Free personal care: workable but underfunded

Lord Sutherland’s review of the free personal and nursing care policy in Scotland says that the scheme is important, workable but chronically underfunded.

That the Independent Review of Free Personal and Nursing Care in Scotland obtained such backing for the policy is significant because the authors consulted some of the fiercest critics of free personal care – the Convention of Scottish Local Authorities (Cosla) and researchers at the University of Stirling.

The Stirling researchers have in the past warned the costs of the policy would triple over the next 50 years because of the aging population, and Cosla said it was causing major budgetary pressures on local authorities which implement the scheme.

Both groups support the review, which calls for an extra £40m in funding and a long-term look at how the aging population can be better supported as forecasts show it is expected to increase dramatically.

Future vision
The review looked at the first five years of the policy and made recommendations for the short, medium and long-term future of the policy, which it regards as an important element of Scotland’s progressive approach to the long-term care and well-being of its older people.

A 12-point action plan for the short-term addresses issues to do with funding and consistency of provision across local authorities. Over the medium term – within the next five years – it calls for another funding review and an analysis of all the funding streams supporting the long-term care of older people, including health, social care, housing and benefits.

A long-term vision for dealing with demographic change and its impact on all services accessed by the elderly, such as pensions, housing and transport, should be established.

Professor of economics at the University of Stirling, David Bell, who contributed to the review, said: “We’re saying that the policy of free personal care and the amount spent on it is only a relatively small proportion of funding for long-term care of the elderly in Scotland, but the costs will spiral. That’s to do with demographic change. We’re looking at significant increases in the 75 and over age group by 2031.

“It’s all about the efficiency of delivery of long-term care services for elderly people. The future is extremely uncertain. What proportion of those people are likely to require care in 10 years time? We don’t know because someone might invent a pill which will cure dementia. On the other hand it may be that there could be an epidemic of obesity. That’s why we’re recommending regular reviews.”

A high price to pay
The review group estimates that personal care costs paid by local authorities will increase from £256m in 2006 to £813m in 2031.

Funding has been the sticking point since the policy was introduced in 2002 as local authorities argued its implementation was costing more than they were receiving from the Scottish government to cover it.

Cosla says it is committed to free personal care and that it is working closely with the Scottish government. “We are hopeful that we will soon be able to conclude our discussions on the residual policy issues that require attention,” says Cosla’s health and well-being spokesperson councillor Ronnie McColl.

“Lord Sutherland’s report highlights the crucial role that councils play in successfully delivering free personal care and points to the real benefits that the policy confers on older people.

“While the report is correct to point to some of the challenges facing the policy – for instance, the long-term impact of demographic change – we are committed to working in partnership with the government to address these.”

Another criticism from the review team is the inconsistency of the provision between local authority areas, with some councils having long waiting times for assessment and receipt of services. It calls for a Scotland-wide framework which would include minimum standards and maximum waiting times.

It also calls for the reinstatement of an attendance allowance benefit for people in care homes worth £30m withdrawn by national government when the policy was introduced. The Department for Work and Pensions said the allowance was a duplication of funds with the new policy in place, but did not pass on the savings to the Scottish government.

Sustainable and affordable
The Scottish government has welcomed the report, the recommendations of which it says it will now consider in detail, and reiterated its commitment to the policy.

A spokesperson for the review said: “Lord Sutherland and the [review] group are very clear that the policy is sustainable and affordable but it’s a question of what the government wants to prioritise.”

The current shortfall of £40m just applies to this year and “was to be expected given the speed of implementation [of the policy] and given that there was an unmet need that was suddenly brought forward”.

Lord Sutherland said: “Scotland has acted as something of a test ground for this new approach to paying for long-term care. The policy was implemented as part of a much wider package of measures and investment aimed at improving care services for older people.

“Our recommendations are intended to address early difficulties, secure improvements in the quality of the policy delivery for older people and to bring to bear greater certainty and transparency.

“The adequate provision of personal and nursing care is now part of the way we want to live. We must build this into the mainstream of our planning for the future.”

Further reading

Independent Review of Free Personal and Nursing Care in Scotland

Scotland: Free personal care needs an extra £40m, review finds