IF YOU ask someone where would you rather be cared for, in hospital or at home, most people would say at home. People prefer to have their personal freedom and their own things around them. So the government policy of integrating health and social care in order to organise proper home care for people who need it, rather than keeping them in hospital, was welcomed by most older people’s groups. Of course, from a government perspective it also has the advantage of saving money as it frees up expensive hospital beds and services.

The problem is though, that with tight budgets neither side has been too willing to transfer resources into the new service. Last week the Royal College of Nursing Scotland protested that the situation will get worse because £450,000 is to be cut from community-based care for older people and that this will undermine the objective of treating more patients outwith hospitals. So how do we ensure that care at home is up the standard of the hospital service? Individual plans and arrangements have to be made before someone can be moved from hospital to their home. Too often that can take weeks to arrange while older people languish unnecessarily in hospital and we have had the occasional horror story of a vulnerable person being dropped off at home too early or in the middle of the night. Once they are at home the important thing is that they can adapt into a regular and clear routine that meets their needs. This means having a care worker who relates to them and can spend sufficient time with them. The Scottish Older People’s Assembly meets older people all round the country who tell us that in many cases this just doesn’t happen. Care workers are too pushed for time and just as they get to know the carer they are replaced and someone new appears.

That is not to say that most carers do not try to provide a good service and they often cope admirably in difficult circumstances. They do – but they are under pressure. These are issues we have taken up with the Scottish Government.

At one time carers were allowed only 15 minutes per visit. We pressed for this to be removed from their contracts as each visit should meet individual requirements. Along with others, we argued that carers should be paid at least the living wage and hopefully all of them should now be getting that.

But even the living wage is meagre and I remember when I raised it with a care manager he said: “It’s alright for you to complain about lack of training and turnover of staff but at the level of wages we can pay if the staff can get £5 a week more working in a supermarket then some of them leave and we have to start again with someone new.” As ever, the problem mainly is one of resources and priorities. How important do we think it is to properly care for our older people? The home-care plan is an example of a well-intentioned and popular policy being undermined by underfunding. The cuts in spending help no-one. Keeping people in hospital costs more. Older people at home will get a poorer service and carers get less security.

Caring is one of the most worthwhile and often most difficult jobs in society yet it is one of the most financially under-rewarded. The inequality of earnings in the UK is among the widest in the world and it is tragic that we have created a situation where people who need the most help are serviced by people among the lowest paid. The poor looking after the very poor is too often the basis of our welfare systems.