Free Personal Care for the elderly

Community Care and Health (Scotland) Act 2002 - Background

The Sutherland Report 1999

Before the Scottish Parliament was fully established a Royal Commission on Long Term Care was set up to examine the short and long-term options for a sustainable system of long-term care for the elderly in the UK, both in their homes and in other settings. In March 1999 the Commission reported to the UK Parliament (The Sutherland Report).

One of the main recommendations of the report was that the costs of caring for older people should be split between living costs, housing costs and personal care. Personal care should be free in all settings and paid for through general taxation.

The UK government rejected proposals to fund free personal care for the elderly from general taxation. However the Scottish Executive introduced the Community Care and Health (Scotland) Bill on 24 September 2001 which proposed changes to the delivery of residential and non-residential care services and provisions for free nursing and personal care for the elderly as well as other measures related to community care.

Stages of the Community Care and Health (Scotland) Bill

Pre-legislative Stage

The Scottish Executive set up the Care Development Group in January 2001. This was a group of experts in the fields of health and social work whose remit was to investigate the best possible ways of introducing free personal care for the elderly and the cost implications. The group carried out extensive research and took evidence from various interested groups then prepared a report Fair Care for Older People. The Executive then drafted the Bill based on the findings in the report (24 September 2001).

Stage 1

The Health and Community Care Committee was given the task of considering the general principles of the Bill before it reached Parliament for debate. During October and November 2001 the committee met several times and called in numerous witnesses to give evidence.

The witnesses at this stage included:

  • Lord Sutherland (responsible for Sutherland Report)
  • Members of the Care Development Group
  • Royal College of Nursing
  • Royal College of General Practitioners
  • Age Concern
  • Carers Scotland
  • Scottish Executive Finance Department
  • Malcolm Chisholm ( Deputy Minister for Health and Community Care) – later became Unison Minister
  • Association of Health Board Chiefs
  • Community Care Providers Scotland (voluntary sector association)

At the end of this consultation process, the committee prepared a report and the Bill was then debated in Parliament. The majority of MSPs voted for the general principles of the Bill on 28 November 2001. It therefore passed on to Stage 2.

Stage 2

At this stage the committee examined the detail of the Bill and made amendments. Again they called on witnesses to give evidence.

Stage 3

The Bill then returned to Parliament to allow all the MSPs an opportunity to debate and vote on further amendments and then the final version of the Bill itself.
The Bill passed at Stage 3 and received Royal Assent on 12 March 2002 to become the Community Care and Health (Scotland) Act 2002.

Community Care and Health (Scotland) Act 2002 - How effective has it been?

On 1st July 2002 free nursing and personal care for the elderly was introduced in Scotland.

In a press release the Scottish Executive announced:

“There will be a £250 million package over two years which will include:

  • all personal care charges for people cared for in their own home will be abolished;
  • everyone needing nursing care, whether at home or in a care home, will receive it free of charge;
  • for those cared for in residential accommodation and who are funding the cost of their care, a ‘free personal and nursing care’ payment of £145 per week; and
  • for those in a nursing home, delivery of ‘free personal and nursing care’ payment of £250 per week.

    Personal care can include:
  • personal hygiene such as bathing and showering;
  • continence management – help with the toilet and skin care;
  • food and diet including assistance with eating;
  • help with mobility;
  • counselling and support services;
  • assistance with medication and simple treatments; and personal assistance such as help getting up and into bed.” 

Health Committee Inquiry

Apart from conducting inquiries when considering legislation, committees may initiate an inquiry about any issue within their subject area.

The Parliament is committed to monitoring the effects of laws it has passed and the committees play a key role in this.

The Health Committee launched an inquiry in December 2005 to find out whether the measures introduced in the Community Care and Health Act, 2002 have delivered what was intended.

The following is a news release about the Committee Inquiry:

Free personal care: Is it working?

Health Committee launches inquiry into free personal care for the elderly

9 December 2005

The Health Committee is today launching its inquiry into implementation of the Scottish Executive's free personal care for the elderly policy. It will also be examining the Care Commission's inspection regime.

In an innovative step to learn more about the practicalities of delivering care, individual committee members will be taking part in Care Commission inspections.

Convener of the committee, Roseanna Cunningham MSP, said:

”Free personal care for the elderly was one of the landmark decisions of the first Parliament. We want to see how it is working in practice, and whether it is delivering what was promised.

“We will also be examining the work of the Care Commission in registering and inspecting care homes.

"Earlier this year, in Perth, we held a major consultation event asking all those involved what the focus of our inquiry should be. We wanted to be certain to focus on the key issues for those directly affected by the operation of free personal care on the ground, as well as the Care Commission's work.

"The committee has today launched the full inquiry and I am pleased to say that the remit we have agreed very much reflects the views that were put to us in Perth.

"Since the outset, listening to those affected has been a prime objective of the committee and we now want to hear from those who have experience of free personal care and the Care Commission.

"Members are particularly keen to hear from ‘consumers' of free personal care, and their carers, to ensure that their views are given a voice in the inquiry.”

As well as an open call for written evidence, the inquiry will involve a number of other ‘evidence gathering' activities:

  • Inspections: Committee members will experience at first hand Care Commission inspections – four members will participate in inspections as observers to get an insight into the work of the Commission.
  • Case Studies: The committee is organising three case studies to examine the implementation of the care legislation on the ground. They will visit care facilities and talk to beneficiaries and providers of free personal care in East Lothian, Inverclyde and South Lanarkshire, and meet with the Highland Care Forum in Inverness.
  • Round tables: The committee will be holding a number of ‘round table' sessions at Holyrood, inviting those with experience of the issues to discuss with the committee and each other their views and recommendations.
  • Research: The Committee is sponsoring research into the low take-up in Scotland of ‘direct payments' – a system which allows those eligible for care to control their own care services.

Health Committee Inquiry - Summary of Conclusions and Recommendations 10 June 2006

Full text of the inquiry can be found here.

Free Personal Care Successes

Conclusion: The Committee believes that the policy of free personal care for the elderly introduced by the Community Care and Health Act has been a success, and has been widely welcomed.

It has:

1) provided greater security and dignity to many elderly people

2) allowed them to be cared for more readily at home

3) assisted their carers

4) reduced delayed discharges, thus freeing up NHS resources

5) largely ended disputes between local authorities and health boards over the care of elderly people

6) led to fewer complaints being reported to the Ombudsman about care of the elderly in Scotland than in England and Wales

7) prompted consideration to be given to the development of elderly care policy in England and Wales

8) in the main, been introduced swiftly and comprehensively

Recommendation: The Committee proposes that the policy of providing free personal care for those over 65 continues to be pursued and developed.

Problems with Implementation

Conclusion: The Committee has heard evidence that would suggest that there have however been some major problems with the implementation of free personal care for the elderly. These could undermine the policy if not addressed.

The problems include:

1) questions about the funding formula put in place by the Scottish Executive

2) the operation of ‘waiting lists’ for free personal care by half of all local authorities

3) a failure by the Scottish Executive to enforce clear guidance on key aspects of eligibility, such as the preparation of meals

4) the level of free personal care funding, which is not increasing in line with inflation

5) a lack of clarity regarding the date from which payments are required to be made, which could create a financial incentive for local authorities to delay assessments

6) continuing confusion over what is covered by the policy.

Recommendations: The Committee supports the principle that everyone who has a right to free personal care under the legislation and is assessed as requiring it should have it provided without undue delay.

In order to address the implementation problems that have arisen a number of initiatives need to be undertaken:

1) the Scottish Executive should undertake a thorough review (based on the experience of the last 3 years) of the resources required by local authorities, collectively and individually, to adequately finance free personal care. This may require an increase in funding, or more equitable distribution amongst local authorities

2) loopholes that permit the use of mechanisms to effectively ‘ration’ free personal care should be closed, if necessary by changes to the legislation

3) the Scottish Executive should enforce the guidance on those aspects of eligibility which local authorities claim remain ambiguous. It should ensure that services such as assistance with meal preparation, where they are part of assessed need, are eligible for free personal care

4) the Scottish Executive should adopt a mechanism for determining the long-term level of financing of free personal care, i.e. whether to increase it in line with the rate of inflation or some other indicator, as decided by the Scottish Executive

5) the Scottish Executive should remove the financial incentive for local authorities to delay assessment by either: allowing claims for free personal care to be backdated from the point of eligibility rather than assessment: or introducing a mandatory deadline for assessments, e.g. within two weeks of application.

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