Architect of free care asks if we can afford it

The architect of Scotland’s flagship free elderly care policy today admits it should be reviewed amid massive pressure on public funding – but also calls for a fundamental examination of the UK’s free health service.

Lord Sutherland is launching a report in Scotland that questions whether all frail pensioners should continue to qualify for the care package, regardless of wealth.

The bill for free personal care has soared by almost 70% in six years to £358 million, fuelling questions about its affordability at a time when there is severe pressure to cut public spending.

There is also a strong lobby from politicians south of the border, where the policy is seen as overly favourable to Scotland.

Chancellor George Osborne will unveil his emergency Budget in just 10 days’ time, and indicated earlier this week that almost all universal benefits, including the current child benefit without means testing, were under scrutiny.

Sutherland, who chaired the Royal Commission that led to the landmark deal on free personal care, told The Herald ahead of today’s event that it was right to discuss it again. He said: “I think this has to be debated because of the current financial crisis.”

However, he said the policy – which provides help with intimate tasks such as washing and dressing to ailing pensioners at no cost – should not be considered in isolation.

“All public expenditure in the UK should be up for review, so that includes [free personal care]. But let’s not jump on it and say this is the anomaly. I would raise the same question about the health service. I do not think we can afford the health service we have got. That is how serious the financial position is.

“People will say that is dreadful, he’s giving away the principle of 1948. Not so. We already pay for prescriptions, and for eye care, and many of us have to pay for dental care because there are no (NHS) dentists.

“The principle has gone. I think we should consider health and social care in the same basket.”

Asked where the NHS might introduce charges, the former principal of Edinburgh University said: “One of the things that should be under consideration is a contribution to the cost of appointments. Apart from anything else, that would persuade people to keep all their appointments.”

The report Sutherland is launching in Edinburgh was commissioned by charity Age Scotland to consider the impact of devolution on older people north of the Border.

Written by Charlie Jeffery, head of the school of social and political science at Edinburgh University, it says there is a greater need to justify benefits that are universal rather than means-tested.

The report questions whether it is right that everyone over the age of 60 qualifies for concessionary bus travel – particularly when the perk does little to help the frailest who cannot reach the bus stop and those who live in rural areas.

The report also asks: “Is it right that all income groups should have access on the same terms to free personal and nursing care?”

What now for free personal care?

The Herald

When it was launched, free personal care was about more than the fair treatment of the elderly in Scotland. It was about showing that devolution could make a difference. It gave people something they could not get in England, and it provided politicians with a source of pride.

Deconstructing the core principle, that every needy pensioner can receive certain care services for free regardless of wealth, has therefore been almost unthinkable, despite lots of noise about affordability as costs have soared.

Today, however, questions about its universal nature are being entertained by the least likely parties.

Lord Sutherland, the former principal of Edinburgh University who chaired the very commission that created the concept, is launching a report that raises a number of questions about the policy – suggesting that, along with free bus passes, it “might be criticised as extending a subsidy to those affluent enough to pay for services themselves.”

With councils and the NHS already axing hundreds of staff and deeper cuts expected next year, he believes free personal care should not be excluded from the discussion about

what the Scottish Government can afford.

He says: “Scotland is a long way ahead of England in this area [elderly care] and it is in a position where it could reasonably raise these questions about how best to use public expenditure.”

While he would support introducing a means test for personal care as a quick way to save money, he says the seven years’ experience of the policy and relatively good relationships between ministers and local authorities enable sensible discussion.

He believes NHS and social care spending should be assessed across the board, and prioritised according to the physical need of the patients. There are big savings to be made, he says, if health and council care budgets are merged.

The report he is unveiling was commissioned by Age Scotland, the charity that now unites the Scottish branches of Age Concern and Help the Aged. As both were feisty guardians of free personal care, it is perhaps even more surprising that they are behind the document.

Chief executive David Manion said the charity was recognising the need for discussion about universal benefits rather than changing its position on the importance of free care.

In fact he remains passionate about the policy, saying: “If you cut back the availability of free personal and nursing care, you will inevitably increase the pressure on hospital beds.”

Manion stresses the need, instead, to improve care in the community in order to cope with the ballooning elderly population – the number of over-60s is expected to rise from 1.12 million to 1.73 million by 2031.

He says: “The issue ought not to be means testing for free personal care, but how we are going to address the fact that if we do not change the health care system we are going to have to build a 50-bed care home every two weeks and a 600-bed district general hospital every two years for the next 15 years.”

The report does describe free personal care as a popular policy and author Professor Charlie Jeffery, head of the school of social and political science at Edinburgh University, says the deal supports the aim of treating older people as “fully fledged citizens” rather than a burden.

The question is what value Scotland places on that.

Jeffery says: “If we are entering an era of austerity, then I do not think we should be advocating for everyone to cut 20% off their budget. What needs to happen is a clear statement of principles about which things are more important to spend money on and which things are not as important, and we have not seen much of that kind of debate in Scotland.”

How the flagship policy works

Free personal care is available to people aged 65 and over who have been assessed by their council social work department as needing help with particular personal tasks.

The Community Care and Health (Scotland) Act 2002 lists the tasks for which pensioners are not charged. They include help with personal hygiene including washing, eating and drinking, mobility problems and management of medication.

Older people may need help with a number of other jobs that are not covered by free personal care and can attract charges, including help with housework, laundry and shopping.

Assistance with the preparation of meals is free but the cost of supplying food or pre-prepared meals is chargeable.

Care home residents who are deemed to have enough money still have to pay for the “hotel costs” of their accommodation.