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The prophets of doom have been circling the Scottish executive since it implemented the Royal Commission on Long-term Care's recommendation that nursing and personal services for older people should be free.

Doubters said the costs of providing such a service to more than 750,000 older people would bankrupt local authorities. Only a shoestring service would be remotely affordable. And with no similar policy in England and Wales, Scotland would face a deluge of pensioners, charging over the border in search of free long-term care.

But 15 months into the new system, the policy of free care appears to be holding up quite well. True, its launch had to be delayed from April until July last year while local authorities and other care providers ensured they had the right assessment and delivery mechanisms in place. Then the executive's expert group on the health care of older people warned that its initial cost estimate of £125m a year to implement the policy would rise to £227m by 2022.

There were also rumblings of discontent within local authorities. Aberdeenshire Council claimed it was facing an £800,000 funding shortfall after the executive incorrectly estimated the number of people paying for their own care in care homes in the area.

But on the one test that really matters - whether free care is benefiting older people in long-term care - the new policy appears to be delivering.

Maureen O'Neill, director of Age Concern Scotland, says the policy is bedding down well. "We certainly haven't been inundated by complaints and the system hasn't run out of money," she says.

"Nor have we had thousands of people from England heading over the border on their Zimmer frames. People don't do that when they are in their nineties, they don't want to move away from home."

Jim Jackson, chief executive of Alzheimer Scotland, agrees that free personal and nursing care is reaching its target. "It has gone remarkably smoothly," he says. "Yes, there were one or two hiccoughs early on - two or three local authorities were concerned that they didn't have the funding - but those problems seem to have been sorted out."

Jackson believes the biggest beneficiaries of the new system are those who had found themselves just above the cut-off line used to means-test services provided by local authorities. "It's been of particular benefit to those people on modest incomes. You don't need to be particularly wealthy to become a self-funder, so free care has benefited those who previously lost out on means-testing and felt they had been hard done by."

He claims the introduction of free care has also facilitated the formation of joint service agreements between health and social services, a move stalled in the past because health services were free but local authority services were means tested.

Even the local authorities are satisfied that free personal care can be delivered within current budgets. A Convention of Scottish Local Authorities spokesperson describes the overall picture as "very positive" throughout Scotland. "CoSLA and the executive are content that the joint working and monitoring arrangements established are adequate and our partnership with the executive will deliver an effective management of the policy."

However, he adds that the executive is not complacent and the implementation and impact of the policy are being closely monitored. "Arrangements are in place to measure the uptake of free personal care," he says.

Perhaps one of the reasons that the portents of financial meltdown have failed to materialise is that the phrase "free care" is somewhat misleading. Although the new system entitles anyone older than 65 to free nursing and personal care, this does not extend to non-personal care such as day care, meals on wheels and help with housework and shopping. Residents of care homes continue to contribute towards their accommodation charges and living costs where they can afford to do so, and those wishing to claim assistance for these non-care costs have to undergo the same assessment process as under the previous system.


According to Jackson, this distinction between care and non-care costs has caught a number of older people by surprise. "There was some confusion early on which was not helped by some of the newspapers implying that everything would be free, including hotel charges for those in care home accommodation."

Indeed, lack of information is one of the key criticisms that emerged from a study of the early days of the free care policy. Published last March by Age Concern Scotland, the research surveyed local authorities and the charity's own member groups. It found that, although some authorities had made strenuous efforts to publicise the new policy, others had not. As a result "there was a lack of clarity about what is meant by personal care, what services are to be included and what still has to be paid for."

Other issues highlighted by the study included the concern that, in order to meet their obligations to fund personal care, some local authorities were cutting back on other major services highly valued by older people. There was also a worrying variation across Scotland in access to services and in the length of time it took many authorities to conduct assessments. "Of course these were all issues even before the free care policy came in," says O'Neill. "But the continuing success of free personal and nursing care is dependent on an adequate community care system."

The executive's decision to extend the policy even to those Scottish residents who move to care homes in England has put pressure on Westminster to follow Scotland's lead.

Such a move is backed by nine of the royal commission's members, who last month accused the government of "betraying" millions of older people by refusing to accept its recommendation.

How free care works

At home

• All local authority charges for personal care services are abolished for those aged 65 or over.
• The services provided are based on a care needs assessment by the local authority.
• They are not means-tested. Free personal care is available regardless of income, capital assets or marital status.
• Non-personal care is still charged for. This includes community alarms, day care, lunch clubs, meals on wheels and help with shopping and housework.
• Anyone moving to Scotland as a permanent resident has the same entitlement to free personal services as any other Scottish resident.

In care homes

• To claim free personal and nursing care payments, residents aged 65 or over must first undergo a full assessment of their needs by the local authority. Those who moved into a care home before 31 March 2002 are not required to undergo assessment.
• Those eligible for payments receive £145 a week towards the cost of personal care and £65 for nursing care. This is paid directly to the care home.
• Payments may be made to Scottish residents who wish to move into a care home outside Scotland.
• Payments do not cover everyday housing and living costs. In practice residents have to pay the balance of care costs after the deduction of £145 or £210 a week.