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2.0 Preparing for an Ageing Population: Future Challenges for Government, the Public Sector and Public Services
Government
Scotland's ageing population will affect almost every aspect of life in Scotland. Government alone cannot capture the immense breadth of possibility. Nor can we specify the precise details of how partners might work to achieve our collective aspiration for Scotland. On the other hand, Government has a crucial role to play in leading and assisting the contribution of all partners taking Scotland forward into the future. Since the demographic shift is long-term and applies across all aspects of policy and delivery, it is vital that policy-making should be both futures-focused and joined-up. It must be informed by the best available evidence and ensure co-ordinated delivery of services through strong partnerships. The demographic opportunity will be a powerful driver of change in Scotland's governance and lead to wide-ranging reforms of public services.
Some of the challenges are more fundamental. The task of defining an overall strategy for Scotland with an ageing population is huge. We must fulfil our responsibilities to meet the needs and demands of older people today, but we must also consider Scotland's long term future and the needs and aspirations of the whole population. Because of that, we intend to develop our strategic approach on a step by step basis, through continued dialogue, observation, identification and analysis of long-term trends and robust examination of evidence. This is an important step on that journey but it is only a beginning.
We shall have to face and overcome the challenge of describing the most effective balance between the respective roles of the state, of communities and of individuals in determining, planning and providing appropriate, timely support for families and individuals with identified needs, and we will need to reconcile this with the challenge of making sure that this is an affordable reality for all. Government at every level will require to work cohesively to put in place a work and pensions system that supports people in contributing throughout their lives in ways that suit the aspirations and abilities of individuals.
Government also has a stakeholder or customer role in funding and regulating the public sector. Funding will increasingly require to be aligned to achievement of strategic outcomes for an ageing population working in partnership with local government, the NHS and with the voluntary and community sectors. The private sector will also continue to be a powerful influence and partner.
In the face of these challenges, government in Scotland will continue to demonstrate strong leadership, stepping in to underwrite risks in testing new thinking, sharing new learning and putting new ideas into practice. We shall have to learn as we go, reviewing and adapting our approaches as necessary and remaining open to new learning as other countries across the world also position themselves to adapt to similar demographic shifts. But we will lead a partnership of all of those who will need to act in order to deliver the kind of future that we want.
Challenges for Government
- Leading the debate and communicating the issues based on robust evidence and analysis
- Fleshing out an overall national strategy and striking the right balance between the roles of the State, the community and the individual
- Working effectively with local, UK and EU Governments and partners in every sector and setting of Scottish society to ensure cohesive policies with co-ordinated delivery
- Developing and supporting innovative approaches
Local Government, Public Sector organisations and Public Services
Local Government manages the development and delivery of local strategies tailored to the needs of local populations, and developed through local processes. Given their powers and responsibilities, local authorities will play a key role in shaping Scotland's future environment.
Local authorities will need to take account of local demographies to ensure appropriate and affordable services for local communities. Community planning will help manage the process to realise opportunities and remove barriers to change. Major planning decisions taken now will have to provide solutions that will remain relevant to the needs of local populations over the longer-term.
Public sector organisations need to act now to develop their long-term strategic and corporate roles. They too will have to take account of the ageing demographic in Scotland. Public service reform provides the setting and context for this process of development. The future challenge for the public sector lies in managing its contribution to Scotland's future development while adapting institutions developed during a different period of history. Without addressing the longer term challenges, the existing system could become increasingly less fit for purpose.
Older people are not all the same now and they will not be a single group in the future. It will thus be important to keep track of all the influences and drivers of change affecting our population over the longer term. We cannot simply continue to plan on the basis that our past provision will be right for the future. We need to plan now to identify those longer term outcomes that we should all work towards over the next 20 years.
In gathering evidence and consulting on this issue, we identified many examples of local innovation. As we look forward, we must all continue to ensure that innovation is encouraged and supported over the longer term. This will require engagement and dialogue at all levels.
In order to enable the contribution of older people and to deliver the right services in the right ways, local government needs to find ways to engage with people of all ages in all their diversity.
As we look forward to a population with many older people, local government and community sectors stand to gain a great deal from skilled and experienced individuals with time and skill to contribute to all aspects of local community life. The challenge now is to ensure that there are no unnecessary barriers to enable their full and rich contribution at every level.
The Scottish Executive will work with the public sector, including local authorities, in planning for and securing the benefits of demographic change.
The Scottish Executive expects local authorities to work with their community planning partners to build on existing good practice to plan, develop and deliver age friendly services with the active involvement of, and engagement with, older people. The Scottish Executive will work with the public and voluntary sectors to support that involvement.
Challenges for Local Government, public sector organisations and public services
- Building local democracy through effective engagement with local communities
- Working in partnership to examine and build the contributions of all relevant partners to Scotland's future
- Developing long term outcomes and community plans that can adapt to the shifting demographic
- Understanding and removing barriers to future success
- Delivering excellent services now while planning for the longer term
Where we are starting from:
The Development of Quality Public Services
Public services will play an important part in releasing the potential of Scotland's older people, and of supporting them in the lives they want to lead. Increasingly, such services will be expected to plan for and respond to the diverse needs of this growing segment of the population.
The First Minister has set out the five fundamental principles of reform: personalisation, quality and innovation, efficiency and productivity, joining up, and accountability.
These principles align closely with the key themes that emerge in research on effective public services such as choice, individualised services, high quality, integration, accessibility and information provision. Whilst important for all age groups, it is likely that they will acquire increasing importance in the context of an ageing population. The literature makes it clear that the baby boomers are and will continue to be more assertive than any other generation in demanding quality services, and that this assertiveness will, over the coming decades have profound implications for how public services are organised (Gillinson et al., 2004). Such rising expectations, coupled with the fact that people are living longer, add to the impetus for public service reform.
Services are already being reformed and many good examples are currently under way. However much effort is still required if Scotland as a whole is to benefit from the generalisation of its current good practice.
What we heard from the consultation:
Consultation responses revealed that the five most important types of services for older people were: health services; help in the home; transport services; support for specific groups; and care services.
Respondents felt that in order for services to work well they must be available when needed and delivered by well-trained staff. Good communication was seen as key to services working well together, and partnership working between different services and organisations was also identified as an important element in the effective and efficient delivery of services. Consultation with people who use services was seen as the main way in which services could develop to meet the needs of those they serve. Good services were recognised as important in people staying able to exercise control and choice over their own lives.
The need for culturally appropriate services that pay more attention to the religious and cultural needs of minority ethnic groups, including recognising and addressing the communication barriers they may face, was an issue raised in particular by respondents among the Asian community.
The discussion document Transforming Public Services - The Next Phase of Reform, (Scottish Executive, 2006g) is based around the 5 key principles of reform set out in the policy context above. Since its publication, a dialogue with the public, private and voluntary sectors and with service users across the range of public services has brought together the different stakeholders and generated innovative ideas. This process continues, through discussion in an adult atmosphere of trust and shared recognition of the value added by public services, and, though sometimes challenging, is driving forward the reform agenda.
The Scottish Executive is interested in exploring the potential of thematic outcome agreements. This is a new approach to the funding of services that links funding more directly to the achievement of outcomes, while offering partnerships more flexibility in the way funding is used or some relaxation of existing reporting burdens. We will set aside funding of £2 million in 2007-08 to support suitable proposals.
Community Planning
The overall aim of Community Planning is to improve the delivery of public services in accordance with two key principles: partnership working and community engagement. As Scotland's population ages, and older Scots make increasing use of public services, good Community Planning has much to offer in making sure that locally delivered services meet their needs.
By bringing public sector agencies, the voluntary and private sectors together at local level, Community Planning promotes better integration of public services, shifting the focus of joint working from bilateral relationships between sectors to a local perspective. This requires all partners to respond to the needs of particular neighbourhoods, using as evidence to support the choice of priorities data gathered from service delivery and through wider community engagement. It therefore allows partnerships to build a picture of the priorities for their areas and develop policies and plans based on a robust analysis of local need, and informed by the experience of communities, including older people.
Improved partnership working and communication also allows for overlaps and synergies at local and regional level to be identified, leading to new solutions for joining up service delivery across administrative and geographical boundaries. In some areas, demographic change is a significant challenge, for example in rural areas where recruiting public service workers in the future to provide services to an ageing population will present real challenges. Community Planning Partnerships ( CPPs) are working on solutions to these problems, focusing increasingly on outcomes for the area that can be delivered only by working in partnership.
Community Planning is designed to address cross-cutting issues that are not the sole responsibility of a single agency and can provide a framework for highlighting the interests of different groups to those who deliver services in their areas. Research into involving older people in Community Planning in November 2003 found that the issues affecting engagement with older people are the same as those for other groups, though with a slightly different focus (Scottish Executive, 2004b). Many Partnerships are now working towards Communities Scotland's Standards for Community Engagement, which are designed to overcome barriers to engagement and promote good practice.
Community Planning is an ongoing process and is still at a relatively early stage; and community engagement in particular presents significant challenges in terms of capacity and resources, both for delivery agencies and for the communities they serve. Currently, Health and Social Care partnerships often list older people's issues as a priority, but only a limited number of CPPs have specific older persons' representation in the wider partnership - a matter that partnerships will wish to consider in the interests of equality and diversity. Older people are well represented in structures such as Community Councils (where they serve as volunteers) which feed in to decision-making on services that affect the quality of their lives, but again these bodies may not always reflect the diversity of older people in their communities.
Models of good practice
A number of examples of good practice have been identified throughout Scotland, where local authorities are working in partnership with older people to involve them in planning and decision-making in service delivery.
Case study: Dumfries and Galloway Older People's Services Development Group
Dumfries and Galloway is a large rural area of Scotland with a rapidly ageing population. Since 2003, its Older People's Services Development Group has provided a formal partnership of older people working together with service providers. The group is a full partner in the formal planning network and has worked to ensure that older people's issues are taken seriously. It has increased the influence older people and their carers have on matters that are important to them, including informing strategic decision-making. Among its other activities, the group collates and disseminates the views of older people and their carers, and strives to improve the quality and standard of life for older people in Dumfries and Galloway.
Case Study: A City for All Ages
A City for All Ages is Edinburgh's Joint Plan for Older People. The Plan is a joint arrangement between The City of Edinburgh Council and its partners in NHS Lothian and the voluntary and commercial sectors. It is about improving opportunities and services for older people, removing discrimination and overcoming barriers. Particular attention has been paid to recognising the diversity of older people through involving all equality strands.
The Older People's Equality Forum has been instrumental in the implementation of the Plan. All of the new initiatives stemming from A City for All Ages have involved older people. That includes membership of steering groups and funding panels, contributing to research methodology, and monitoring the progress of the Plan. It advises the Council and partner organisations on issues concerning older people, and links with groups and forums representing older people across the city.
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