Politics

Scotland’s approach to personal care is having
an increasing effect on the debate south of the border, says Mervyn
Kohler.

Scotland implemented “free” personal care at
the beginning of the month, throwing down the gauntlet to
Westminster. How will this play out politically?

The
deal in Scotland is somewhat circumscribed by its financial
dependence on Westminster. The cost of personal care has had to be
capped at £145 per week, and an anomaly has emerged in the
eligibility for attendance allowance – payable to people living in
their own homes but not to people in formal care homes. And
Westminster is happy to pocket the £20m or so that would have
been paid to those now ineligible.

So far
there is little evidence of England claiming parity of treatment,
but the volume of parliamentary concern about care home fees and
closures, and nursing care payments is rising. It seems only a
matter of time before Scotland’s approach becomes an additional
factor in the general disquiet. Ministers defending the Westminster
line have made much of the fact that 70 per cent of care home
residents get some or all of their care costs met from public
funds, but the residual 30 per cent represent more than 200
residents per constituency. Many of these will have interested
relatives and friends who may well vent their feelings in
elections.

The
issue is not just one of self-interest. There is a profoundly moral
point, which the Royal Commission tried to capture by subtitling
its report With Respect to Old Age. The need for long-term
care is unpredictable, like illness or injury. There are few who
would argue against the universal provision for the latter, so why
do we have such a wretched debate about the former? It is not as if
people queue up greedily to enjoy illness and long-term care: these
are mainly frail and vulnerable people with real
problems.

Another accusation is that free
personal care would benefit the rich. That is precisely why the
Royal Commission recommended it should be paid for from general
taxation – the better-off would pay the most for it. But they would
pay in a fairer, more predictable way than the random costs that
arise now.

Resolving how to deal with
long-term care costs is also part of the uncertainty over pensions.
It is one thing to aspire to build a pension pot that supports
one’s general standard of living: it is quite another to assemble
the funds to meet the contingency of long-term care needs. People
are losing the appetite to save, and one reason is the awareness
that those savings would be consumed by care home fees.

The
NHS is receiving a generous settlement in the comprehensive
spending review. There are many calls on these new resources, but
it is not impossible to imagine that some of these might just
become available for long-term care if the political clamour to
emulate Scotland rises.

Mervyn Kohler is head of public
affairs at Help the Aged.