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SCOTTISH PLANS TO IMPLEMENT PERSONAL CARE

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The report of the Care Development Group into long-term care of the elderly has been published*. ...
The report of the Care Development Group into long-term care of the elderly has been published*.

The report was received by ministers at the start of the month, following consultation and consideration by the group since February. As some copies of the report have been circulated in advance of the planned publication, it has been decided to make the report more widely available today.

A spokesman for the executive said:

'We have made clear our determination to take forward implementation of free personal care for Scotland's older people. The Care Development Group have over past months carried out a thorough and proper analysis of the issues around implementation and have produced a comprehensive report. Ministers are now considering carefully the recommendations of the report and will respond as soon as possible.'

BACKGROUND

1. The full terms of reference of the Care Development Group were announced on 31 January 2001. They are:

To examine existing service provision and to identify gaps, deficiencies and duplication which may require to be addressed

To bring forward proposals for the implementation of free personal care for all, along with an analysis of the costs and implications of so doing

To provide a clear definition of what is meant by personal care

To examine the current deployment of resources from all funding streams for the care of older people and make any recommendations for change that are thought to be necessary

To work with the Chief Nursing Officer's Group to develop a person-centred, holistic needs assessment process

To consider the interrelationships with UK matters, notably the tax and social security benefits system and cross border movement

To bring forward recommendations, together with costs and possible opportunity costs, of providing sustainable changes which will meet current and projected need and likely demand

And to report to the minister for Health and Community Care by August 2001 with a view to the first stage of implementation beginning in April 2002

2. The members of the Care Development Group were announced on 14 February 2001.

They are:

Deputy Minister for Health and Community Care Malcolm Chisholm,

Professor David Bell

Dr Roger Gibbins

Professor Alan Gilloran

Dr Sandra M Grant

Jim Jackson

Alexis Jay

David Kelly

Professor Mary Marshall

Dr Kenneth O'Neill

Professor Alison Petch

Sue Plummer

* a full copy of the report is available here.

EXECUTIVE SUMMARY OF CDG REPORT

The Scottish Executive decided and announced in January 2001 its intention to move towards theintroduction of free personal care for older people. We were invited to advise on this, against a background of wider analysis of social and health care services available to older people and related matters.

The care of older people has rightly come up the political agenda, particularly since publication of the Report of the Royal Commission on LongTerm Care. A lot of progress is already being made. In Scotland, the Executive's initial response to the Royal Commission Report provided significant and welcome new resources to improve care services for people in their own homes and to help older people stay at home and maintain their independence for longer. The Regulation of Care (Scotland) Act was enacted by the Scottish Parliament in July and provides a major new framework for regulating and improving the quality and standard of care available to older people and to others, in whatever setting they find themselves. It also provides important new arrangements for the regulation and training of the social services workforce. Good progress is being made in the development of joint working among agencies on services for older people. Other work underway in the Scottish Executive is examining the standard and appropriateness of services offered to older people by the National Health Service.

This heightened awareness of the needs of older people, and the extent to which it appears to be becoming embedded in the Scottish Executive's thinking, is very welcome. However, even in the brief time available to us it has become clear that there is still much to do and it will cost money.

Numbers of older people in the population are increasing. Their expectations, along with those of the rest of society, are likely to increase. The cost of care is likely to rise in real terms over the years, for example as a result of higher standards of care, cost pressures resulting from a tighter labour market and other employment related factors. It is therefore important that changes introduced now are sustainable.

Against that background, we warmly welcome the decision of the Scottish Executive to allocate£125 million a year, starting in April 2002, to facilitate the introduction of free nursing and personal care and the improvement of current services. This provision opens the door wide and enables us to recommend a substantial move forward from next April.

We undertook a substantial programme of consultation with older people, their carers and some younger people who do not yet need care to get a good feel for public opinion around issues relating to the care of our older people. We used this information in coming to our recommendations on how free personal care should be implemented.

We came to the following conclusions. For older people who are already in care homes, if their costs are already being met from the public purse, that will obviously continue. Those who move into a care home after a date to be named will be required to undergo an assessment of their level of need before qualifying for free nursing or personal care. Payment will then be made at a rate which reflects their level of assessed need for personal care up to a maximum of£90 per week and at a flat rate of£65 per week for nursing care. For those already in care homes on the named date who are funding their own care, we recommend thatas from next April they should receive contribution towards their costs of£90 per week for personal care and£65 per week for nursing care without further assessment as a transitional measure towards the new arrangements. This is on the assumption that these individuals will continue to be eligible for Attendance Allowance.

For those currently receiving care services at home, we recommend that where these come within the definition of 'personal care' which we propose in our report, all charging should be ended from next April.

Alongside these changes, we still expect people to pay for or contribute to their own living and accommodation costs whether they are at home or in a care home. However, in all of this we recognise that there is still much more progress to be made in improving the standard and availability of services to older people at home and we recommend that substantial progress needs to be made in this area, if we are to have a proper balance of care. We feel strongly that, where practical and reasonable, older people should be encouraged to stay in their homes as long as possible and certainly should be helped to do so, where they want to. We therefore think that a significant amount of the new financial provision - at least£50m - should be devoted to securing a step-change in the provision of home care services for older people. On the basis of our costings, this is affordable. However, we recognise that this will take time to deliver, since it will have organisational and staffing implications for local authorities. In the first 2 or 3 years, a significant amount of the available budget will need to be spent on training and other preparation by local authorities and other providers.

We think it is also important to ensure that older people throughout Scotland should be able to have the same expectations of the range and standards of services with which they will be provided and in what circumstances, irrespective of where they live. That gives rise to two important recommendations.

First, we have looked at the definition of what should constitute 'personal' care. We have decided to endorse the definition used by the Royal Commission on Long Term Care, which is already well understood and accepted. In broad terms, this includes the provision of non-medical services which involve close personal contact and touching but we have also decided that, particularly for those older people with dementia, the definition should include psychological support and counselling.

Second, we have examined work that is underway to design a single shared assessment process, which would put an end to older people having to repeat the same information to different professionals during the assessment of different aspects of their needs, and other work to design a resource use measure. We recognised that many local authorities already have in place reasonable assessment procedures and felt this could be built on to develop a shared assessment process by April next year.

We did not however feel that the work on the resource use measure was sufficiently far developed that we could make recommendations for its adoption in the same timescale, although we support the work in principle.

A further important consideration is the need to ensure that the resources which the Executive makes available for older peoples' services are used properly for the intended purpose. While we understand the financial pressures under which local authorities operate, we noted with some concern that actual expenditure on older peoples' services is currently running below the grant aided provision. We have therefore recommended that the new money now being made available should be ring-fenced until robust outcome agreements are put in place in order to ensure that it is used entirely to move forward the older people's agenda and improve services. We also recommend that all existing money spent on older people's services should be set against clear outcome agreements, agreed among local authorities, the NHS and the Scottish Executive.

We have made a number of other important but subsidiary recommendations, which along with our detailed analysis is set out in the full report.

We commend these recommendations to the Scottish Executive and hope that they will be implemented. We recognise that the job the Executive has set itself, in providing free personal care in addition to all the other improvements to services for older people, will be difficult and complex to achieve and cannot be fully achieved overnight. We are confident however that the resources now made available and the recommendations in this report will allow substantial and rapid progress to be made.

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