Hansard

There can be little doubt that Parliament is proud of the introduction of free personal care for all of Scotland's elderly population. The Community Care and Health (Scotland) Act 2002 was supported by all parties and the policy is rightly seen as one of Parliament's most significant achievements.

As a member of the Health Committee when both the Community Care and Health (Scotland) Act 2002 and the Regulation of Care (Scotland) Act 2001 were scrutinised, I was acutely aware of the work that had gone into ensuring that the legislation was robust and would deliver its objectives. However, the time is now right to evaluate how delivery of care services has changed in the past four years. We might all have supported the proposals in 2002, but how have they worked since then? Has free personal care delivered for Scotland's elderly population? Have there been problems with implementation of the policy?

To answer those questions, the committee decided to conduct formal post-legislative scrutiny of two of the most important acts that have been passed by Parliament. However, because of the wide-ranging nature of both acts, we decided to focus our remit somewhat by identifying key issues. In order to do so, we issued an open call for evidence in June 2005, inviting people with an interest in the legislation to suggest the main issues on which we should focus our inquiry. In addition, we organised a consultation event in Perth in September last year. The event brought together more than 100 people to discuss where the committee should concentrate its energies. A series of workshops identified potential issues. The outcome of the process was a decision to focus on three key elements of the legislation: free personal care for the elderly; the regulation of care services for the elderly; and the take-up of direct payments.

Free personal care has always been the headline-grabbing policy from the legislation, and throughout our inquiry we found a great deal of support for the policy from people throughout Scotland. For many, it is considered to be one of the most positive things Parliament has achieved. The committee found widespread support for the principle of free personal care, and evidence of considerable successes in its implementation.

We received significant evidence from the immediate families of older people—families who have a responsibility to care. The introduction of free personal care appears to have gone a considerable way towards alleviating their concerns about care of their elderly relatives, which has no doubt led to a great deal of support for the policy.

One of the major concerns of the committee back in 2001-02, when we scrutinised the legislation, was that the introduction of free personal care might simply lead to a reduction in informal caring by relatives and others, and might encourage more people to be cared for in institutional settings rather than in their own homes. It appears, however, that that is not happening. The Executive's figures show that the increase in people receiving free personal care while remaining at home is more than double the increase in the number of people in care homes. That is a clear demonstration that the policy appears to be working by allowing elderly people, if they so choose, to remain in their own homes.

Another aspect that characterised pre-2002 care was the number of disputes between local authorities and health boards about who was responsible for the care of many older people. Those who were admitted to hospital, but were considered well enough to leave were often subject to delayed discharge because finding—and funding—care accommodation proved to be difficult. Apart from causing problems for the individuals involved, bedblocking can—as we all know—cause a significant problem for the national health service. The advent of free personal care has addressed that by largely removing the financial barrier and by making discharge much easier. That has had the beneficial knock-on effect of releasing significant NHS resources. The committee feels that that has certainly improved working relations between local councils and health boards, which are now expected to work closely together on delivery of health and care. That can only be advantageous.

In the committee's opinion, the introduction of free personal care has provided greater security and dignity to many elderly people. It has allowed them to be cared for more readily at home, assisted their carers, reduced delayed discharges—thus freeing up NHS resources—and has largely ended disputes between local authorities and health boards about the care of elderly people. It has also led to fewer complaints about care of the elderly being reported to the ombudsman in Scotland than has been the case in England in Wales, which has prompted consideration of whether such a policy should be introduced in England and Wales. In the main, free personal care has been introduced swiftly and comprehensively.

The committee's conclusions are backed up by research that was undertaken by the University of Stirling for the Joseph Rowntree Foundation. One of the researchers 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 to 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."

The committee considers the policy to have been a success: we propose that it continue to be pursued and developed.

However, not everything in the garden is rosy. Although there is widespread support for the policy, which has delivered for many elderly people, the committee acknowledges that there have been problems with implementation. Most of the problems that were described to us relate to funding. We heard serious concerns that the cost of implementing the policy had been underestimated to the extent that significant pressure had been placed on Scottish local authorities. Indeed, we received from some local authorities detailed calculations that quantified the shortfall between what they received from the Executive and the cost of implementing the policy. The committee submitted to all 32 local authorities requests under the Freedom of Information (Scotland) Act 2002 for details of how much authorities received from the Executive and how much they spent on free personal care. We are persuaded that there is a significant problem in funding care.

A number of submissions made the point that the ceiling for free personal care has remained the same since the policy was introduced, which means in essence that the value of the free personal care allowance is declining year on year. The Executive does not appear to have a clear policy for calculating the ceiling. The committee wants that to be addressed.

Free personal care payments may be made only from the date on which the assessment of need was undertaken. There is no facility for backdating payment and the approach has caused concern that some local authorities delay assessments for budgetary reasons. That cannot be allowed to happen and the Executive should legislate to prevent it from happening.

The committee was also concerned by evidence that a number of local authorities are operating waiting lists for free personal care. We discovered during our inquiry that almost half Scotland's local authorities operate such lists. The legislation was not intended to operate in that way, so we have called on the Executive to rectify the situation.

The committee was also concerned about the guidance that the Executive issued in support of the legislation. It became apparent during our inquiry that there is a significant dispute between the Executive and local authorities about whether assistance with preparation of meals is an eligible cost. In general, the Executive considers that it is, but a number of local authorities and the Convention of Scottish Local Authorities think that it is not. That is cause for real concern, given that the Community Care and Health (Scotland) Bill was passed in 2002. It is imperative that the Executive and local authorities work together to ensure that there is a clear definition of the care that our elderly people are entitled to expect.