Suzanne Cumberbatch looks at the mixed fortunes of Scotland’s policy of free care for the elderly The care system for the elderly in Scotland has fallen into a state of confusion over the past few weeks, with some councils claiming they were under-funded and the Scottish Executive saying they needed to spend more. Incidents in Argyll and Bute and Renfrewshire Councils highlighted a lack of clarity over Scotland’s free care policy, and isolated stories created a particularly-negative image of councils charging elderly people for services that should be free. And when the executive intervened and warned councils should come up with the cash and provide the services, COSLA slammed claims that authorities were under-spending. ‘To imply councils are not spending the money they are given for free personal care is simply not true. Councils spend every penny they are given, plus an extra £70m,’ claimed COSLA president Pat Watters (The MJ, 15 June 2006). But the recent Scottish Parliament’s health committee report, published on 13 June, paints a more positive picture by heralding free personal care in Scotland as a success. Indeed, COSLA has applauded the report and appeared to change its tune after, earlier in the week, stating the policy was heading towards a crisis. However, it has stated it must be properly funded, and clear guidelines have to be established over what it should include. Cllr Watters described the policy as ‘a defining one’ for Scotland and a cause for celebration by the executive and Scottish local government. ‘The current situation, with regard to a small number of individual circumstances where the policy does not appear to be fully implemented, arose because of one important factor,’ he says. ‘Since 2002, when the policy was first introduced and costs were estimated, there has been an increase of 29% for care in nursing homes and 68% for care provided in individuals’ own homes.’ He explains that while some increase was estimated and budgeted for, this level of increase could not have been, which therefore puts pressure on the policy. Cllr Watters added it was now paramount that mature discussion between local government and the executive takes place to ensure ‘clarity and long-term sustainability of the policy’, identifying three keys areas. First, absolute clarity about the extent to which waiting lists are an ‘appropriate form of actual management of individual care needs and second, complete clarity about what is provided in terms of free food preparation. Third, Mr Cllr adds: ‘Given the huge increase in the numbers of elderly people involved, we are concerned to ensure that there is enough money in the system to pay for this policy. ‘There is no crisis in free personal care, and we are already involved in sensible discussions with the executive to ensure that this popular policy is sustainable over coming years. ‘This policy is too important for it to become the subject of an ill informed debate in the press.’ Deputy health minister, Lewis Macdonald, welcomed the health committee’s report, which examined implementation of the policy and how it was operating across Scotland, for recognising the free personal and nursing care policy as a success. ‘It has benefited almost 50,000 older people in Scotland, allowing many more to be cared for at home,’ he says. We remain fully committed to the policy and continue to work with councils to ensure older people receive services in line with their needs.’ He does, however, emphasise that money has been allocated to councils across Scotland, and it the responsibility of individual councils to decide how that money is spent. Mr Macdonald adds: ‘We have always made clear that older people who require care should not wait unnecessarily for this to be arranged. ‘If there is a delay, local authorities have a legal duty to ensure people’s care needs are being met in some way, until a longer-term care package can be put in place.’ w
