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Scotland's go-it-alone policy of providing free personal care for older people at home and in residential and nursi...
Scotland's go-it-alone policy of providing free personal care for older people at home and in residential and nursing homes has created a fairer system without undue extra public spending. Older people who use care services and their families feel that the arrangements introduced in 2001 are more equitable and an improvement on the past, as do social care managers in Scottish local authorities and care home providers, according to an independent assessment carried out for the Joseph Rowntree Foundation.

And while free personal care - such as help with washing, dressing and grooming - has reduced means-testing and money worries for older people with modest means, it has not led to a feared reduction in informal support provided by relatives and friends. Researchers from the University of Stirling, who organised group discussions with older people and their relatives, indicated that free personal care at home had helped informal carers by allowing them more time to carry out other, less hands-on support tasks.

An economic analysis included in the report shows that the policy has cost more than expected (for example,£127 million in 2002/3 compared with the£107 million planned). However, the current annual cost of£140 million takes 0.6 per cent of the Scottish Executive's total£25 billion budget, so only makes a marginal impact on other areas of public spending.

The study also concludes that differences between Scotland and the rest of the UK in the public costs of personal and nursing care are smaller than policy debates have suggested. This is because care home residents in Scotland no longer receive Attendance Allowance (worth£61 a week at the higher rate) while payments for nursing care are typically more generous in England, Wales and Northern Ireland (£65 per week in Scotland, compared with up to£129 a week in England). Scotland has also managed to reduce its cost profile by making proportionally greater use of care at home for frail, older people.

Looking ahead, the report anticipates that a major increase in the number of people aged 85 and over might lead to a potential tripling of the public costs of personal care by 2053. However, a further shift towards providing more care services at home, combined with policies to promote healthier life expectancy, could significantly reduce the projected bill.

Researchers David Bell and Alison Bowes also found that:

* Free personal and nursing care has particularly benefited older people with degenerative conditions such as dementia, ensuring that means-tested payments are no longer a burden at a time when they require increasing personal care.

* There are still some misunderstandings among older people and carers about the extent of free personal care. When the policy was first introduced, many had believed that all care would be free of charge, including bed and board 'hotel' charges in residential homes. Even so, free personal and nursing care are seen as an improvement.

* There is continuing concern among local authorities as well as older people and their carers about the interaction between care charging policies and other parts of the welfare system, especially benefits.

* Older people from black and minority ethnic groups continue to have limited access to care services that recognise and provide for their cultural needs.

Alison Bowes said: 'We found that free personal care in Scotland has promoted more 'joined up' approaches to the care of older people, while reducing their money worries and enabling their relatives and friends to continue provide additional, informal care. In that way, it has helped to improve the quality of life for frail older people and improve and support their choice of care services.'

David Bell added that the Scottish experience had important implications for the rest of the UK - although a transfer of the free personal care policy to England, Wales and Northern Ireland would not be simple or straightforward: 'Changes in the past five years in provision of nursing care have caused the funding of the care systems in different parts of the UK to diverge. As a result, applying free personal care in other parts of the UK would be extremely complex. Even so, the Scottish experience offers valuable insights for future care policies that could be pursued elsewhere.'

Welcoming the report, Sir Christopher Kelly, former Permanent Secretary at the Department of Heath in Whitehall and chair of the JRF's Advisory Group on Long-term Care of Older People said: 'Although older people, their families, local authorities and care home providers agree there are anomalies that need ironing out, it is clear that the arrangements in Scotland are an improvement on the past and regarded as fairer than comparable schemes for the rest of the UK. The Scottish experience provides important clues to the ways that the English White Paper on health and social care could produce reforms that better fit the aspirations and sense of fairness of those affected.'


Financial care models in Scotland and the UK by David Bell and Alison Bowes is published by the Joseph Rowntree Foundation and available from York Publishing Services, 64 Hallfield Road, Layerthorpe, York YO31 7ZQ, price£17.95 plus£2 p&p.

Read the Findings summary

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