Absolutely. We should value family carers and the care and work they do, right across the United Kingdom, for people who need help in all our communities, yet they are so poorly valued. Carer’s allowance does not even equal jobseeker’s allowance, which is something we have tried to repair in Scotland, but obviously we do not know whether that money will simply be clawed back by the Department for Work and Pensions in other benefits. That is always the problem. We are supporting carers so poorly. Not only do they have the physical burden and the lack of time to look after themselves, but often they are in financial difficulty.
Scotland is the only one of the four nations to provide free personal care, which we have been providing since 2002. Having integrated health in 2004, we have been working since 2014 to try to integrate health and social care, which is a lot more difficult. The social care environment is different. It has multiple companies and different set-ups. It is means-tested, rather than being provided free. Social care is a real challenge, and therefore local authorities and the health structures within any local health system will require support and funding to work out how to achieve it so that they are wrapped around the patient, not bitching about whose purse the money will come out of. As we have heard today, the problem is that there simply is not enough money in the purse to start with.
In Scotland, we now allocate half of our health funding to integrated joint boards, which are made up of health and local authorities, to look at how we provide primary healthcare, mental healthcare, social care and children’s services so they are driven locally and take account of all the support that is required.
There are three main groups that require social care. First, the elderly. Many of us are heading that way ourselves, and the No. 1 important thing is to maintain people’s independence for as long as possible. That is the importance of not rationing surgery for hips, knees and eyes. If we can keep people seeing and walking, and if we can give them a bus pass so that they are out and about with their cronies down the town, they will stay independent and functional for longer.
Of course we have the frail elderly, who require to be looked after in comfort and support. By their own choice, that would be in their own home if at all possible. In Scotland, home care hours have been increased from six hours to 12 hours a week, which has allowed us to keep people with greater dependency at home. Looking at A&E attendances and emergency admissions over the past five years, we can see that Scotland’s increase—we are all facing increased demand—has been only one third of that in England. That is why we have had our best performance against the four-hour target since March 2015. It is a combination of supporting people not to arrive at the hospital door and not to be stuck at the other end, because we have driven down delayed discharges every year.
When we talk about numbers such as four-hour targets, it is important that we remember that they are a thermometer taking the temperature of the acute system. They look at how we bring people through. Everyone in hospital wants to get home. They do not want to be stuck there.
The next group is people facing end of life, and they would like, if possible, to be cared for with dignity at home. They want to be with their family but, equally, they do not want to be a burden to their family. If they need respite, they want to have access to it. Since 2015, the Convention of Scottish Local Authorities agreed that even people under 65 will be provided with free social care if they are defined as facing end of life, which means they will not be stuck in hospital facing a means test that fritters away their remaining weeks and days of life. A quarter of us will die in a care home, and we want to make sure that we would be happy with the quality of care in that care home, rather than living in squalor or being mistreated.
The third big group is the working-age disabled. For them, quality of life, mobility and, particularly, participation in society are critical. Both in England and Scotland, almost half of local authority social care spending is on people of working age. We tend automatically to think that social care means the elderly. Two thirds of the working-age disabled told a survey that they are not given any help or signposting, and a majority said they are not given enough hours to help them live independently.
Frank’s law comes in this month in Scotland, which means that those under 65 with dementia, motor neurone disease or multiple sclerosis will also be eligible for free personal care. The law is named after Frank Kopel, the footballer who unfortunately developed dementia very early.
Workforce is a challenge for all of us. Our workforce has gone up 12% in the past three years, but all care providers report difficulties in recruiting, and Brexit is only making that worse. We need to value care, and we need to let it develop as a career. People should be paid the real living wage, not the pretendy living wage, for all the hours they work, including at night. A carer coming into a patient’s house for 15 minutes to throw them out of bed, particularly a carer that patient has never seen before, is not providing quality of care. We need continuity between the patient and the carer. Caring needs a career structure to ensure that people stay in the profession and develop, grow and lead others.
It was said that the UK Government Green Paper would give us a chance to rethink funding, but we still have not seen it to enable us to debate the options. Will that be done by a rise in national insurance, or by continuing national insurance after retirement for better-off pensioners? People have mentioned the German and Japanese systems, but we need to look at the pluses and minuses of both. By 2030, the number of 85-year-olds will have doubled. We need to prepare to look after them, and to give them independence and dignity, so that they do not end their lives in complete misery and squalor.