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What Price Free Care? That's the Question Being Asked of an Inquiry into the Scottish Parliament's Flagship Policy. By Cate Devine

Posted on: Wednesday, 22 February 2006, 09:00 CST

By Cate Devine

FOR all its ultra-noble intent, there can be no doubt that the first four years of the Scottish parliament's flagship legislation on free care for the elderly have been bumpy, to say the least. So news that the Scottish parliament's health committee is conducting an inquiry into the implementation of the policy and the work of the Care Commission, and is seeking input from individuals on the ground, will be welcomed by many - and viewed with trepidation by others.

The inquiry was convened by Roseanna Cunningham, SNP MSP, and yesterday heard evidence from Lord Sutherland, chairman of the Royal Commission that created the ground-breaking framework for long-term care in Scotland. It hopes to report in mid-June and is currently at the evidence-gathering stage. Submissions so far to what is effectively the first post-legislative inquiry undertaken by the Scottish parliament show that there is a yawning disparity between intention and implementation.

Some local authorities, for example, are already finding it cheaper to put older people into residential care because they can't afford to meet the costs of looking after them in their own homes; there are massive inconsistencies in charging for assistance with food preparation; increasing demand means fewer available home- helps; a failure to ring-fence budgets has increased local authorities' autonomy in funding care provision (which means they're blatantly means-testing). All this despite a steady increase in funding from an initial [GBP]127m in 2002/3 to [GBP]140m in the current year.

And just in case you don't think this has anything to do with you, listen up. The number of people living in Scotland aged 65 and over is set to rise by almost half in the next 23 years. Even if you escape that particular demographic, it's likely that by the time you reach your 30s or 40s you will be involved in the care of at least one elderly relative.

Little wonder, then, that my first question to Roseanna Cunningham is met with a rather terse smile. I ask if, in opening this parliamentary Pandora's box, she knows what she's letting herself in for.

"There has been an enormous row and it is ongoing, " she concedes. "We were aware of the difficulties being experienced even before I was convener, and through what was being published in the pages of The Herald and other media." But she is resolutely committed to the policy.

"The danger is we end up pursuing a line where it begins to look as if the whole thing is unsustainable. That's certainly not my intention, and I don't think the health committee has set out to find a way of justifying a retreat from our flagship policy. My personal view is that this is a worthwhile policy which is a mark, I hope, of the way in which in Scotland we want to treat vulnerable people."

The argument that it was always going to cost too much to fund properly is secondary, she says, to honouring that fundamental principle. "If we are committed to this policy, then I think we have an obligation to make sure it's funded properly."

It was vital to get the widest possible input of information to this major inquiry so that its remit could be decided, problems identified and solutions sought. A huge undertaking by anyone's standards.

"The idea did become quite overwhelming, " says Cunningham. "We needed to find a way to identify the priorities."

The health committee held consultations in Perth last November with around 100 representatives of different care groups and asked them to score priorities. Care-home inspections and registration of complaints, free personal care and related provisions, and the low uptake of direct payments emerged as the three key areas. Cunningham says: "The cost of care-home inspections is high, and care-home owners have to pay for these themselves. Respite units are subject to separate inspections, meaning homes that offer respite have to pay twice. And the Care Commission is not the only inspecting body. So funding these inspections is another burden on care homes. There's also concern about the issue of complaints. There is lots of anecdotal evidence that people are afraid to complain about care homes because of come-backs."

How can she be sure councils are telling the truth about what they do? "We test their evidence against what other people are telling us. That's the whole point about giving evidence. We need people to tell us what is actually happening, and not just anecdotally. One of the things that bedevil all of us in parliament is people saying they've heard this or know somebody that. Well, we'd like to speak directly to those people."

Unusually, the inquiry has invited "consumers" of free personal care and their carers to submit written evidence, meaning lay people are involved at an earlier stage of the inquiry than would normally be the case. This, says Cunningham, is because she wanted us to help her define the inquiry's remit. Evidence to the care inquiry has been submitted by 33 organisations, including the Association of Directors of Social Work, Age Concern Scotland, Cosla, the Care Commission and six individuals with personal experience of care homes.

A series of six round-table sessions at Holyrood, where committee members and those with experience of the issues discuss views and recommendations, will take place this month and next. The first took place on February 7. Submissions came from Alzheimer's Scotland, Age Concern Scotland, Carers Scotland and Patient Partnership in Practice. Lord Sutherland was the first witness to the second roundtable session yesterday.

The deadline for individual submissions from people with experience of free personal care at home was February 10. Round- table discussions with these people will take place on March 7 and 21.

One of these submissions will be from my family on behalf of our mother [see below]. Our issue is with Renfrewshire Council continuing to charge my 86-year-old mother [GBP]310 a month for effectively providing a slice of toast for breakfast and a cold sandwich for lunch.

Cunningham says: "Charging for assistance with food preparation will undoubtedly be part and parcel of the inquiry, although it did not arise specifically in early discussions. The implementation of free personal care is of particular concern regarding clarity and delivery and that is probably where food preparation comes in. There are issues of sustainability."

There are no sanctions in place against local authorities who pursue unlawful charging.

"The problem is that it would need an individual to test the argument in court, and for obvious reasons that isn't often an attractive option, " she says.

"The executive does have some powers it can use, including capping council tax, but it is hard to see how effective that would be unless it also started ring-fencing areas of the councils' budgets. If it began to do that as a matter of routine, it does begin to raise issues about local democracy.

"Whether the committee will come to that conclusion isn't something I can say at this early stage although it is a recommendation that might be considered."

Cunningham's personal experience of free personal care has increased her awareness of the looming problem of unmet need. Her late mother came to live with herwhen she was 90. When she fell and fractured her collarbone, home helps from the local council came to help her wash and dress. But Cunningham did not realise until too late that she had become her mother's primary carer.

"I HAD BEEN ACCUSTOMED TO my mother being independent and fit and healthy but I didn't really understand the extent to which that wasn't the case any more, " she says. "Had I understood more clearly what was happening, I would have made sure we had somebody to come to stay overnight. That would have made a difference to my mum in terms of her feeling secure. Her physical illness cleared up quite quickly, but there were other problems arising that were related to her mental wellbeing. I don't know at what point it would have dawned on me that my brother and I needed to sit down and be more proactively aware of the situation.

"It seems to me there is no easy mechanism to trigger support. My issue is a tiny issue, but it gives me an insight into how people slide into becoming carers of elderly relatives and don't know that's what they are. Somebody else has to tell them.

"However, there isn't going to be any enthusiasm to go out and check on unmet need because the last thing councils are going to do is go out proactively to look for more folk to add to the list."

Even so, she repeats her undying commitment to free personal care. "This policy was based on the best principles, but while some anticipated problems have not arisen, clearly some problems have arisen that weren't forseen.

"What we have to do is get to the bottom of the unintended problems and see if we can get some resolution. A lot of things have to come out before we can tell if it's working or not."

www. scottish. parliament. uk/ committees/health/inquiries

Source: Herald, The; Glasgow (UK)

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