Scotland's social care services 'unsustainable'
The current system of social care in Scotland is "unsustainable", according to a financial watchdog.
The Accounts Commission said an additional £667m would be needed by 2020 to maintain current levels of service, and called for a "frank and wide-ranging" debate on the issue.
It said an ageing population, budget cuts and legislative changes were putting pressure on the system.
Scotland's 32 councils currently spend about £3.1bn on social care.
That money was used to provide support to more than 300,000 people in 2014/15 - about 70% of whom were aged over 65.
- Leadership warning over care services
- How the care system works across the UK
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The commission also said the public and service users needed to be more involved in shaping future care.
Councils plan to save £54m from their social work budgets over the next financial year, with most now only providing services for people aged over 65 assessed as being at "critical or substantial risk".
Accounts Commission chairman, Douglas Sinclair told BBC Scotland's Good Morning Scotland programme: "The main message is that the current approaches are not sustainable. Why do we say that? It's really largely about money, but not only about money.
"Each year, councils spend over £3bn on social work and we estimate that if you wanted to maintain services in the way they're currently delivered, you'd need not far short of £700m by 2020."
Scotland's social care
Annual spending in 2014/15
300,000 people supported
759,000 unpaid carers in Scotland
£54m planned saving in 2017
27% more pensioners by 2037
Social work departments also cover services for vulnerable children, with 17,357 youngsters being looked after by local authorities or appearing on child protection registers as of July 2015.
That represents an increase of 36% since 2000, said the report.
'Not enough money'
The overall aim of the audit by the Accounts Commission was to examine how prepared social work departments were for future financial and demographic changes.
Mr Sinclair said it was not possible to divorce current pressures on the system from recent cuts in local government budgets, where funding has fallen by 11% in the past five years.
He added: "Councils have increased spending on social work. They've tried to protect it over that period of time, but there just isn't enough money in the system. The other problem is that as the money flat-lines, demand is always increasing."
The commission's report said that between 2012 and 2037, Scotland's population was projected to increase by 9% - that included a 27% rise in the number of people of pensionable age.
Although life expectancy had continued to rise, the number of years that a person can expect to live in good health has not changed significantly since 2008, said the report.
Recent legislative changes have seen the increased integration of health and care services and a real-terms reduction in overall council spending.
Spending on social care now accounts for a third of overall council spending in Scotland.
However, the Scottish government estimates that there are 759,000 unpaid carers aged 16 and over in Scotland, while Carers UK estimated the value of unpaid care in Scotland at £10.8bn.
The commission also said there was;
- a recruitment issue in the care sector
- low pay
- anti-social hours
- and difficult working conditions
They also said that some care providers had expressed concerns that Brexit and the possibility of a future points-based immigration system could add to this.
They cited a 2008 survey which indicated that 6.1% of the workforce in Scottish care homes were EU - non-UK workers, and a further 7.3% were employed under work permits from places such as the Philippines, India and China.
Just over 200,000 people work in social work and social care services, representing about one in 13 people in employment in Scotland - 85% are women.
Responding to the report, Health Secretary Shona Robison said: "The integration of health and social care services is one of the most ambitious programmes of work that this government has undertaken and we have committed over half a billion pounds towards making the integration of services a success.
"Integration will support better provision of care within communities and in people's homes - helping people to lead longer, more independent lives."
'Cuts on services'
Scottish Labour's communities spokesman Alex Rowley said the report showed the human cost of "SNP cuts to councils".
He added: "The fact that many pensioners are not getting the care they need is a clear demonstration of the failure of this SNP government to fund these vital services.
"The demand on social work services continues to grow whilst the budgets fall putting increasing pressure on staff. The SNP government must reflect on the cuts they are imposing on these services.
"This failure to invest in councils who deliver children's and social care services rebounds on our NHS, meaning more pressure on our hospitals."