Challenges for local authorities

“Funding is an obvious difficulty as it is with all services.”

- Local authority staff member

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For the last five years councils have had to cope with managing austerity, reducing resources, increasing demand for services, and ever increasing public expectations. In order to gain a better understanding of the impact of these pressures in relation to HIV, local authorities were asked specifically about the challenges they face when providing services for people living with or at risk of HIV as part of research for the 2015 HIV Scotland report 'Making the Vision a Reality'.

Difficulty identifying needs and engaging communities

Councils are considering ways of delivering services more efficiently and so need to involve service users and local communities in developing options to improve services and help save money. However, the research showed 42% of local authorities feel that difficulty identifying local needs was the primary challenge they face when providing services for people living with or at risk of HIV. This rose to 69% when local authorities were asked to consider future challenges.

When considering future challenges, comments highlighted that the increasing numbers of people living with HIV into older age presented additional challenges in terms of identifying and responding to people’s needs.

Quotes from local authority staff:

“There is still a real lack of being able to identify exactly what individuals require from services and given the vast area, I also think it is difficult to target the community in the right way.”

“There are some difficulties in engaging with groups of service users due to the stigma issues for the service user who may want to keep their health issue confidential.”

“Our local testing rates are low and we have difficulty in getting at-risk populations to come forward for testing.”

“(A key challenge is the) changing and disparate needs of the aging cohort of HIV infected service users”

Funding and increased demand for services

Funding was identified as a current challenge by 33% of local authorities, with 62% identifying that funding was likely to present a significant challenge in the future. Councils’ share of the Scottish budget has remained relatively constant over the last few years. However, in the context of overall reductions in public sector budgets the amount of funding that councils receive from the Scottish Government has gone down. In 2013/14, the Scottish Government allocated £10.3 billion to councils. This is 8.5 per cent lower, in real terms, than in 2010/11.

Many councils are now reporting gaps between their income and the cost of providing services, and with further funding reductions expected, councils face tough decisions to balance their budgets. Some local authorities expressed concern that reduced funding and budget pressures may result in fewer people with HIV who have support needs being able to receive support. In other areas, social work services were being refocused and as a result some types of services and supports were no longer being provided directly by the council.

“From a social work perspective, all service users with HIV who are referred to the service are required to meet the service eligibility criteria prior to being considered for funding for services. Due to current budget constraints, funding is targeted at those with significant need/risk, and not all people with HIV may meet the critical eligibility criteria we can currently fund, therefore may not be able to access social work funded services.”
- Local authority staff member

“A male service user who has had care at home/housing support service, had a service agreed many years ago. Part of the service at that time was a counselling/listening service. Due to changes in service eligibility criteria, this is not a service now provided by the Council, and this has caused concern for the service user. The service user will be supported to consider other options for this. The focus of social work funded services now, needs to be prioritised in line with need and risk. Due to the potential for fluctuating healthcare needs, the focus of work needs to be flexible in relation to the role of supporting/enabling and doing for.”
- Local authority staff member

In addition to reduced funding, councils face other pressures as demand for services continues to increase. The increasing demand for services is largely due to changes in the population, which is increasing by about 0.2 per cent a year. People are also living longer; the percentage of people aged 65 or over is projected to increase from 17 per cent in 2012 to 25 per cent by 2037. An older population has implications particularly for social care and housing services. In addition, due to advances in treatment, people are living with HIV into older age for the first time, but it is unclear whether the social care system currently in place for older people is properly equipped to meet their needs.

Staff training and development

Staff development and training was identified as a current challenge by 42% of local authorities, with specialist training for social care staff being particularly highlighted.

Quotes from local authority staff:

“There is a lack of specialist training for social care staff in relation to HIV and supporting people living with this.”

“Service users would all prefer more specialist service provision in relation to HIV, but services are often commissioned on a more generic basis, with the assumption that the service providers provide specialist staff training accordingly to meet specific needs.”

Geography

Several local authorities highlighted geographical inequalities in access to services and service provision across Scotland as key challenge, with 42% identifying this as a key current challenge. The delivery of specialist services was seen as unsustainable in some rural areas, while some had found it difficult to establish supports such as peer support for people living with HIV.

Quotes from local authority staff members:

“(The local authority) mainly link (people) with the NHS who provide a range of services however some of these tend to be located centrally so there is a geographic accessibility issue.”

“Peer support in the local area. We would like to support/ develop this more effectively, but due to the rurality of the area, and small population sites, there remains an unwillingness to become involved.”

Find out more

This information was accurate as of May 2015. Download this information as a briefing sheet [PDF - 73kB], go back to the local authorities and HIV main page, or read the next section, about the integration of health and social care.

Contact HIV Scotland for more detail, or to discuss.