Alzheimer Scotland briefing on the Scottish Government debate Reshaping care for older people

Alzheimer Scotland supports the need to reshape care for older people; the current failing system must be transformed so that public resources provide value for money and deliver care that meets the needs of the growing, older population. This review process should not be rushed; time must be taken to consider the options ahead of the public consultation.

Dementia is one of the key reasons why older people need care and support services. The number of people with dementia in Scotland is set to double in the next 25 years.

Unless there is wholesale change the existing void between diagnosis and support for people with dementia and their carers will become greater, as the number of people with dementia increases and the impact of the economic environment takes its toll on public services.

The agenda must not be set by the way services are currently delivered. Looking for ways to prop-up the current system will not work:

• Most care for people with dementia is already provided by informal carers, typically family members. Rather than looking at ways to tap-into volunteer capacity, the priority should be finding ways of using public money to support families in ways that provide value for money.
• Evidence provided in the English National Dementia Strategy showed that early stage support for people with dementia may have the potential to prevent or delay more expensive interventions later on. It also offers the opportunity to plan support for people in a way that maximises their natural supports and community links. However, tightening eligibility criteria mean that people are not offered support until their condition has deteriorated and it is too late to reconnect with community supports. Furthermore, care services can remove people from their community and create dependency.
• It seems clear the current care management system is not working for many people with dementia and it will only become more difficult as resource pressures mount. Many people are being allocated small amounts of support at the wrong time of day and there is a real danger that hours will become smaller and ultimately less effective.
• Specialist dementia services are vital to support people with dementia and their families, because of the wide-ranging and often challenging difficulties the illness brings as it progresses. However, commissioning practices such as large generic tenders based on economies of scale often fail to allow for the possibility of specialisation. Furthermore, as much of the resources are tied-up in block commissioned services, support is largely determined by what is available, denying people choice and control over the support they receive.

Alzheimer Scotland believes people with dementia should have access to a fair and equitable individual budget that they, their families and social work or health professionals can use in order to best meet their individual needs and circumstances. We believe the key objective of health and social care services must be to assist people with dementia and their carers to continue to live their normal lives in the community for as long as possible; and that a move to long-term care should be a positive choice, not a last resort.

The Social Work (Scotland) Act 1968, along with the NHS and Community Care Act 1990, continue to form the basis of care provision in Scotland; there is a need for new legislation to bring it up-to-date with the requirements of the twenty first century. The principles of self determination, choice and control must be enshrined in legislation so that people, wherever they live in Scotland, are given the same opportunity to ensure the support they receive is meaningful to their lives.