Five priorities for new Health Secretary

Age Scotland write to Neil Gray outlining older people’s health and social care to-do list

Age Scotland’s chief executive has written to the new Cabinet Secretary for NHS Recovery, Health and Social Care, Neil Gray, to outline the escalating challenges faced by older people accessing health and care.

In her letter, Katherine Crawford shared findings from the charity’s 2023 Big Survey, in which 84% of respondents said getting timely access to healthcare was the single most important issue facing older people. She also highlighted the increasingly desperate state of social care services across the country and urged Mr Gray to make fixing social care a priority.

She wrote:

“I’m sure you would acknowledge we are facing a crisis of access to social care, medical assessments, and many treatments, as the NHS and health and social care partnerships struggle to overcome shortages of staff, resource challenges and growing waiting lists.

“We must fix social care in Scotland. We cannot wait for the delivery of the National Care Service as the sole means of doing so. There is so much to be proud of in our social care sector, but a crisis of resource, staffing and service availability is having a profound effect on the country. Many of the challenges facing our NHS, not least delayed discharge figures, could be addressed if social care really got the attention it deserved.”

The letter outlined five initial priority areas identified by older people:

• Cut waiting lists - particularly for routine operations and procedures
• Bring forward the renewed health and social care strategy for older people.
• Introduce a timeline and plan to scrap day care charges.
• Take swifter action on Anne’s Law to ensure vital care home visiting rights are embedded in legislation.
• Fix social care by addressing the crisis of resource, staffing and service availability.

Ms Crawford issued an invitation for Mr Gray to meet with Scotland’s national charity for older people, with a view to sharing more insights and finding out what his plans are for improving the lifeline services.

Text of the letter:

Dear Mr Gray,

First of all, many congratulations on your new role as Cabinet Secretary for NHS Recovery, Health and Social Care. I look forward to hearing of your plans to improve health and care in Scotland in due course.

I write to share insights and concerns gathered from thousands of older people in Scotland over the past year about health and their access to care. The insights are based data gathered from older people’s calls to our helpline – which handles around 30,000 callers a year – and on results from the Age Scotland 2023 Big Survey, which more than 4,100 over 50s took part in. I hope you find these useful in your new role.

As Scotland’s national charity for older people, we are acutely aware that challenges accessing lifeline health and social care services are already having a devastating impact on older people’s lives.

Delayed discharge, for example, has already exceeded pre-pandemic levels, with the most recent Public Health Scotland figures showing that many older people are spending an average of 29 days longer in hospital than medically necessary because of the lack of social care provision. The physical and mental health consequences for older people of staying in hospital an extra month can be catastrophic. Around 7 in 10 of these cases are due to a lack of available social care.

I’m sure you would acknowledge we are facing a crisis of access to social care, medical assessments, and many treatments, as the NHS and health and social care partnerships struggle to overcome shortages of staff, resource challenges and growing waiting lists.

In our Big Survey an overwhelming 84% of respondents said that having timely access to healthcare was the single most important issue facing older people. Forty per cent cited concerns about deteriorating health as their biggest worry about getting older, with 21% expressing concern about access to social care.

Asked what would make Scotland the best place in the world to grow older, respondents ranked improved social care in top place and better healthcare in second place, highlighting just how crucial it is to prioritise fixing both the health and social care systems.

A practical consequence of the pandemic has been the growing movement to accessing health services and information online, including video calls with GPs. Our findings make very clear that is not what older people want – 82% of over 50s prefer an in-person doctor’s appointment to discuss health concerns. Only 1% had a preference for video calls. While it is clear that there is a high level of satisfaction from those who use video call technology to participate in appointments, it clearly misses the huge number of people for whom this digital route isn’t applicable.

Unfortunately, as a result of not being able to get appointments, assessments or sometimes a date for scheduled surgery, a substantial number of older people, 3 in 10, have either paid or would consider paying for private health treatment.

We are supporters of a National Care Service, as I’m sure you know, and believe that it is the vehicle for the necessary reform of social care in Scotland. Older people believe this too. When asked in our Big Survey, 40% agreed this was a good idea and only 10% disagreed. The highest levels of support were from people in their 50s and 60s. 44% of respondents wanted to know more about it before making their mind up, which demonstrates that there is work to do to demonstrate the positive benefits that a National Care Service may bring.

There are several matters we believe need your urgent attention.

We must fix social care in Scotland. We cannot wait for the delivery of the National Care Service as the sole means of doing so. There is so much to be proud of in our social care sector, but a crisis of resource, staffing and service availability is having a profound effect on the country. Many of the challenges facing our NHS, not least delayed discharge figures, could be addressed if social care really got the attention it deserved.

There also must be swifter action on Anne’s Law. Tying it to the National Care Service further delays the necessary embedding of vital care home visiting rights in legislation. We believe that it should be de-coupled and a Bill taken through the parliamentary process on its own merits.

Similarly, we believe that the overdue, renewed health and social care strategy for older people which had been pegged to the delivery of the National Care Service must be brought forward. As the National Care Service timeframe has moved, so too has this important strategy.

The manifesto pledge to scrap day care charges must now become a reality. A timeline and plan for doing so is necessary.

Waiting lists for routine operations and treatments really do need to be reduced. I know this will be firmly on your own action plan. The longer an older person waits for a knee or hip replacement, for example, the greater their deconditioning can become which will in turn impacts on recovery. The subsequent costs, both human and financial, are substantial.

I would welcome the opportunity to meet to share more of our research and insights from older people. You would be very welcome to visit our Edinburgh offices at any time, and also meet with our helpline team to hear from them about the issues they are presented with.

I look forward to hearing from you.

Yours sincerely

Katherine Crawford
Chief Executive Officer