A timebomb of rising demand and funding cuts is putting Scotland’s flagship care policy at risk, yet it still has many defenders, reports Jeremy Dunning
The future of Scotland’s free personal care policy for older people is in doubt once again as resources dry up and costs continue to mount.
Only this month, council body Cosla’s social care spokesperson claimed authorities had no idea about how they could meet the future costs of the policy as they faced cuts of 20%-plus from 2011-15.
So far, the Scottish government has maintained that the policy is here to stay, but it is clear new ways of minimising costs must be found.
Under the policy, introduced in 2002, over-65s who live at home are not charged for personal care services, while those paying their own way in care homes receive £156 a week from councils to fund their personal care costs.
Free personal care cost £353m in 2008-9, almost double the £194m of 2003-4. The vast majority of the rise in costs comes from caring for people in their own homes, rather than in residential care (see box).
The policy last came under the spotlight in 2008, as a result of rising costs and concerns over some councils operating waiting lists for free personal care, a postcode lottery in eligibility and charges being wrongly made for services such as food preparation.
Then, an independent review for the Scottish government, chaired by Lord Sutherland, found that free personal care would be sustainable until 2013, when the demographic pressures of increasing numbers of older people would start to bite.
However, that was before the public sector was faced with massive cuts in funding.
In July, this context sparked calls for the policy to be reviewed from the Scottish government’s Independent Budget Review Panel, which was tasked with identifying how to manage the coming era of austerity.
It suggested several ways in which free personal care could be made more affordable, including removing eligibility from self-funding care home residents or reducing the level of weekly payments.
And this month, Cosla’s spokesperson on health and social care, Douglas Yates, triggered a storm by saying that Scottish councils “did not have a clue” how they would be able to meet the future costs of free personal care. He warned that the public sector crunch meant individuals would face paying more in taxes or charges for care and families would have to bear more of the burden of care.
His comments sparked anger from older people’s charity Age Scotland (formerly Age Concern and Help the Aged), which issued a staunch defence of free personal care.
Yates insists that he has never advocated the scrapping of free personal care but says that the care system for older people needs reform if the policy is to be cost-effective.
“The current financial challenges give us the opportunity to reshape social care,” he says. “However, the way we are doing things currently isn’t sustainable because there’s not enough money in the system.”
This seems to be recognised by the SNP government, despite its unwavering support for free personal care.
A spokesperson for finance secretary John Swinney says: “We are working with Scotland’s local authorities and over the summer we have had frequent dialogue through the Convention of Scottish Local Authorities [Cosla] to address the significant challenges we all face as a result of Westminster cuts.
“We are committed to retaining existing eligibility for free personal care. Once we know the outcome of October’s UK comprehensive spending review, we will set a Scottish budget focused on protecting frontline services and economic recovery.”
So how can free personal care become more cost-effective?
Cosla advocates early intervention programmes that reduce people’s need for care and keep them in their own homes and out of residential care for as long as possible. Free personal care generally costs less per home care user (£6,200 a year in 2008-9) than per care home resident (£8,300 a year), reflecting lower levels of need.
But Yates says it is important for the NHS to work with councils to reshape services, particularly in light of the SNP government’s decision to follow the Westminster government in pledging to protect NHS spending from cuts.
The difficulty is in ensuring that savings from early intervention are reinvested in community services rather than being swallowed up by the acute health sector, which would reap the benefits in reduced hospital admissions.
Yates says this requires pooling of resources across health and social care.
The need for reform is echoed by the British Association of Social Workers, which says more needs to be done within communities to help people “look after each other”.
Professional officer for Scotland Ruth Stark says: “What people are trying to do is find imaginative ways of meeting people’s needs and that means going back to families and communities. The principle that personal care should be free will remain.”
Age Scotland is clear that free personal care is already delivering efficiency gains by enabling people to remain at home rather than in residential care or hospital. It also points out that it accounts for less than 8% of the £4.5bn spent on health and social care for older people in Scotland, and costs far less than the £1.4bn spent a year on emergency hospital admissions for older people.
Chief executive David Manion says: “Justifying something that we know will be expensive is going to be increasingly difficult… and incredibly important if we are to reap the benefits further down the line.”
Case study: ‘Without free care I would end up in hospital’
Belle Fladell, who lives in Glasgow, receives free personal care at home.
The 70-year-old suffered a stroke six years ago and is now paralysed down her left side. She requires help on a daily basis.
This is help she and her 72-year-old husband Bob could not afford otherwise and she fears she would spiral into a decline, perhaps spending lengthy periods in hospital, if it were removed.
“I would end up a prisoner in my own home,” she says. “I really need it. If you are stuck in the house it’s very depressing.”
Fladell, who attends the Donald Dewar Day Care Centre in Yorker, Glasgow, believes that through free personal care she is costing the system less. “Without it, I would end up in hospital,” she says.
Centre manager Tony Thomson adds: “For a lot of my service users it would be a detriment to their health if free care were withdrawn.”
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The Scottish care timebomb
● The cost of free personal care rose from £194m to £353m between 2003-4 and 2008-9.
● The cost of free personal care for people at home rose from £129m to £274m between 2003 and 2009.
● Scottish councils are expected to face real terms cuts of at least 20% between 2011 and 2015.
● The number of people aged over 65 is expected to rise by 64% between 2008 and 2033, from 856,000 to 1.4 million.
● The number of over-65s needing care in care homes is expected to rise by 116% between 2008 and 2033.
● The number of over-65s needing home care is expected to rise by 97% between 2008 and 2033.
Scottish government, Reshaping Care for Older People programme demographic projections