Hansard

Thank you, Presiding Officer. That sounded like I might have 15 or 16 minutes!

I am pleased to open this debate on rehabilitation and enablement, particularly given their importance to and the role that they can play in the health and social wellbeing of the people of Scotland.

As the motion states, it is essential that we recognise the importance of rehabilitation and re-enablement in supporting the health and wellbeing of Scotland’s population, the key role that rehabilitation and re-enablement services play in enabling individuals to live productive and meaningful lives and the importance of that approach in underpinning the future sustainability and affordability of Scotland’s health and social care service provision.

I emphasise just how central the approach to enablement is to the Government’s ambition of improving the health and wellbeing of the population of Scotland, and my belief that rehabilitation and re-enablement will be instrumental in achieving many of the key national outcomes agreed both with NHS Scotland and by our local authorities.

Scotland has a growing elderly population, which is testament to the many successful measures that have been taken over the years to improve public health overall and to the improvement in the standard of care that is available in the national health service.

The fact that more people are living longer is not new information, but the way in which the demographics of Scotland are changing demonstrates the extent of the challenge that we face in ensuring that the systems that we have in place are sustainable and provide the best quality of care for individuals.

We must recognise the full extent of the demographic shift in Scotland, the challenges that lie ahead and the financial pressures that will be experienced as a result.

Let me remind the chamber of some of the challenges. It is predicted that there will be a 62 per cent increase in the number of over-65s by 2031. It is also predicted that emergency admissions will rise by 84 per cent by 2031; that by the age of 65 nearly two thirds of people will have one or more long-term condition; and that people with a long-term condition will be twice as likely to be admitted to hospital and will account for 60 per cent of all hospital bed days used. By 2031, it is predicted that there will be an increase of 144 per cent in the number of over-85s in Scotland. I believe that those statistics show the context for the need to address how we provide services and to ensure that they are both focused on the needs of individuals and sustainable in the long term.

Our reshaping care for older people programme is focusing on improving services across health and social care for older people. All 32 partnerships agreed local change plans and received their allocations of the £70 million change fund available in this financial year. Following the 2012 spending review, we announced a further £80 million change fund for partnerships in 2012-13, with £80 million committed for 2013-14 and £70 million for 2014-15, to drive the development of services that optimise the independence and wellbeing of older people at home or in a homely setting. We will also continue to ensure that we address the challenges that arise even with the provision of funding through the change fund.

Too many older people and vulnerable individuals end up in hospital when they should not, and too many stay there much longer than need be the case. That is why the Cabinet Secretary for Health, Wellbeing and Cities Strategy recently announced new targets to reduce delayed discharges in our health settings: by April 2015 we want no one to be delayed in hospital for more than two weeks.

Now, more than ever before, we need to deliver health and social care in an integrated way and to ensure that primary healthcare and community care staff work efficiently together to prevent unnecessary hospital admissions and inappropriate referrals to secondary healthcare services. Moreover, we must enable our health professionals and support staff to meet the growing demand for their expertise and interventions. That will require a not insignificant shift from traditional models of care that have tended to focus on deficits and naming and fixing problems to a model that embraces the concept of assets and sees the patient’s own experience and knowledge of their condition as a resource that can be built on to support resilience and self-management.

Of course, rehabilitation is not a new concept. In fact, it was established around the time of the first world war to support soldiers who were recuperating and adapting to life after injury in service. Fundamentally, it is a partnership between patient and therapist as well as family and carers. It is not a passive process and relies heavily on the individual’s motivation and participation to recover and adjust, achieve their full potential and, where possible, live a full and active life, whatever their age.

Improving community-based rehabilitation and re-enablement services is already integral to the prevention of dependency on healthcare and support services through the promotion of independent living, making better use of resources and improving outcomes for users. Although much has been done to develop rehabilitation and re-enablement services since the publication in 2007 of the delivery framework for adult rehabilitation, I recognise that we still have a significant way to go on this journey.

Rehabilitation co-ordinators, directors of allied health professionals in NHS boards and directors of social work have all played an important role in mapping out services across health and social care and supporting multi-agency working to address gaps and join up service provision, particularly at key transitions between care settings. We have expanded rehabilitation and re-enablement services in a range of speciality areas such as chronic obstructive airways disease, stroke and cardiac services and have also seen significant growth in local authorities’ development of rehabilitation and re-enablement services, using occupational therapy expertise to transform the delivery of home care across Scotland. However, challenges remain in meeting the needs of those who require rapid access to advice and self-management support and in enabling the transition between services provided in hospital and community settings or for those with complex care needs and multiple long-term conditions who wish to remain in their own home.

The earlier that advice or intervention can be provided, the more likelihood there is of a positive outcome, be it a return to work, preventing a condition from becoming chronic or avoiding hospital referrals or admissions to care settings. Indeed, such an approach will be critical, given the demographic changes ahead and the financial pressures that public sector budgets are already under.