news analysis of free personal care in Scotland

The Scottish Parliament took the lead in announcing it
would make personal care free for those in need of long-term care
from 1 July. Clare Jerrom reports.

Older people and organisations that have campaigned long and
hard for the introduction of free personal and nursing care have
reason to celebrate this week: both are being implemented in
Scotland from 1 July.

Scotland’s deputy health minister Frank McAveety confirmed last
week that implementation was “on track across local authorities and
will be effective and sustainable”.

McAveety added that although he could not guarantee that every
case would be ready by 1 July, significant numbers of people were
coming forward to discuss their needs and entitlements and all
indications were that the assessment process was going well.

Last month the Scottish executive launched a campaign to
highlight the introduction of free personal and nursing care.
Advertisements were placed in newspapers, a website and freephone
helpline were set up, and leaflets were distributed through social
work offices, doctors’ surgeries and other public places.

Linda Bauld, research adviser to the care development group
which was charged with developing the policy, there will be more
than 7,500 self-funding older people currently in care homes who
will benefit from free personal care. Figures for people in the
community who will benefit are less clear as they will need an
initial assessment or reassessment of their needs.

In practice, any older person who was in a care home before 1
April will automatically be eligible for funding for personal and
nursing care, but the onus is on them to apply for it. This should
equate to £145 per week for those in a residential home and
£210 for people in a nursing home.

Anyone who went into a care home after 1 April, and those people
in the community who receive personal or nursing care, will have to
undergo an assessment. But the new system relies on these people
coming forward and stating they would like financial assistance
with the personal or nursing care they receive – hence the campaign
launched earlier this year to publicise it.

Social work departments handle the budgets and will be
responsible for giving care homes the money for the free personal
care and nursing care of their residents. So older people will not
receive the money directly, but should see a reduction in their
bill for the corresponding amount.

People in the community assessed as needing personal or nursing
care again do not receive money directly, but care is provided free
of charge. If the local authority cannot provide that care, it is
their responsibility to ensure the care is contracted to a company
that can.

Despite the preparation some have already begun to voice
concerns. Head of policy and public affairs at Age Concern
Scotland, Jess Barrow, said: “People think it’s free care and
everything is free. The difficulty is the understanding of what it
includes.”

President of the Association of Directors of Social Work, Jim
Dickie agrees that it may come as a surprise to some older people
when they are still charged for certain services that do not fall
within the definition of personal care.

The Scottish executive states that personal care can include
personal hygiene such as bathing, continence management, food and
diet including assistance with eating and special diets, help with
immobility, counselling and support services, assistance with
medication, and personal assistance such as help with dressing or
getting in and out of bed.

But Dickie says: “It is vital that the explanation is repeated
in a variety of information forms.” It could pose difficulties for
people who are not in the care system and need to find their way in
and understand the different elements, he added.

Dickie says that in North Lanarkshire Council, where he is
director, a considerable amount of investment has been made in
training staff so they are fully prepared to deal with queries
about the system and able to explain this complex issue.

Meanwhile, the Convention of Scottish Local Authorities’ main
concern is the amount of money set aside to fund the system. The
Scottish executive has invested £250m into the package over
two-years.

The package includes the removal of charges for personal care
received in the community, a payment of £145 a week to those
people in a care home who are currently self-funding (with an
additional £65 a week for those requiring nursing care), and
additional funding for local authorities to continue to offer more
care in people’s homes.

But Cosla’s spokesperson for social work and health improvement,
councillor Ronnie McColl, says the figures are estimates and may
mean funding is insufficient in some areas.

However, he adds that the executive has reassured Cosla for the
time being by promising to look into any funding problems that
should arise and shift funding if necessary.

The ADSW has concerns about this promise, however, as political
judgements would need to be taken over how to find extra funds if
the funding for free personal care has been underestimated. Dickie
says it is imperative that other developments are not stunted as a
result of implementation of free nursing and personal care.

Age Concern Scotland also has concerns around the guidance on
the implementation of free personal care given to local
authorities, which states that, following a needs assessment,
payment towards personal care “should commence when the authority
is in a position to arrange or provide the required services”.

Barrow says Age Concern believes this could potentially be used
as a get-out clause: “If you compare it to schools, they have to
provide education. If someone needs care, they should get it. This
should be addressed in the guidance.”

Preparing to implement free nursing and personal care has meant
a great deal of work in social work departments. McAveety describes
it as “the largest single investment in older people’s
services”.

Front-line staff have been busy reviewing the charges of over
70,000 people, taking hundreds of enquiries, and speaking to older
people about their entitlements.

According to Barrows, it would have been impossible to meet the
earlier April deadline. But Dickie says the implementation group on
free personal care, which was established to take forward the CDG’s
recommendations, has now written to all authorities about the
implementation and believes that things are now ready to roll.

The movement in favour of free personal and nursing care began
to really gather momentum with the Royal Commission on Long Term
Care report, published in March 1999.

The Royal Commission said the costs of long-term care should be
split between living costs, housing costs and personal care, and
that personal care should be available after assessment, according
to need and paid for from general taxation. The rest should be
subject to a means test.

In England, the government responded by announcing that from
October 2001 it would cover the costs of care provided by a
registered nurse to people in residential and nursing homes. But it
said the costs of accommodation and personal care would remain
means-tested.

In Scotland, however, a very different approach was taken. In
January 2001, the Care Development Group on Free Personal Care was
established, chaired by deputy health and community care minister
Malcolm Chisholm. It was asked to bring forward proposals to ensure
older people in Scotland had access to high quality and responsive
long-term care, in the appropriate setting and on a fair and
equitable basis. This included proposals for the implementation of
free personal care.

The CDG reported back in August 2001 and a month later the then
first minister, Henry McLeish, announced that the recommendations
had been accepted in full. Many of the proposals on free personal
care were subsequently embodied in the Community Care and Health
(Scotland) Bill.

The bill was put before the Scottish parliament last September,
and passed through its final stage in February this year.

The timetable for the introduction of free personal and nursing
care was extended by three months from April to July in order to
allow local authorities and other providers time to ensure the
right assessment and delivery mechanisms were in place.