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2. SUMMARY OF RECOMMENDATIONS
1. Scotland has acted as something of a test ground for this new approach to paying for long-term care; it has not been without its challenges but the new Scottish Government has stated its commitment to securing the Free Personal & Nursing Care ( FPNC) policy for the longer term and in doing so, to ensuring it is implemented properly and fairly across the country. Despite some practical difficulties in its formative years, the FPNC policy remains popular and has worked well in the largest part, delivering better outcomes for Scotland's older people.
2. Our review has been conducted at a time of great change, with a new partnership signalled with the signing of a Concordat between central and local government in Scotland in November 2007, which is focussed on a number of shared objectives and outcomes. That partnership underpins new local government funding arrangements which apply from 2008-09 and are based around delivery of the Scottish Government's 5 strategic objectives and 15 national outcomes.
3. We have had to conduct our review as the details of the new funding arrangements for local government have been evolving and our recommendations are made at a time when there are still a number of unknowns. However, we hope that in that same spirit of co-operation in which the new Concordat was signed, central and local government will work together, putting any political differences aside to take forward our recommendations.
4. Our recommendations are intended to address the early difficulties, secure improvements in the quality of life and care experience for our older people and to bring to bear greater certainty and transparency (both in respect of the resources underpinning the policy and in respect of the entitlement of individuals).
5. In forming our recommendations we have had regard to 5 fundamental principles:
- That FPNC should be an entitlement for everyone assessed as needing this level of care and support; analogous with the NHS;
- Responsibility for the wider provision of care should be shared between the state and individuals;
- FPNC should stop being regarded as an 'optional extra', but should be viewed as an established and 'mainstreamed' part of long-term care funding;
- The system should be fair and equitable; and
- The system should be transparent in respect of the resources underpinning it, the entitlement of individuals, realistic timescales for delivery and what it leaves to personal responsibility.
6. Our recommendations are set out in the 12 point plan which is set out below. These are explained in more detail in Chapters 6 to 10 below. The plan, comprises 3 distinct sets of recommendations, which are best viewed in terms of:
Set One - those required for the short-term, to stabilise the policy and address current difficulties in funding and in the variability of provision across the country;
Set Two - those for the short to medium-term, which are aimed at securing the policy and keeping it under review within the next 5 years; and
Set Three - one recommendation for the longer-term which requires more strategic long-term policy planning and vision.
Recommendations: 12-Point Plan
Short-term - stabilise and address difficulties in funding and variability of provision | 1. Address Funding gap. The Scottish Government should provide additional funding to stabilise the policy in the short-term, i.e. for the next 5 years. It is estimated that the shortfall in funding is around £40 million. |
2. Up-rate Fixed rate allowances. The Residential and Nursing Care Fixed Rate Allowances should in future be up-rated annually in line with inflation. |
3. Standardise assessment & delivery. There should be a clear 'entitlement' for all those assessed as needing personal and nursing care, analgous with the NHS, and in line with that, local authorities and their partners should consolidate standardisation of assessment for and delivery of services, to common processes and clearly stated target waiting times. |
4. Establish clear national priorities and outcomes for older people. There should be a specific reference to securing the wellbeing of older people included within the Scottish Government's 15 National Outcomes set out in its National Performance Framework. |
5. Ensure costs are accurately monitored and reported. The current failings in information systems indentified should be addressed and more accurate systems to collect comprehensive and accurate cost information set in place. |
6. Improve local accountability. A performance framework for long-term care services for older people should be built into the Single Outcome Agreement model. |
7. Address imbalance in funding streams. The UK Government should not have withdrawn the Attendance Allowance funding in respect of self-funding clients in care homes, currently amounting to £30 million a year. That funding should be reinstated in the short-term while longer-term work to re-assess funding streams takes place. |
8. Clarify expectations. Renew efforts to improve public information and understanding of the policy. A clear understanding of shared responsibility needs to be fostered. |
9. Address cross-border/boundary issues. Conclude work to ensure greater consistency in interpretation and application of Ordinary Residence legislation and guidance without further delay. |
Medium-term - within the next 5 years | 10. Review and re-model. The uncertainty associated with projecting future costs of long-term care means demand must be reviewed and re-modelled regularly and be reflected accurately in future local government finance settlements and capacity planning by local authorities and their health partners. |
11. Review public funding arrangements. There should be a holistic review over the next few years of all the sources of public funding for long-term care of older people, including health, social care and housing support, but also UK Government benefit funding, in particular through Attendance Allowance and Disability Living Allowance. |
Longer-term - beyond 5 years | 12. Establish long-term vision. Government at all levels should seek to establish a new vision for dealing with the challenge of demographic change, not just looking at long-term care, but also pensions, housing, transport, etc. |
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