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PART ONE: BACKGROUND TO REVIEW: MEMBERSHIP, REMIT & PROCESS
3 BACKGROUND TO REVIEW: MEMBERSHIP, REMIT & PROCESS
"The Scottish Government has looked to the Independent Review to investigate the level and distribution of resources for the policy and to make recommendations on its long-term sustainability."
3 BACKGROUND TO REVIEW: MEMBERSHIP, REMIT & PROCESS
The policy in Scotland
7. In March 1999 the Royal Commission into the funding of long-term care of the elderly published its report. 1 The Commission's recommendations on free personal and nursing care ( FPNC) for older people were based on the premise that long-term care of older people is a responsibility shared by the state and the individual and that as such, the system should be fair and equitable, transparent in respect of the resources underpinning it and in respect of the entitlement of individuals and what it leaves to personal responsibility.
8. The Commission recommended that the costs of care for all those who need it should be split between living costs, housing costs and personal care and that the third element - personal care - should be universally available free of charge to everyone assessed as having personal care needs. Its recommendations on nursing care were accepted across the UK and in January 2001 the then Scottish Executive announced its intention to go one step further and also implement the Commission's proposals for free personal care for all. The policy was introduced Scotland-wide on 1 July 2002.
9. Although the FPNC policy has been extensively reviewed and widely reported on the new SNP Government wanted to take a closer look at funding, costs and sustainability. It made clear in its Manifesto and has reaffirmed in early Ministerial statements its commitment to securing the policy in the longer-term and to ensuring it is implemented properly and consistently across the country. The funding review has been positioned to provide independent advice on that.
Remit & Membership
10. The Scottish Government has looked to the Independent Review to investigate the level and distribution of resources for the policy and to make recommendations on its long-term sustainability. Specifically, the remit set by Scottish Ministers asked us to examine 4 key areas:
- The total level of resources available to Scottish local authorities for the implementation of FPNC since the policy was introduced, including:
- The resources available for the provision of personal care at home without charge to certain people prior to the introduction of the policy; and
- The extra resources provided when the policy was implemented.
- The distribution of the total FPNC resources amongst local authorities through the Grant Aided Expenditure ( GAE) mechanism;
- The impact of the withdrawal of Attendance Allowance to pensioners in receipt of FPNC on the financial balance between the Scottish Government and the UK Government; and
- The long-term sustainability of the FPNC policy.
11. The Review Group begun work on 3 September 2007 and was asked to give the Cabinet Secretary for Health & Wellbeing a report on its initial discussions by the end of that month and to submit a full report by March 2008. It has since met on 10 occasions and convened a further meeting specifically to take oral evidence.
12. Lord Sutherland invited the following experts to support him in his Review:
Anne Jarvie CBE, former Chief Nursing Officer for Scotland;
Mary Marshall OBE, former Director of the Dementia Services Development Centre at the University of Stirling;
Professor David Bell, University of Stirling;
Jim Dickie, former Director of Social Work, North Lanarkshire Council and past President of the Association of Directors of Social Work; and
Rory Mair, Chief Executive of the Convention of Scottish Local Authorities ( COSLA).
The Process and what we looked at
13. It was important that our work was informed by the experience of the past 5 years, in terms of decision makers and others involved directly in the delivery of FPNC across the country but also those affected by it, either directly or indirectly and those organisations and representative bodies who supported their interests. There had been a number of studies into the working of the policy, including 2 Parliamentary inquiries, a number of research studies and a recent evaluation commissioned by the last Administration. Ministers asked us to have regard to that body of evidence and make the maximum use of the information already available, in particular, and insofar as they may be relevant:
- The report of the Session 2 Audit and Health Committees' Inquiries, published in 2005 and 2006, and the Scottish Executive's responses;
- The Hexagon Evaluation of the Operation and Impact of Free Personal Care, published in February 2007 and the Scottish Executive's response;
- The work of the Scottish Executive/ COSLA Care Costs Sub-Group; and
- Other recent research findings, including work by the Joseph Rowntree Foundation and in particular the 2007 report by David Bell, Alison Bowes and Alison Dawson on recent developments in the operation of free personal care policy.
14. The Review Group would also have regard to the study into FPNC which Audit Scotland would be undertaking on behalf of the Auditor General for Scotland to a similar timeframe. Lord Sutherland met with the Auditor General and agreed at the outset that in an attempt to minimise overlap and the burden on local authorities and others, the 2 reviews would share information wherever that was possible. Principally, the Review Group would look to draw on the output from the Audit Scotland local authority data collection exercise and the focus groups with older people which it had commissioned Age Concern to carry out on its behalf.
15. With the wealth of information already available in mind and to avoid duplicating efforts and putting contributors to the trouble of repeating what they may already have said in response to other recent work, the Review Group agreed at its first meeting that contributions should be invited by way of an open opportunity to either add afresh to the debate or to up-date views expressed already. However, it did widen the parameters, seeking more qualitative input than in previous work, focussing on the wider impact FPNC had had across social care, local authority, health and housing support finances and on the quality and effectiveness of overall services provided to older people in need and other vulnerable groups.
16. The Review Group also carried out its own small study of the views and experience of front-line social work staff. Interviews were conducted with staff involved in the implementation and operation of the FPNC policy across a range of local authorities. Interviews were conducted in the 3 month period November 2007 to January 2008 on an anonymous, confidential basis with 34 front-line staff in a rural/urban cross-section of 9 local authorities.
What we did not look at
17. While the Independent Funding Review was given a broad remit to look at the level and distribution of resources to deliver the FPNC policy since 2002 and to look at its future sustainability it was not invited specifically to look at the implementation or interpretation issues encountered variously by local authorities across the country. Work had begun separately to do that through 2 Scottish Government and COSLA official level working groups which would look concurrently at the issue of consistency and the various practical issues around implementation which had emerged.
18. However, in considering the long-term sustainability of the policy and its consistent and equitable delivery it has not been possible to frame our recommendations without having regard to those long-standing concerns, which if left unchecked will continue to undermine what is otherwise a positive and in the largest part successful policy. Whilst recognising the separate work going on to address these difficulties we have taken account of these problems in pulling together a cohesive set of recommendations to Ministers on the policy's sustainability.
Responses received
19. The Review Group received written responses from 21 of Scotland's 32 local authorities and a further 11 written contributions from other bodies and individuals, including some very detailed views and some ideas on how to address difficulties. The Group also took oral evidence from the Chief Inspector of Social Work, the Scottish Public Services Ombudsman and from a SOLACE, CIPFA, ADSW working group established to look at, and contribute to thinking on the issues raised by the Independent Review. A summary of responses received, which records in detail the views expressed to us, can be found (along with the agendas and minutes of our meetings) in a special section on the review, hosted for us on the Health & Community Care pages of the Scottish Government's web site, at: http://www.scotland.gov.uk/Topics/Health/care
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