Debating the balance of care at the SNP Conference

by Richard Meade
Head of Policy & Public Affairs, Scotland

Richard Meade. Head of Policy and Public Affairs, Scotland



On Friday, Marie Curie hosted a fringe event at the SNP Conference in Perth where we posed the question: Are we shifting the balance of care away from hospital services towards the community?


I was joined on a panel of speakers by the Minister for Public Health, Michael Matheson MSP; Sandy Watson, the Chairman of NHS Tayside; and Aileen McLeod MSP, member of the Scottish Parliament’s Health and Sport Committee, who chaired the event.

We need to shift the balance of care


Far too often at Marie Curie we see and hear stories of terminally ill people having to go to hospital for care they could and should be getting at home or in the community.

We know that the vast majority of people who are terminally ill want to receive their care at home or as close to home as possible. Unfortunately far too many are still finding themselves in hospital and close to 60% of the 55,000 people who die each year in Scotland die in hospital.

Moreover Research from the Nuffield Trust has shown that the cost of receiving care at home in the last days of life is actually notably less than in hospital, delivering significant savings.

I spoke about all these challenges at the event and the rest of the panel made some very interesting contributions as well.

What the panel said


Sue Charlton, Liz Whelen, Sandy Watson, Michael
(L to R) Sue Charlton, Liz Whelen, Sandy Watson, Michael Matheson MSP, Heather Dempster, Richard Meade, Aileen McLeod MSP


The Scottish government is committed to shifting the balance of care from hospital to the community and has made it a priority in its 2020 vision and its Quality Strategy. Despite this, progress has been slow and we are still a long way from completing the journey. This has been highlighted in recent Audit Scotland reports.

During his remarks Michael Matheson stated that the Scottish government’s approach was to expand primary care while also continuing investment in acute care. He went on to say that the NHS could not deliver the change on its own and that primary care needed partnerships between the NHS and third sector bodies.

Sandy Watson recognised the importance of integration of health and social care in Scotland, as being part of the solution. He said that health boards and councils accepted that there needed to be cooperation and strong relationships.

He emphasised that it was not about starting again but challenging ourselves and focusing efforts to raise the bar.

An ageing population


We all agreed that the pressure on existing services is coming primarily from Scotland’s ageing population, which is increasing rapidly. More people are living longer, and with numerous chronic conditions, which makes their care complex. This changing demographic will bring more demands on health and social care services, which will simply not be possible or appropriate to meet in hospital. Scotland currently spends £4.5 billion on health and social care services for those over 65 and a third of that is on emergency hospital admissions.

It is essential, as everyone on the panel agreed, that we get this right now, as the burden on services is only going to grow and the risk is that as pressure grows vital hospital services could become unsustainable.