WHEN we talk health and social care in Scotland, the debate tends to orbit big numbers and long-term policy frameworks (writes Councillor PAUL KELLY, COSLA Spokesperson for Health and Social Care) .
But from where I sit, speaking to councils and communities every day, the reality is far more immediate. It’s about people waiting longer for help, care workers stretched too thin, and a system close to burnout.
The £750 million COSLA is calling for isn’t a throwaway figure. It’s what’s needed just to stabilise social care and start rebuilding confidence, and right now, integration authorities are staring down a half-billion-pound deficit. That’s not theoretical. It means fewer care packages, longer waits, and more families left in limbo.
We can’t keep papering over the cracks. Care isn’t a luxury – it’s the infrastructure that allows people to live with dignity in their homes and communities and if we fail to fund it properly, we’re choosing crisis over prevention every time.
I’ve seen what good looks like, councils across Scotland are proving that when local partners are trusted, empowered and resourced, they deliver. Hospital admissions go down, delayed discharges drop and people get to stay in their homes, with the right support around them.
But the truth is, those successes are happening despite the system, not because of it.
Short sighted one-year budgets force local authorities into short-term firefighting, providers can’t plan, good staff leave for more stable work elsewhere.
The same goes for prevention, everyone talks about it but few fund it. Yet we’ve known since the Christie Commission in 2011 that unless we shift spending upstream, public services will buckle under the weight of demand. Fourteen years later, the shift still hasn’t happened.
The result? Hospitals are under strain, community are services stretched, and the most vulnerable people keep falling through the cracks. But it doesn’t have to be this way.
Across Scotland, local authorities are already delivering services that tackle inequality at the source. From mental health and suicide prevention work to alcohol and drug partnerships, councils are embedded in the places where support makes the most difference, but they’re doing it with one hand tied behind their backs.
The evidence is clear, outcomes improve when decisions are made locally and in partnership with communities, we need government to match that ambition, not with more centralisation, but with trust, flexibility and proper funding at local democracy level.
If we want to get serious about health inequalities, that starts with recognising that most of the determinants of health – housing, transport, education, employment – sit within the remit of local government and you can’t improve population health without improving people’s lives.
So, here’s the ask: fund social care properly. Commit to multi-year budgets, back prevention, and most importantly, hand decision-making power back to local communities.
If we keep waiting for someone in the centre to fix this, we’ll still be having this conversation in ten year’s time, and the system will be in a worse place.
Local government is ready to lead, it just needs the tools to do the job.
