INDEPENDENT FUNDING REVIEW OF FREE PERSONAL AND NURSING CARE
News Release
April 28, 2008
SUTHERLAND REVIEW CALLS FOR ACTION TO SECURE SUSTAINABLE FUTURE FOR FREE PERSONAL CARE
Scotland's Free Personal and Nursing Care policy is sound but increased funding, greater consistency and transparency, and better planning for the future are to key ensuring it is sustainable for the long-term.
These main conclusions are delivered by the Independent Funding Review of Free Personal and Nursing Care in its report submitted to Scottish Ministers today.
The Review was commissioned by the Scottish Government's Cabinet Secretary for Health and Well-Being last summer and was led by Lord Sutherland, who chaired the Royal Commission on the Long-Term Care of the Elderly in 1999, the recommendations of which became the foundation for Scotland's policy.
The Review considered the first five years of the operation of the landmark policy and examined its resourcing and sustainability.
Its Report delivers a 12-Point Action Plan, recommending key areas for action for the short, medium and longer term.
Among other issues, action for the short-term is intended to address immediate concerns regarding funding and variability of provision, and includes a call:
- to address a funding gap of around £40 million a year in local authority finances;
- for the reinstatement of the £30 million a year in Attendance Allowance withdrawn in respect of those in care homes at the time the policy was introduced; and
- for a common Scotland-wide framework to be established, to include minimum standards and maximum waiting times for assessment and receipt of services.
The recommendations require the attention and co-operation of many partners involved in delivering the policy if Scotland is to successfully achieve a long-term sustainable policy, which the Review sees as an important element of Scotland's progressive approach to the long-term care and well-being of its older people.
Underpinning the recommendations are 5 fundamental principles:
- Free personal and nursing care 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;
- Free personal and nursing care 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.
The 12-Point Action Plan recommends:
Over the short-term, in order to 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, analogous 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 identified 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 reassess 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.
Over the 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 the Attendance Allowance and Disability Living Allowance.
For the longer-term, beyond the next 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, and other factors.
Announcing his recommendations to Scottish Ministers today Lord Sutherland said:
"Scotland has acted as something of a test ground for this new approach to paying for long-term care. The policy was implemented as part of a much wider package of measures and investment aimed at improving care services for older people.
"Five years into operation it has been important to review the delivery of the policy and recommend ways in which to address issues which have arisen.
"Despite some practical difficulties in its formative years, the policy remains popular and has worked well in the largest part, delivering better outcomes for Scotland's older people.
"Free personal and nursing care services are not delivered in isolation and in most local authorities sit within the broader range of community care services. That is as it should be. They are an entitlement - not an optional extra, but a key and vital aspect of long-term care.
"Our recommendations are intended to address early difficulties, secure improvements in the quality of the policy delivery for older people and to bring to bear greater certainty and transparency.
"I believe that when taken together as a package - and provided they are fully embraced by both central and local government - the recommended action can resolve the problems which affected the policy in its early years and present Ministers with a clear way forward in embedding free personal care as an important part of the Scottish care system.
"The adequate provision of personal and nursing care is now part of the way we want to live. We must build this into the mainstream of our planning for the future.
"There are very serious demographic and societal challenges just around the corner which government needs to plan for now. It is rather like climbing a Scottish mountain. Having reached the vista provided by one horizon we realise that a much larger vista lies before us for which we must prepare."
Background information
Key funding and cost conclusions of the Review
The Review Group's central projection is that the real terms increase in the overall costs of care will be 4.4 per cent per annum. The report outlines the calculations which indicate that personal care costs, which are paid by local authorities, will increase from £256 million to £813 million between 2006 and 2031.
The Review Group estimates that in terms of total funding there is a shortfall in the region of around £40 million which requires to be addressed by government.
The Residential and Nursing Care Fixed-Rate Allowances increased on 1st April 2008 from £145 to £149 and from £65 to £67 respectively. The Review Group recommends these allowances should in future be up-rated annually, in line with inflation.
The legislative context
The Community Care and Health (Scotland) Act 2002 provided the legislation for introducing the free personal care policy. Effectively, under the Act, since 1 July 2002 Scottish local authorities have been obliged to:
- Provide personal care services such as help with washing, dressing and getting in and out of bed free of charge to those at home (the NHS remains responsible for providing nursing care to people who live at home); and
- Make payments to care home providers on behalf of self-funding clients in care homes who are also entitled to have the personal care and nursing care elements of their care package free of charge.
Self-funders remain and remained liable for the accommodation and other living cost elements of their care costs.
In the case of residential care, funding is on the basis of flat rate payments for personal and nursing care for self-funders aged 65 and over, set by Regulation by the Scottish Government. On 1 April 2008, payments to eligible residents increased for the first time since the policy was introduced.
The legislation did not affect the position of clients who could not afford to pay for their own care: local authorities continued and continue to wholly fund their care needs.
This News Release was issued independently by the Independent Funding Review of Free Personal and Nursing Care and is hosted here on the Scottish Government's website.