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Scotland's much-vaunted plans for free care for the elderly are back in the policy melting pot. But ministers are g...
Scotland's much-vaunted plans for free care for the elderly are back in the policy melting pot. But ministers are growing increasingly anxious and believe the costs will spiral out of control. So far£125m a year has been budgeted for, but the McConnell administration is signaling a rethink might be necessary.

Local government is being asked to deliver the pledge on long-term care for the elderly. Yet there is genuine disagreement on the best way forward and what constitutes good value for money. Many believe the additional resources should concentrate on home-care support where, arguably, they will

do more good.

The policy may end up costing the Scottish Executive£300m in five years' time. Scotland's new first minister, Jack McConnell, is staking everything on improving services with the next Holyrood elections less than 18 months away. Delivery is vital to Labour's chances of success. Mr McConnell is a tough-minded politician and has already shown his ruthless streak by sacking most of the cabinet inherited from his disgraced predecessor, Henry McLeish (LGC, 30 November 2001).

Scotland's new minister for health and community care, Malcolm Chisolm, is enjoying a baptism of fire. NHS waiting lists and times are at an all-time high, despite record levels of spending. Prime minister Tony Blair may want to raise spending to European levels, but Scotland has already reached this promised land - 20% extra is spent per head of population compared to the rest of the UK.

Mr Chisolm is an interesting character, on the Labour left historically, an ex-teacher and member of Unison, which he joined only after becoming an MSP.

He acquired hero status when he resigned as a junior minister, prior to devolution, over cuts in child benefit. His predecessor, Susan Deacon, argued against free care for the elderly, only to be undermined by her first minister, Henry McLeish. Ms Deacon's deputy, Mr Chisolm, was put in charge of a policy review, but ironically, as minister, he may have to eat his own words.

Mr Chisolm's problems are piling up. His first days in post were spent sorting a major failure at the Beatson Oncology Centre in Glasgow, which treats 60% of Scotland's cancer patients. Staff morale at the unit is at a low ebb with 10 consultant vacancies.

Another hot potato is using private hospitals to reduce waiting times. Up till now, Scotland rejected the concordat signed by health secretary Alan Milburn, guaranteeing patients alternative treatment in a private hospital if the NHS wait is more than six months.

Yet NHS patients from Liverpool are having heart operations carried out at a private hospital in Clydebank. Mr Chisolm has now accepted a bigger role for the private sector. Scottish patients are clearly willing to embrace private care for quicker treatment, just like anyone else. Scotland's first minister has ordered an independent review of all NHS waiting lists after being mightily embarrassed by the Scottish Nationals and Conservatives.

Scottish Labour's shibboleths are now being faced down. Jack McConnell is a modern politician and is determined to make a virtue of facing up to the hard decisions his predecessors ran away from; pragmatism is triumphing slowly over ideology north of the border.

Mark Irvine

Freelance journalist

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