Call for costs review as waiting lists and meal charges undermine free care policy

The financial viability of Scotland’s free personal care policy was called into question again in last week’s report by the Scottish parliament’s health committee (Scottish executive called upon to ‘adequately finance’ personal care , 15 June).

For some time, critics of the policy, including the UK government, have said that providing free personal care to anyone older than 65 who needs it is too costly.

In 2004-5, councils received 147m but they said the policy cost 220m. During the inquiry, the committee was told that nearly half of Scotland’s 32 councils were operating waiting lists and about 13 were charging for food preparation, given a lack of clarity from the executive over whether it should be free. Some were delaying assessments for care, taking advantage of the fact that free care could not be backdated from the time of eligibility.

Although the committee praised the policy for providing “greater security and dignity” to older people since its introduction in 2003, it said the executive needed to review its cost. It also recommended councils stop using waiting lists, cease charging for food preparation and end financial incentives that result in delayed assessments.

The funding problems are beginning to undermine public confidence in the system and have placed the Scottish executive in difficulties over the flagship policy.

For Alan McKeown, health and social care policy manager at the Convention of Scottish Local Authorities, delivering the committee’s recommendations is dependent on more funding for councils from the executive. He welcomes a budgetary review, saying councils are “being funded at 2002 prices”.

He says: “If the minister wants us to deliver food preparation then, as long as we’re properly funded, we’ll do it.”

But McKeown says to achieve this there needs to be “open-ended funding” – something that is unlikely to receive political backing.

McKeown says he would support reducing the maximum period for a person’s assessment from five to two weeks.

But he asks: “Can you have no waiting lists if it is a demand-led system with a capped budget? We need to look carefully at what we can do and afford and what the price will be to other services.”

Kate Fearnley, policy director at Alzheimer’s Scotland, says waiting lists are unacceptable and she would support a change in legislation to end them.

Fearnley also backs a funding review as part of the executive’s current wider review of the policy. “It’s proving itself to be a worthwhile policy and has brought positives for Scotland but costs clearly need to be monitored. The review should look in detail at how much local authorities receive. This should take place every so often to take into account demographic changes.”

But Ian Baillie, chair of the Social Care Association’s education committee and former director of social work at the Church of Scotland, says: “We’ve always had waiting lists and not everyone objects to that. What people object to is waiting eight to 10 weeks for an assessment,” he adds.

Baillie says the policy was always going to be expensive to deliver and that the executive and councils should decide how best to use existing resources more effectively.

“It is unrealistic for the executive to produce an extra 40m. It is about making choices and how to spend the existing money,” he adds.