Tough decisions on how we pay for care
Headlines over the past month have highlighted significant concerns, expressed by communities, staff and politicians, related to the potential changes which the Argyll and Bute Health and Social Care Partnership have considered in order to balance their budget.
It is right that these issues are flagged up and communities feel ownership of the precious services which exist to support people in their local areas.
It is also essential that those faced with making the difficult decisions about prioritisation of public finances listen to those who use services and to local communities.
I worked in NHS Highland until May 2017 and I am aware of how challenging it is for service managers to meet the growing costs of health and social care from existing budgets. Continuous efforts are made to address areas of harm, waste and variation in the systems of care and some of these yield significant financial benefits – for example, reducing the number of people who fall and sustain injuries is beneficial primarily for the people themselves, but it also reduces the financial costs of hospital stays and surgery.
Nonetheless, the growing need for care cannot be ignored and neither can the growing costs of care. The current health and social care budget in Scotland is insufficient to cover the costs of delivering the kind of care we would like.
Service managers are faced with daily challenges about how the available budget is allocated for those with the greatest need.
Having worked with these managers, I know the level of commitment and hard work each dedicates to the provision of care.
In the same way that the frontline teams of care at home staff, social workers, doctors, nurses, pharmacists and allied health professionals work for the good of the people of Argyll and Bute, so too do those who are less visible to the public but who are nonetheless focused on doing the right thing.
Rather than vilifying the providers of services in Argyll and Bute, we must find ways to work together to ensure our communities’ needs are met in the best ways possible.
Argyll and Bute’s communities hold many of the answers, are committed to sustainable and resilient futures, and are keen to work in collaboration with the statutory service providers.
This will require more active and meaningful engagement by the Health and Social Care Partnership with communities, so the voices of those who use, and of those who need, the services are not only heard but also attended to.
By forging new relationships we can find innovative and creative solutions to the challenges.
We need to consider what kind of health and social care services we want and whether we are willing to pay more for them.
We must address the issues which cause people in more deprived areas to have poorer health, and we must increase the investment in primary and community care to help people to stay independent and well.
We must also invest in social care and develop a career structure that recognises the contribution of carers to sustaining people in their own homes. All of this will require a greater percentage of our GDP than we currently pay.