will be expected to achieve.

We are also looking to establish an inclusive programme of retrofitting social homes to make them more accessible and providing help to older and disabled homeowners who want to move to a home that better meets their needs.

We are planning to streamline and accelerate the housing adaptations system and will develop recommendations on how best to improve the system so that it will be fit and capable of dealing with the increased demand that an ageing population will drive.

And we are working to embed a person-centred approach that aligns Housing and Health and Social Care services.

We have also issued guidance requiring local authorities to set all-tenure targets for the delivery of wheelchair accessible homes and expect them to set out this requirement in their annual Strategic Housing Investment Plans along with planned investment and delivery to date.

National Care Service

The development of the National Care Service (NCS) will bring together social work, social care and community health to strengthen health and social care integration and to create a comprehensive service that focusses on the support people need to live a full life with human rights at its heart.  It will ensure fair and high quality care for everyone in Scotland. Within the NCS, services will continue to be designed and delivered locally but there will be national oversight to ensure consistency, allow for better sharing of good practice and innovation and to remove unwarranted duplication, making best use of public funds.  We introduced the National Care Service (Scotland) Bill in June 2022 and we are committed to establishing a functioning NCS within the lifetime of this Parliament, by 2026.

Palliative and End of Life Care

We have appointed a Clinical Lead for Palliative and End of Life Care - Kirsty Boyd, Reader in Palliative Care, University of Edinburgh - and an expert Clinical Leadership Team to drive and support the development and delivery of the next Palliative and End of Life Care Strategy. 

We will continue to work jointly and engage closely with those partners to develop a new strategy to achieve the very highest standards of care right up to the end of life, and ensure that everyone who needs it can access seamless, timely and high quality palliative care.

This will contribute to a holistic, integrated and multi-disciplinary approach which will ensure access to palliative and end of life care wherever and whenever it is needed, and which has the person and their families and carers at the centre. 

We will also now be able to consider the implications and benefits arising from a new National Care Service.