Free personal care for the elderly was the flagship policy of the fledgling devolved government in Edinburgh in 2002. Six years on, the ideals have to be squared with the economic reality of a £40m shortfall. That is according to no less an authority than Lord Sutherland, the architect of the original plans for free personal and nursing care for the elderly, who was asked by the SNP government to review how the pioneering policy was working. His answer is not unexpected - a report by Audit Scotland in February warned of a funding shortfall of up to £63m, which would become worse as the population ages.
Yesterday, however, Lord Sutherland had an answer to the funding shortfall: reinstating the attendance allowance which has not been paid to those in care homes since free personal care came into effect. This would inject £30m a year into the scheme, leaving only £10m a year, which he believes should be provided by the Scottish Government. There are two serious drawbacks to this. One is that the top-up is a short-term fix; as the review commission acknowledges, it would stabilise the policy for the next five years, "until the demographics really begin to bite". The second is that it cannot be achieved without a major battle with the Westminster Government's Department for Work and Pensions. Campaigners, such as Help the Aged in Scotland, believe there is a legal case to be made for transferring the £30m a year savings to the Scottish Government, but that fault line between London and Edinburgh will not be bridged easily. More urgently, ministers at Holyrood must turn their attention to implementing the policy more fairly and with greater clarity. As The Herald has reported over the past few years, there have been serious inconsistencies between different authorities in what is provided as personal care. The most obvious has been whether or not it includes the preparation of food. Despite official guidance in 2006, the issue is still unresolved and, as Lord Sutherland's commission urges, there is a need for greater clarity.
This confusion stems in part from high public expectations from a much-trumpeted policy leading to a greater demand (and therefore much higher costs) than had been envisaged. It is now clear that those costs will increase even further, with the number of very elderly people in the population now expected to be many more than projected in 1999. The commission's recommendation - that clients and carers should have a clear understanding of their entitlement and the minimum standards of service they can expect wherever they live in Scotland - should be the first priority. The removal of ring-fencing from the councils' funding allocations makes a Scotland-wide agreement for minimum standards even more necessary. It does not prevent adapting to local circumstances.
In likening his review to reaching a false summit, Lord Sutherland reveals the task to be more daunting than anticipated. That does not mean we should turn back; the challenge now is to find the best route.
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