Policy responses and statements
Background: Scotland is changing. Uniquely amongst the other nations in the UK, Scotland's population is not growing, it is more or less static - in fact it has remained at around 5 million for most of the last century. However, the age structure of the population is changing significantly. As a result of lower birth rates and greater life expectancy, there will be many more older people in Scotland, and fewer younger people. The aim of the strategy is to provide a long term framework for:
The Strategy is being developed within the context of existing work and initiatives of the Scottish Executive and the UK Government. The need to respond to the ageing population lies not just with the Scottish Executive, but with local authorities, health boards, professions, the voluntary sector, the private sector, communities, and individuals. Some issues, like pensions, benefits, and discrimination legislation, are the responsibility of the UK Government. The Scottish Executive works closely with the UK government on these reserved matters, for example to promote better take-up of benefits. The Scotland Act 1998 gives the Scottish Parliament power to encourage equal opportunities, including in relation to age. The objectives of the Strategy are:
This paper sets out some of the issues within which a Strategy for a Scotland with an Ageing Population is being developed, and highlights some of the areas which will need to be considered. This paper is available on request in alternative formats and languages. Please contact Jess Barrow on 0131 244 0718 or email jess.barrow@scotland.gsi.gov.uk 1 Introduction Scotland is changing. As a result of lower birth rates and greater life expectancy, in the coming decades there will be many more older people in Scotland, and fewer younger people. This poses a challenge for Scotland's government - how to ensure that Scotland is a fit place in which to grow old? And how can Scotland benefit from this change? It's also a challenge for local authorities, businesses, charities, communities, and individuals. There have been two significant baby-booms in the last century - the first was after the second world war, and the second was in the 1960s. In previous years government responded to the challenge by building and expanding schools - now as these baby-boom generations age, Scotland needs to respond in new and different ways, to make sure that its services, buildings, transport, structures and society are fit for purpose. Because of this, the Scottish Executive is developing a Strategy for a Scotland with an Ageing Population, which will be published by the end of 2006. We want to know what you think should be in the Strategy. Some issues, like pensions and benefits, are the responsibility of the UK Government. The Scottish Executive works closely with the UK government on these reserved matters, for example to promote better take-up of benefits. The Scottish Executive wants to recognise and maximise the contribution made by older people to society. That's why we're asking you for ideas on how we might be able to do this. 2 How to use this paper This paper is meant to stimulate discussion on Scotland's ageing population. There is space after each question to write in your comments, or you can send your response separately, but please remember to fill in the Respondent Information Form ( RIF) that is at the end of the questionnaire. The paper can be used in various ways by groups, individuals, or organisations. It is easy to copy and share. If you need extra copies, please let us know and we'll send them out to you.
You can send us your own views. Please remember to give us your details on the RIF at the end of the questionnaire.
You can use the form to submit your organisational view. You could also use it for group discussions (as below), or you could circulate it to your members and collate their responses. If you do consult your members, please can you let us know how many people you involved. Please remember to complete the RIF.
You can also copy the form and use it as the basis for group discussion, and fill in a summary of the discussion. If you submit a collective response, please let us know how many people took part in the discussion, and complete the RIF. 3 The Questions There are six broad questions, covering a very wide range of issues. Don't worry about answering the questions exactly - we want to know what issues concern you about the ageing population. You can also tell us about things that you think are currently working well. 3.1 Contribution and Opportunity Older people today contribute in many ways to Scottish society. For example they provide care for partners, parents, grandchildren, friends and relations. They might go to work, or be self-employed. They pay taxes and support the economy. They are consumers, buying goods and services, and supporting business. They are volunteers, giving their time and skills to communities and charities; and they are citizens, involved with friends, neighbours, families and communities. They have also contributed to society throughout their lives. The Scottish Executive wants to know how best to support older people who wish to contribute to society, and to recognise the contribution that people have already made. For example,
Please tell use what you think: Answer to Q. 3.1 - Contribution and Opportunity Older people in Scotland are a rich resource, but significantly undervalued. For example, they often provide crucial support for many working parents by caring for grandchildren, whilst parents contribute to the economy. This economic contribution is unrecognised. Many older people would prefer to continue to work beyond current retirement age, often on a part-time basis, but opportunities for this are limited because of employers’ attitudes. In some ways older people could be regarded as the equivalent of the “institutional memory” of our society. Much can be learned from the experience of others and much of that is not written down but transmitted from person to person. Empowered older people can bring a degree of caution and good sense to consensus and perhaps sometimes balance the zeal and idealism of the young. It is important, therefore, that all representative and consultative work for the Executive retains a proportion of older people or older people’s views. An obstacle to involvement at present could be the rapid expansion of information technology. Although many younger individuals are comfortable with accessing information on the internet, older individuals are often not so fluent. It remains important, therefore, until our current younger generation ages, that we produce high quality information and access to information in forms other than electronic forms, and also increase opportunities for older people to learn and gain access to simple information technology. There is underlying ageism, which is embedded within society and promoted through media, with a youth culture dominating spoken, written and visual communications. Approaches to reduce intergenerational conflict and promote understanding should be developed. The government and charities should work together to broaden understanding about older people and raise the value placed on our seniors by society at large. 3.2 Work Some people want to retire early, and others want to keep working for as long as they can, but too often it doesn't work out the way people want. The Scottish Executive wants to know what you think about work for people who are not yet retired, for example:
Please tell us what you think: Answer to Q. 3.2 - Work If people are to be encouraged (or obliged) to work beyond current retirement age, then more flexible ways of working need to be introduced around the age of 50 years. A graduated approach to retirement, without a fixed chronological time being identified, would allow for continued contributions by an older and experienced workforce. The opportunities for job sharing and increasingly part time work should be promoted across a wide variety of sectors, with perhaps financial incentives to employer and employee. The current situation in which senior staff work harder and harder up to retirement, then suddenly stop work overnight needs to change. 3.3 Services for older people Lots of services for older people are provided by councils, charities, the NHS and business; services such as health care, housing, community care and transport. As society ages, we will need to make sure that we can continue to provide services for older people, and that these services work well for the people who use them. The Scottish Executive wants to know what you think about services for older people. For example:
Please tell us what you think: Answer to Q. 3.3 – Services for Older People The biggest issue in the intermediate future for Scotland to confront is the care of the frail disabled old. Although these people represent a minority of the older population in general, their numbers are increasing greatly and the burden of care that they impose upon others in our society is significant. Service planning for older people in relation to health, social and community care has been too much on an “ad hoc” rather than population basis. Deregulation and promotion of the private sector has resulted in inequalities of provision, such that some local populations cannot access services they need. In other areas, there is excessive provision of eg care homes. The divide between local authority supported services, with the influence of local politics and “free” NHS services makes joint working difficult. Levels of means tested support are inconsistent across local authority areas and there is a tension between health and local authorities as both are cash strapped and apt to pass on costs to the other. These inequalities are unfair on families and their older relatives. At a local level, many older people are now getting care and services that allow them to remain in their own homes for much longer, this usually being their wish. The introduction of free personal care has supported this. However, it is unrealistic to suggest that we will be able to afford, or provide the personnel, to provide increased levels of domiciliary care for all frail older people. An increase in the number of quality care home places will be necessary. More than financial resources would be required to achieve this - because of the shifting dependency ratio, there is a proportionally smaller number of younger people available to care for the frail old and current wage structures and alternative employment opportunities are such that these posts are not attractive. The timeous provision of effective ongoing care for our frail older patients would unlock a large number of NHS acute hospital beds all over Scotland. At present, lengthy hospital waits for community care, with resultant delayed discharges, are quite unacceptable parts of the Scottish scene. With regard to the issue of ensuring that different services work together properly, the most important change would be to dissolve the division between health care and social care funding, infrastructure and management in Scotland. The presence of this division creates tremendous difficulty for patients and carers who are attempting to understand and access services, and just as importantly, for those within those services who are trying to develop new initiatives, which, inevitably cross the current arbitrary divide between the two services. The current situation in which older peoples’ care needs are included under the social care budget means that they are competing for resources with other truly “social” problems such as child abuse. A direct example of that is the relative loss of focus from the Lothian Social Work Department recently on older peoples’ issues following the controversy regarding their management of younger children. In terms of regulation, initiatives such the care commission require to communicate more intelligently and sensitively with a range of service providers and “stakeholders”. 3.4 Health and well-being The following questions ask about older people and the importance of health and well-being in old age. The questions also ask what needs to be done to support good health in later life. These questions deal with both physical and mental health. The Scottish Executive wants to know what you think about helping people stay healthy and well in later life. For example:
Please tell us what you think: Answer to Q. 3.4 – Health and well-being It is important to work to dispel the myth that “old age” is to blame for many of the common everyday problems of older people. We should strive to ensure that older people, their families and carers recognise that in the first instance, active treatable disease should be excluded in patients of all ages. At present, too many individuals, and the agencies involved in their care, continue to accept decline in health with inadequate explanation or attempt at improvement or cure. The most important modifiable influences on health in later life are social and economic environment (low incomes, poverty, poor housing, social isolation) lifestyle (exercise, obesity, cigarette smoking, alcohol intake) and nutrition. Unfortunately, older people are infrequently targeted by health promotion campaigns, and most healthcare professionals lack the skills, time and/or inclination to give appropriate advice. Limited parts of the new GP contract support improving care for older people, but further modification is suggested. The National Service Framework for Older People in England explicitly accepted that ageism did exist within the English Health Service and set up a framework for monitoring, identifying and tackling the problem. No similar initiative exists within the Scottish NHS and the Executive seems reluctant to acknowledge that older people can, for example, in the area of access to interventional Cardiology, experience a different and less effective care pathway purely on account of their age. The Scottish Executive should have a specific initiative in which means of monitoring the access to and delivery of care to older people in comparison to younger people is explicitly demonstrated. Acute services need to be responsive to emergency care requirements for older people, such that ageism is not seen as a barrier to the access of acute care in high quality secondary care settings. Supporting those with mental health problems and particularly cognitive impairment should be increased with local teams helping maintain the vulnerable in community settings. Equally, there should be a higher level of support in both primary and secondary care to maintain older people in community settings, preventing unnecessary admissions. The development of community geriatrics and psychogeriatric services, augmented by GPs with a special interest, will be necessary to manage an expanding very elderly population, and the cost benefits of Comprehensive Geriatric Assessment should be more widely recognised. In terms of managing future levels of frailty, both physical and mental, appropriate planning of resources for those unable to remain in their own homes is necessary. These will include increased numbers of care home places, with an appropriate skill mix, as well as specialised housing provision. However, the use of such expensive resources must be appropriately targeted, with assessment and rehabilitation opportunities being fully explored prior to a move into care. Such integrated services are not yet prevalent and need to be further developed. 3.5 Housing, transport and surroundings Houses that are being built today will last for many decades. The same goes for communities, roads, towns - but how suitable are they for older people of the future? Many older people have lived in the family home for many years, near to friends and neighbours. It can be really difficult for people who no longer drive a car to get to shops, community centres, local facilities, or just out to visit family and friends. How our communities are designed can make a difference to safety too. The Scottish Executive wants to know what you think about our houses and environments. For example:
Please tell us what you think: Answer to Q. 3.5 – Housing, transport and surroundings Attention to the design of built environment is crucial. Good lighting, clean pavements, which are well maintained, and pedestrian crossings which actually allow enough time for a frail older person to cross. Avoid cobbles in pedestrian precincts (see Dundee city centre), which looks very attractive but highly likely to provoke a fall if you are old, or if you are wearing high heels! Environments and houses should be built to be suitable for mothers with prams and wheelchair users. This would make them ideal for older people also. Work on why older people are sedentary highlights loneliness (lack of confidence and lack of someone to go out with) and lack of access to a car as common reasons. Local transport networks should be further developed to reduce isolation and allow individuals and those involved in their support and welfare to have low cost and efficient travel facilities. 3.6 Other There may be lots of other things that need to be done to help Scotland benefit from its ageing population. We need to think about things like new technology, or the different needs of people with disabilities or from minority ethnic communities. We might need to think about how different generations can work together, and about how older people can have a better say about the services they get. We might need to think about how we can encourage businesses to provide products and services designed for older people; or about how older people are viewed by society. Please tell us what you think: Answer to Q. 3.6 – Other No comments.
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