Health and social care for older people: statement of intent

Older People's Health and Social Care: Statement of Intent

Commitment

Older people are a vital part of ensuring Scotland's future success – essential to our communities, our economy, our public services and to society as a whole. That is why we must ensure we remove barriers, tackle inequalities and allow people to flourish and be themselves.

This statement sets out the Scottish Government's strong intent to make a significant difference to how we approach older people's health and social care in Scotland.

The COVID-19 pandemic has shone a spotlight on older people, who have been among the worst affected by the virus in society. As we rebuild and remobilise our health and social care services in Scotland, we have a significant opportunity to ensure that older people are placed at the centre of the recovery and to focus on a preventative, joined-up approach to healthy ageing in older people.

Building upon the great foundation created by 'A Fairer Scotland for Older People – A Framework for Action', we plan to develop a new integrated health and social care strategy for older people. The Scottish Government are committed to developing the strategy with older people and the people and organisations which support them.

By working together we can help provide everyone with the opportunities and support they need to make Scotland the best place in the world to grow old.

Why we need a new health and social care strategy for older people

Advancements in medicines, improved living standards and public health initiatives have enabled many of us to live longer lives. By mid-2043, it is projected that 22.9% of the population will be of pensionable age, compared to 19.0% in mid-2018. Scotland's age-structural shift is also projected to contain increasing numbers of people aged in the oldest age categories - the number of people aged 90 and over in Scotland is anticipated to double between 2019 and 2043 from 41,927 to 83,335.^[1]

These additional years of life offer great opportunities for us as individuals, for communities, for society and for our economy. Older people provide a valuable contribution to our society through employment, spending, volunteering and often through unpaid caring.

However, not everyone benefits equally from longer lifespans. An accumulation of inequalities - broadly determined by the conditions in which we are born, grow, live, work and age - mean that people living in the most deprived circumstances can expect to spend more than 20 fewer years in good health than those who live in the least deprived areas.^[2] And many, regardless of where they live or their background, may experience mental or physical conditions or functional limitations that can come with age. In Scotland, someone aged 70 has on average 3 significant co existing medical conditions^[3],[4]. This frequency increases with age.

We also cannot ignore the impact the pandemic has had on older people. We know that older people are at serious risk of harm from the virus and that they have been particularly affected by the restrictions put in place to reduce transmission of the virus. We must make proactive efforts to increase and improve the physical health of older people, especially as for many activity will have dramatically decreased over the pandemic. And, addressing the mental health impacts experienced by older people over the past year must be central to our long term response to the pandemic.

There is significant work already underway to address these issues. However we need to make sure it is delivered in a consistent way across Scotland. Development of this strategy will be taken forward alongside the programme of work to implement the Independent Review of Adult Social Care. Together this will ensure our health and social care system consistently delivers high quality services across Scotland – a system that is founded in fairness, equality, and human rights, and that puts lived experience at the heart of its redesign and delivery.

Our vision for Scotland

We want people to enjoy a high quality of life as they grow older. Our ambition is to make Scotland the best place in the world to grow old. We want to achieve this through safe, integrated, person centred health and social care. Everyone should be able to live independently, and drive the decisions about their health and wellbeing; with their human rights respected and their dignity protected.

In order to achieve this, our health and social care systems must work together to support everyone as they age to live as independently as possible, whatever their needs and no matter where they live.

Prevention

Prevention will be central to our new strategy. Staying physically and mentally active can make us more resilient as we age, reduce our risks of dementia, widen our social circle and help prevent falls. This can delay frailty, the stage at which we may become more at risk to illness and disability or become dependent on others for care. We need to get smarter at using our existing information to better anticipate those who may need additional support.

Person-centred care

Older people must lead the decision making around their care and treatment. They must be able to say what matters most to them and these wishes should be recorded, shared with relevant health and social care professionals and acted on. This will enable older people to receive their care, treatment and support in the way that they would prefer. It will ensure that everyone involved in the care and support of that individual is aware of these wishes and can act together to support them.

Older people are not a homogenous group. This demographic is diverse and intersectional, reflecting all protected characteristics and includes people living in social deprivation and those without recourse to public funds. We will consider all experiences of ageing and plan to include them.

Home first approach

People have told us that they would like their care and treatment to be delivered in their home or local community as much as possible. Our health and social care services must reorganise themselves to better support people to live well and independently in their communities as they age. We will build upon our Hospital at Home and Care at Home services to ensure that they are available throughout Scotland. Hospital care should only occur when necessary and we need to ensure that a person's journey through hospital is seamless, with access to specialist care in a timely fashion.

Integrated health and social care

Supporting people to age well and live well requires a multidisciplinary or even multiagency response. We have integrated health and social care in Scotland but it is not delivered consistently. The Independent Review of Adult Social Care paves the way for fundamental changes to our system and provides a roadmap for the future of care provision in Scotland. This ambitious reform will ensure delivery of a high quality, human rights-based service that people need to age well and live well, whatever their circumstances.

Dignity and respect at end of life

As people become older there is a growing awareness of mortality, yet this can be a difficult subject to talk about. We need to discuss issues around death and dying in an open and honest way, and support and encourage opportunities for these conversations. When people require end of life care, they must have access to high quality care, focussing on the physical, social, psychological and spiritual dimensions of care. This care must be provided in a way that minimises harms whilst retaining dignity and humanity. We must also acknowledge and continue to support families through their bereavement, recognising that people grieve in different ways.

Next Steps

This statement is just the beginning of the conversation we need to understand how health and social care services are currently delivering for older people and what kind of system we will need for the future. The pandemic has changed life in Scotland considerably. As we move forward, we must be bold enough to ensure that we have a health and social care system which upholds older people's human rights and allows them to drive the decisions about their care and treatment.

Throughout the remainder of 2021, the Scottish Government will work in partnership with older people including the Older People's Strategic Action Forum, and the people and organisations that work with and support them to identify how we want the health and social care systems to work for older people in the future. This will be followed by a consultation on a draft strategy.

Building on the knowledge and strength of people will lead to the best outcomes and will ensure we make Scotland the best place in the world to grow old.

Jeane Freeman MSP
Cabinet Secretary for Health and Sport

Shirley-Anne Somerville MSP
Cabinet Secretary for Social Security and Older People