Scotland like many western European countries is faced with an ageing population that is likely to have major economic and social implications for policy-makers, service providers, and commercial organisations in the future (van Dalen et al, 2010). For example, in 1999 to 2009 there was a 12% increase in those in the 60-74 age group and the increase in the over 75s was higher still at 14%. According to Audit Scotland (2013) the number of people aged 75 and over will rise by 60% by 2031. There is a predicted rise of 38% in the number of people who will be over 85 in the population by 2016, and a 144% in the over 85s by 2031. Population ageing will continue for the next few decades as result of improving survival rates and the two post-World War baby booms of 1947 (Cohort 1) and the 1960s (Cohort 2) begin to impact (GROS, 2013).
Figure 1 provides a detailed account of Scotland’s ageing population as it has grown from 2000 and the projections through to 2035. Figure 1: Scotland’s ageing nation 2000 -2035 (Source: GROS)
Consequently, Scotland’s social care services are likely to face significant challenges as the population ages and demand for front-line services increases (Davidson, Maclardie & Murray, 2007). For public sector organisations in Scotland, service change is inevitable as policy objectives develop innovative thinking around service provision that improves performance and reduces cost (Christie Commission, 2011). The current sense of urgency elevating social care up the national policy agenda is fuelled in part by what is often described as a demographic time bomb that will increase the need for and cost of social care (Razavi and Staab, 2010). In the current gloomy economic climate and faced with imminent cuts in public expenditure at both local and central government levels, the public funds available for social care are likely to be restricted (Unison, 2010). Consequently, policy initiatives driven by the Scottish Government have now challenged the public services to develop future innovative services that will: (i) consider how best to address the increase in demand (Reshaping Care, 2010), and (ii) provide services that will be sustainable in the future (Christie Commission, 2011). Prevention and early intervention are at the very heart of future care and support provision and it is argued that and the promotion of independence in older people through a strategic shift to maximise independence and regain skills (rather than being cared for in the traditional sense) have been shown to offer considerable benefits for many people (Pitts et al, 2011). At the centre of the redesign programme is the paradigmatic shift from traditional care provision based on task and time (where services have dedicated times allocated to frontline staff to carry out specific support) to one that adopts the principles of enablement [Enablement – also referred to as reablement or re-ablement throughout literature. For the purposes of this dissertation the researcher will use enablement throughout] (where services are short-term and are designed to promote independence and optimise levels of functionality). By adopting an enablement approach, greater emphasis is placed on 1 Enablement – also referred to as reablement or re-ablement throughout literature. For the purposes of this dissertation the researcher will use enablement throughout supporting service users towards maximising independence and making them less reliant on services in the future. Consequently, the time savings that can be realised are then used to offset increased demand, effectively doing more with less. A recent report (Joint Improvement Team, 2013) on Scotland’s thirty-two local authorities’ approach to enablement confirmed that: “the enablement approach is shifting the focus of services from task and time approaches to a person centred outcome focus through dedicated and goal focussed assessment, which is well received by service users and carers”. (Dr Margaret Whorisky, Joint Improvement Team, 2013 p4).
The report concluded that additional work is necessary to fully understand the impact of enablement in relation to cost and correlation to health activity upon discharge (JIT, 2013). This dissertation does not seek to address these issues specifically but considers more broadly the impact of a rapidly ageing population on a Scottish local authority (LA) and its attempt to shift the focus to a more contemporary service provision. The overall aim is to explore what factors are inhibiting the effectiveness of enablement. Using a case study approach this dissertation will explore whether: (i) enablement is wholly effective in addressing the increase in current service demands; (ii) the approach adopted by the local authority is undermined as services are now over extended and are attempting to address competing objectives, and; (iii) the paradigmatic change across the sector in the future will materialise if organisations cannot create the capacity and infrastructure to enable change to occur. These issues will be considered by investigating the following research questions. First, what is the demographic context in which social care services are being delivered today. Second, what is the approach taken to enablement in LA. Third, to what extent are enablement services offsetting and preventing increased service demands. Fourth, what are the factors that are impacting (positively or negatively) on the LA’s ability to deliver enablement services. The remainder of this dissertation is structured as follows. Chapter 2 will consider the literature that has provided the evidence base and supported the introduction of enablement practice in Scotland. Chapter 3 will discuss the methodological approach that this researcher has adopted to gather data to answer the research questions. Chapter 4 will present findings from the data. Chapter 5 will conclude with a discussion and recommendations for the future.