CHAPTER 7: SERVICES FOR OLDER PEOPLE
Introduction
Providers, whether in the private or public sector, need to ensure that their services are appropriate for the needs of older people and to incorporate these needs into their planning for the future. The consultation document asked for views on current, as well as ideas on future, service provision.
7.1 IMPORTANT SERVICES FOR OLDER PEOPLE IN THE FUTURE
In response to the question, "What sort of services do you think will be important for older people in the future?" respondents identified 9 key areas. Only 12% of respondents chose not to comment on this question. Chart 7.1 shows a summary of 5 key services identified as being important for older people in the future.
Chart 7.1
Top 5 services for older people in the future
7.1.1 Health Services
Health services in general were seen as important by 39% of consultees and this included 51% of the 50-64 age group but only 28% of consultees under 50.
Specific comments on the NHS and, in particular, waiting lists were made by 21% with a further 20% commenting on the importance of health care and local health care. Waiting lists were identified as an area of concern by one local authority who felt, " NHS services are of variable quality, for example ambulance services and waiting times need to be improved".
While most comments focused on the NHS, services from dentists and opticians were mentioned by 3% and a further 2% mentioned support in relation to diet, food and nutrition. A small number, less than 0%, wanted to see more Alzheimer units.
7.1.2 Help in the Home
Twenty-eight percent of consultees commented on services provided in the home and this included 37% of organisations. We noted earlier that higher proportions of women had commented on support for carers and this was also the case for help in the home, with 29% of women commenting in comparison to only 17% of men. This issue featured in only 15% of responses from members of the Asian community.
Comments from 20% of respondents stated the importance of support such as home helps while 5% pinpointed the need for services which enable people to remain living, independently, in their own homes. Help with shopping or services like 'Meals-on-Wheels' were identified as important by 7% of consultees. Smaller numbers, 2%, commented on help with repairs in the home or with gardening. One charity raised a concern about support for independent living,
"For those who need assistance to remain living independently, Free Personal Care has been invaluable. However, there are many well-reported problems with the policy which need to be addressed with some urgency if the policy is to achieve its aim of allowing people who would otherwise be in residential care to live at home. The most prominent of these problems have been issues surrounding charges for assistance with the preparation of food, and waiting lists, but there are also concerns that the policy is not being implemented uniformly across the whole of Scotland."
7.1.3 Transport
Transportation services attracted comments from 27% of respondents and this included public transport as well as transport to hospital. In relation to transport to hospital specifically, one charity commented,
" The nature of cancer treatment has changed significantly over the last few years, in that most people now receive their treatment as an outpatient. This is, of course, an extremely positive development, but has raised other issues for cancer patients, such as the cost and organisation of travelling to and from hospital. The Hospital Travel Costs Scheme should be extended to benefit all cancer patients, who should also be exempted from hospital parking charges."
7.1.4 Services for Specific Groups
Services aimed at specific groups of older people were mentioned by just under one in four (23%) consultees overall, although this figure rose to 51% among respondents from the Asian community. This was less of an issue from those in the Scottish sub-group (11%) and in responses from the under 50 age group (9%).
The main comment, from 10% of consultees, was that care services should provide carers from the same ethnic group as the older person in need of care.
Increased availability of interpreters, or other solutions for language barriers, were identified by 5% of consultees, while 4% felt that service providers should pay more attention to the religious or cultural needs of ethnic groups. One public body commented on the need for "Culturally appropriate services."
Five percent of consultees felt that specific facilities, such as care homes, leisure centres or day-care centres for minority groups, were needed. One percent saw groups specifically for women as important.
The provision of aids for disabled people was identified by 2% of consultees. One special interest group representing the sizeable minority of visually impaired people ( VIP) in our society noted,
" New technology: yes, assistive technology can restore literacy to VIPs. It is available at a cost. VIPs with some residual sight may pay up to or over £2000 for CCTV to be able to read. Apart from VAT exemption, there is no financial help. A member commented that her husband had been given a motorised scooter, two different Zimmers and an electric bath aid. She was his carer and all she got was a white stick and a cardboard guide to sign cheques. What is literacy worth to an individual and to the community that has to support that individual? With a home PC and software, VIP illiteracy could be almost eradicated. The problem will change, as a computer using generation reaches the age of sight loss, but the groundwork needs to be done now."
The need for partnership working between different organisations was noted in a response from a special interest group who felt,
"Care organisations in the Jewish community (such as Jewish Care which works in partnership with East Renfrewshire Council) provide many facilities and services for the elderly in that area, but there is a need for mainstream services to consult with faith communities in order to support the provision of appropriate services for minority communities across Scotland."
7.1.5 Care Services
The importance of care services was highlighted by 22% of consultees and this included 37% of local authorities but only 11% of the under 50s. Comments included:
- Community services or centres (6%);
- Social services/ workers (6%);
- Local care homes (6%);
- More/ better day-care centres (6%);
- Respite care (2%).
7.1.6 Housing
Sixteen percent commented on housing services and again fewer of those under 50 noted this (8%). The provision of suitable housing, including adapted or sheltered housing, was commented on by 15% of consultees. Help with repairs or upgrading was identified by 1%.
7.1.7 Financial Support
Assistance with financial matters was commented on by 14% of consultees, with 8% specifically mentioning assistance with entitlements and claiming benefits. The need for free or subsidised services in general was seen as important by 5% of respondents while 2% felt that help may be needed with administration such as filling in forms or making insurance claims. Comments from those aged under 50 were again at the lowest levels (9% as opposed to 22% in the 50-64 age group).
7.1.8 Leisure Facilities
Thirteen percent of respondents identified the importance of appropriate, accessible leisure facilities and this included 8% specifically commenting on the need for more, or improved, opportunities for social activities. Eight percent also highlighted the importance of facilities for leisure or entertainment and 3% mentioned sports or fitness activities. One individual commented,
"Leisure and social activities are sharply divided by age, and non-governmental organisations in civic society should be funded or supported by central government to sustain activities or pursuits which engage broad cross-sections of the population. Extra mural/curricular series in universities/schools should be modified to provide integrated free-time pursuits across the generations."
7.1.9 Emotional Support
While most comments centred on facilities available to older people, a small proportion of consultees noted the importance of emotional support services, and this featured in 6% of responses with 5% commenting on the importance of befriender or similar schemes and 1% mentioning support groups.
7.1.10 Other
Various other services or support were identified and these included:
- Information on availability of services and support (8%);
- Education or training services (4%);
- Support for using new technology (3%);
- Security-related (more police, etc.) (3%);
- Libraries (2%).
7.2 WHAT MAKES SERVICES WORK WELL?
Respondents were asked, "Thinking about services that work well, what makes those services good?" Less than half (43%) of consultees chose to comment on this question. Of those that commented, four key issues were raised - availability of services, staff, communication and attitude (see chart 7.2).
Chart 7.2
Why services work well
7.2.1 Availability
In order for services to work well, they must be there when they are needed. Overall, 20% of all consultees and 30% of organisations, cited availability as a factor that makes services good.
Seven percent specifically commented on availability of services in general. A further 13% of consultees noted the need for services to be flexible and responsive to needs. Seven percent saw accessibility as a factor, while 2% identified reliability and timely delivery. A choice in available services was mentioned by 2%, while 1% wanted to see continuity of service.
One charity felt that accessibility was a key issue and commented that,
"Services need to be physically accessible for older people. This may mean providing wheelchair or walking aid access, or providing materials in easy to read large print. It may also mean having services available at certain times of the day, or in particular places. Older people may only be able to access certain services if they are provided in their homes, or may need support in order to access external services (e.g. transport, carers etc.). Services may need to be tailored to individuals, particularly where they have complex or multiple needs. Local provision - services for older people should be provided locally, where possible. Older people may have specific needs in relation to transport, or may have carer responsibilities which mean they cannot travel far, or for long periods of time."
7.2.2 Staff
Alongside the availability of services, the need for staff who are caring and professional in their approach was seen to be a factor in making services work well and this was cited by 15% of consultees. The lowest level of reference to this was from those aged under 50 (7%). As noted by a health organisation,
"Services that work well are good because the staff are caring, professional, and make elderly people feel safe" .
Nine percent of consultees perceived that services can be improved by continuity of care, and 3% saw staff training as a contributing factor. The need to ensure continued recruitment of good staff was voiced by one voluntary organisation who commented,
"More work is needed to encourage young people to work in the caring professions, including an improved pay settlement for care workers and improved methods of recognition and reward."
The need for staff to have an understanding of different cultures or languages was identified by 3% of consultees as important to the efficient running of a service. Perhaps not surprisingly, this factor was more important to the Asian community (12%).
7.2.3 Communication
Communicating with the people who actually use services was seen as important by 9% of consultees overall.
Listening to clients was mentioned by 5%. Inviting client input into services was also important to 5%, and one local authority described how this was being put into practice in their area,
" Capacity building work is underway in [our] area to engage sheltered housing residents in tenant participation to promote greater input to the management and planning of these services for older people."
7.2.4 Attitude of Service Providers
Eight percent of consultees identified the attitude of service providers and their staff to their clients as bringing about good services. Respect for the individual was noted by 6%, and the need for older people not to be made to feel a burden was mentioned in 4% of responses. This was summed up by a health organisation,
"A good care package which is well-timed, gives people, and where appropriate their carer, involvement in care-planning and treats clients with dignity and respect."
7.2.5 Other
Other comments on important features of services included:
- Good organisation and management (5%);
- Regular reviews (4%);
- Sufficient funding (2%);
- High standards (2%);
- Safety and security (1%).
7.3 SERVICES WORKING TOGETHER
The consultation paper asked, "What can be done to make sure that different services work together properly?" and comments on this specific issue were received from 40% of consultees overall. The key issues emerging in relation to this specific question largely reflected those noted in the previous sub-section of this report. In the words of one charity,
"Services that work well generally have good accessibility, a high standard of communication and are prepared to work with local agencies, charities etc., which understand, and are trusted by and familiar to, the local community. Duplication is avoided and barriers are removed in delivery."
7.3.1 Communication
The main theme to emerge to this specific question was the need for good communication between services (mentioned by 12% of consultees, although only 4% of those under 50 provided any comment).
7.3.2 Joined-up Services
The need for more joined-up services was identified by 7% overall, with a further 2% specifying the need for Health and Social Work Services to be more closely aligned. A higher proportion of organisations (16%) wanted to see joined-up services than did individuals (4%).
The need for closer co-operation in general featured in 8% of responses with 6% more specifically mentioning the need for a combined management structure or one overseeing agency. Six percent suggested more partnership working. One voluntary organisation,
"welcomes measures being developed in some areas, such as Edinburgh, to develop shared management systems to break down service barriers, particularly between local authorities and the NHS in Scotland. Such partnerships should be encouraged and best practice shared across the country."
7.3.3 Localised Services
While some consultees commented generally on the services needed, some others made specific comments in relation to localised services and this was cited by 5% of consultees. One individual commented, "A devolution of services to as local a level as is practicable is an obvious first step. The NHS is making a welcome and positive contribution to this."
7.3.4 Sharing Information
Problems caused by the Data Protection Act and other regulations protecting confidentiality were seen as a barrier to services working together, and 5% commented on the need for information to be more easily shared between services. Four percent wanted to see more interaction between service providers in the public sector and voluntary organisations.
7.4 CONTINUING TO MEET THE NEEDS OF OLDER PEOPLE
Services are continually changing in order to adapt to new developments and to meet the changing needs of the population. The consultation asked, "How can we make sure that as services develop and change, they continue to meet the needs of older people?" One in three (33%) consultees commented at this question.
7.4.1 Consultation
One key theme emerged to this question, with 23% of respondents commenting that consultation with older people, whether individuals or groups, was the best way to ensure services were enabled to fully meet their needs. A local authority commented,
"Consultation with older people and with people in communities is essential in planning for the future. In particular, the role of communities and the resources they hold needs to be explored."
Again, there was a difference in responses from different age groups with 30% of the 50-64 age range commenting on the need for consultation, compared to only 15% of those aged under 50.
Two percent felt that consulting more widely, with all age groups, was important and 3% mentioned surveys but did not specify the audience.
Other comments included:
- Cutting bureaucracy and improving efficiency (4%);
- Auditing and accountability of services (3%);
- Respond according to changing needs (3%);
- Evaluate systems in other countries or areas (1%).
7.5 WHAT ELSE COULD BE DONE?
The consultation paper asked, "What else could be done?" Suggestions were received from 43% of consultees and the need for increased or sustained public funding was identified by 7% as another way of providing appropriate services for older people. One individual noted the importance of funding to enable services to continue,
"Too many times a service has been funded for a limited period of time, then, just as it has come to be relied on the funding has been stopped."
Inspection and monitoring were identified by 6% of consultees and 3% felt funding should be targeted on providing more staff. Small numbers made the following suggestions:
- Recognition of the needs of older people (4%);
- More attention to needs of older people in rural areas (3%);
- Employing more staff from older age groups (2%);
- Support from the Executive or local authorities (2%);
- More rapid response to the organisation and delivery of care (2%);
- Ensure there are sufficient personnel (1%);
- Keep forms simple or avoid jargon (1%);
- General appreciation of services (1%);
- An even spread of services across Scotland (1%);
- More support to the voluntary sector (1%).
In summary,
- The five most important types of services for older people were:
- - health services;
- - help in the home;
- - transport services;
- - support for specific groups;
- - care services.
- In order for services to work well they must be available when needed and delivered by well trained staff. Partnership working between different services and organisations was also identified as an important element in the effective and efficient delivery of services.
- Good communication was seen as key to services working well together while consultation with clients (service users and stakeholders) was seen as the main way in which services could continue to meet the needs of those they serve.
- Increased funding along with regular inspection and monitoring were also pinpointed as important in ensuring services can operate effectively.