Scottish government public health minister Shona Robison is adamant that free personal care will survive, despite doubts about affordability
Ever since Scotland introduced free personal care for older people in 2002, commentators have questioned its affordability, with sector leaders posing the most urgent questions in recent months.
And, when the Scottish government launched a public debate on the future of older people’s care last month, the Convention of Scottish Local Authorities spoke of the need for “tough decisions” – taken as code for debating free personal care by some in the media.
But public health minister Shona Robison could not be clearer about the Scottish National Party government’s commitment to the policy. She tells Community Care: “Free personal care is a given and it will remain. It is a small part of the overall health and social care budget that goes on older people’s services.”
The figures show this. Scotland spent £5.3bn on health and social care for older people in 2007-8 – £336m of this on free personal care. However, this was up by 12% on the year before and the ageing of the population means the figure will rise significantly in future years.
Robison believes changing the way services are commissioned and delivered – rather than the funding system itself – is the way to cope with increasing costs.
“What we want to do is take that big [health and social care] budget for older people and make sure that we are spending that in a way that’s preventive and keeps people safe and well in their own homes.”
The emphasis will be on investing in telecare, preventive and reablement services and provision to stop people being delayed in hospital, rather than calculating how far users should contribute to funding their own care needs.
Robison supports closer working between councils and NHS boards to create a “seamless” health and social care service. She says current structures do not lend themselves to joint working and has not ruled out legislating to boost integration, though there are no specific proposals as yet.
“I wouldn’t rule out structural change. What I want to focus on is the outcomes so we get to the position where there are no barriers between health and social care.”
The public debate comes out of the Reshaping Care for Older People programme, led by a strategic group chaired by Robison and including council and NHS leaders. This covers eight workstreams including demographic pressures, care at home, residential care, housing, joint working and the workforce.
The public will be asked to take part in telephone surveys, local public meetings and online questionnaires. Robison says her aim is to forge a public consensus about the way forward.
Diverting cash from hospitals
This will look at such perennially difficult issues as the need to divert cash from much loved local services, notably hospitals, to provide more care closer to home.
“We know that people want to remain in their own homes and we can’t spend money in both places,” she says. “How can we optimise independence?”
Being part of a minority Scottish National Party government, Robison also needs cross-party consensus to achieve change.
“We’ve made quite a lot of effort on that and we will try to keep that going,” she adds.
She is also keen to have a dialogue with the UK government about how decisions taken to reform the care system south of the border will impact on Scotland.
The SNP had raised significant concerns about the Labour government’s plans to take money from attendance allowance – a UK-wide benefit for disabled older people – to fund improved personal care for all.
This is no longer immediately on the cards. It is opposed outright by the Conservatives and a re-elected Labour government would not introduce the measure in the next parliament, according to last month’s White Paper.
However, Robison says dialogue on these issues has so far been “fairly limited” and she hopes things will change under the next UK government, whatever its colour.
In the meantime, she will be focused on Scotland, where, she says, the current situation in terms of older people’s care is “unsustainable”.
“The costs of standing still are quite frightening. The option to do nothing is not there.”
Shona Robison biography
Before being elected as an MSP in 1999, Robison worked for Glasgow Council’s social work department as a home care organiser and community worker. She was shadow minister for health and social justice before the SNP came into government in 2007.
This article is published in the 15 April 2010 edition of Community Care magazine under the headline A Personal Commitment