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David StewartDecember 05, 2023
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The wealthy nations that make up the so-called First World are increasingly experiencing health and care worries associated with their aging populations. Complex needs that accompany aging demand ever more expensive care, stretching family resources and public finances exponentially.

Care providers, even in a state-funded health care system like Scotland’s, are not well paid, and staff retention is among the challenges affecting the availability of care. Poor wages push many to leave the profession, leading to inefficiencies in the delivery of social care to the people who need it most and putting a deeper strain on the health service. The minimum rate of pay for care workers in Scotland is just under 11 pounds an hour with a “pledge,” not a commitment, by the government to raise it to 12 pounds (about $15) an hour by 2024.

Care providers, even in a state-funded health care system like Scotland’s, are not well paid, and staff retention is among the challenges affecting the availability of care.

Exact figures for 2023 are hard to find, but health workers are said to be “leaving in droves.” It is reported that in the United Kingdom health care workers, from caregivers to qualified nurses, have been leaving the health care sector for better wages at Amazon warehouses or even working at the cash-tills of supermarkets and petrol stations.

Catholic leaders in Scotland, including the bishop’s conference’s Justice and Peace Commission, recently joined their Presbyterian Church of Scotland counterparts in advocacy for fair pay for workers in this increasingly essential sector. The Most Rev. Bill Nolan, archbishop of Glasgow, and the Rev. Iain Greenshields, at the time moderator of the Church of Scotland, signed a joint declaration in May petitioning the Scottish government for better pay for care workers, seeking an immediate increase to at least 12 pounds an hour. They encouraged other faith leaders across Scotland to endorse the declaration.

Political devolution in the United Kingdom in 1999 allowed greater degrees of self-rule in Scotland, Wales and Northern Ireland. Health care became primarily the responsibility not of the U.K. Parliament in Westminster but of the first sitting of the newly established Scottish Parliament. Now the Parliament at Holyrood in Edinburgh sets its own health care budgets and policy without the need for approval from London.

But Scottish governments of whatever stripe—the Scottish National Party has been in power since 2007—still have to operate within the fiscal restraints of the current devolution settlement. It cannot, for example, borrow or issue “fiat” money as an independent country could. Health care provision is paid for by a Westminster “block grant”—a portion of U.K. taxes raised in Scotland is returned each year for public spending.

The Parliament in Edinburgh can raise some resources for health care through the limited tax-raising powers held by the Scottish Government. The current year’s spending on health and social care is a record 19 billion pounds, but the health sector could use much more.

A further challenge related to an aging society is the large number of unpaid carers, usually family members of the elderly, an often invisible workforce.

Global life expectancy, measured by the World Health Organization’s Global Health Observatory, has grown from 67 years in 2000 to 73 years in 2019. Recent figures have been affected by the many deaths linked to the Covid-19 pandemic in 2020 and 2021, but most baby boys born in the United Kingdom in 2020, according to a current U.K. government report, can still expect to live to 87 and most baby girls to 89 years. Those who reached 65 in 2020 can anticipate an additional 22 years for females and 20 years for males.

After a long period of steady increases, life expectancy in Scotland stalled in 2012. In 2020 life expectancy was 77 years for males and 81 years for females, several years lower than the expectancy outcomes south of the border in England. More of us are indeed living longer, but this does not necessarily correlate directly to an increased need for care.

The relationship between age and need is more complicated. Many elderly people are able to continue to live independently, but many are coping with long-term conditions that require complex care. Demand for caregivers will only increase.

One serious consequence of the shortage of caregivers has been “bed blocking”—patients who remain in National Health Service hospitals because they have no place to go when they are ready to be discharged. There are too few caregivers available to help them at home or to expand the capacity of existing residential care facilities.

A further challenge related to an aging society is the large number of unpaid carers, usually family members of the elderly, an often invisible workforce. Pre-pandemic numbers of uncompensated caregivers, called carers in Scotland, were estimated to be as high as 800,000 in Scotland, a nation of 5.5 million; an estimated 29,000 of them are under 18.

The loss of salaried work to care for a parent, spouse or other family member brings not only a reduction in their own and their families’ living standards; it represents a loss to the national economy overall. Since 2018 the Scottish government has made financial and other support available through legislative recognition of the rights of carers with special attention to young carers.

Catholic leaders in Scotland recently joined their Presbyterian counterparts in advocacy for fair pay for workers in the increasingly essential sector of health care givers for the elderly.

At the inaugural meeting launching the church’s campaign to increase wages for caregivers in lowland Scotland, Archbishop Nolan said that failure to value care workers means also “to treat those they look after with a lack of respect and dignity,” and the Rev. Greenshields said that the church’s mission of continuing the work of Jesus implies “a system of care that is fair and provides equitable access.”

Health care providers, particularly those who serve the elderly, whether in their own homes or in care facilities, do not possess much disruptive economic power and are reluctant to deploy the power that they do have. That makes it even more incumbent on civil society and government to better value those who serve our elders. The call to protect human dignity applies to those who need care but also to those who provide it.

As for biblical values and Christian justice, our whole tradition has demanded an absolute concern for the less fortunate, the “widow and the orphan.” Now, at this point in the long human story, we must add our sick and elderly to that list.

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