Free care for the elderly is expensive, unfair, and too popular to remove

Free care for the elderly, the so-called “dream ticket” of old age which has been available in Scotland since 2002, can boast uneasily that it is both a defining policy of devolution and yet also one of the most contentious.

Those in receipt of it love it — their only criticism being that it does not go far enough — just as much as socialists and the sceptical classes hate it.

In the words of its architect, Lord Sutherland of Houndwood, the policy of offering free personal care to people, whether in their own houses or in residential homes, suffers from “tall poppy syndrome”: it is both highly visible and easily lopped.

The argument over free personal care has raged since the birth of this hurried child of the Labour-Liberal Democrat coalition in the Scottish Parliament. Those of an old Labour persuasion despair of it because they believe the country cannot afford it; and also because it is universal, and therefore feeds their prejudice about benefiting the comfortably off.

Certainly the costs are huge. More people have sought it than expected, and by some estimates the costs were twice as high as anticipated. Nearly 55,000 Scots receive free personal care at home at a cost running at £256 million a year. Costs are projected to rise to £813 million a year by 2031, when Scotland will have 1.3 million pensioners.

Although the number of residents in care homes has reduced slightly since the introduction of free personal and nursing care — 31,890 in 2003-04 compared with 31,310 in 2008-09 — the number of hours of personal care provided has risen from a weekly average of 226,000 hours in 2003-04 to 347,600 in 2008-09, an increase of 54 per cent.

This, say its critics, is unsustainable, especially with the Scottish government facing a 14 per cent reduction in its budget by 2013.

Those in favour of the policy say that the current costs represent only 3 per cent of the Holyrood budget. Such advocates take a long view, pointing out that the cost of keeping the elderly at home more than outweighs the alternative — the need to build hundreds of new care homes and hospitals to house burgeoning numbers in the future.

David Mannion, the chief executive of Age Concern and Help the Aged in Scotland, said: “These people who describe free personal care as a tall poppy to be lopped are being very shortsighted. This system keeps an awful lot of people out of hospital or the in-patient system. Without free personal care, in a couple of years’ time the goverment would have to start building care homes every couple of weeks and a new hospital every couple of years.

“It is absolutely in the strategic interests of everyone that free personal care is delivered, because it’s cheaper and better. The idea that it’s not affordable is nonsense.”

In 2008 Lord Sutherland reviewed his controversial policy, pronouncing it sound, affordable and an essential part of planning for demographic change. He conceded some difficulties and inconsistencies, and called for £40 million of extra funding.

It is no surprise that English councils are wary. In Scotland free personal care caused many tensions between local authorities, who bear the burden of delivery, and the government. There were — and still are — startling examples of postcode lottery, with the elderly in some areas waiting only four days, while others waiting four months. Initially some councils continued to charge for food preparation, arguing that it was not included, until a court ruling to the contrary.

Councils, of course, are aware that they can be accused of self-interest. Proponents of free care question whether front-line services should be cut when fundamental reform of local authorities would bring in more money. Why not axe 32 different Scottish councils, with 32 chief executives and 32 directors of social work, first?

Critics are particularly hostile to the wealthy elderly receiving the benefit. They point out that if, as a result of free personal care, old people are not having to sell their homes, then in effect the state is subsidising their sons and daughters to pocket the inheritance.

The argument against means testing is that only a small number of the well-off are in receipt of the service, and they are far outweighed by the vast number of poorer people who are eligible. The cost of setting up a complex means=testing bureaucracy, supporters argue, would be huge.

While the politicians squirm at the cost, the fact remains: would any party be so bold as to withdraw something so overwhelmingly popular with the electorate? It seems highly unlikely.