Answer: This question covers a huge range of issues, about how we provide services - particularly health and community care services - both now and in the future. Building a Health Service Fit for the Future (the Kerr Report) (May 2005) was a thorough review of the future shape of the NHS in Scotland, taking account of demographic pressures, the changing expectations of patients, improvements in healthcare technology, and workforce legislation and pressures. It signals a move towards preventive care and management of long term conditions as the right approach for the 21st century, reflecting the needs of an older population in particular. Chapter 4 of the report, 'Changing the Balance of Care', is particularly relevant to these issues. In its response Delivering for Health (October 2005), the Scottish Executive recognized these challenges and set out a new vision for service delivery, based on: · a fundamental shift in the way the NHS works, from an acute, hospital-driven service to one that is community based; · a focus on meeting the twin challenges of an ageing population and the rising incidence of long-term conditions; · a concentration on preventing ill-health and treating people faster and closer to home; · a determination to develop responses that are proactive, modern, safe and set in communities. The Range and Capacity Review Group's report The Future Care of Older People in Scotland (Scottish Executive: May 2006) looked at these pressures for community care, and the links between community care services and the health service. The Scottish Government are providing increased resources through the local authority revenue settlement, with increased provision specifically for: · increasing number of elderly people - an additional £16.3m for 2006-07 and £42m for 2007-08. · Free Personal and Nursing Care - £153m for 2005-06, rising to £162m in 2006-07 and £169m in 2007-08. · Care Home Fees, we are investing an additional £37m in 2006-07 and £57.5m in 2007-08. Thus provision being made for the care of older people in Scotland is already increasing substantially, and is met from taxation. |