This piece originally appeared on LabourHame on 17 October 2012.
A constituent told me today about his problems in securing adequate care for his wife who suffered from early onset Alzheimers. After several years of coping on his own he sought help from the council and she began to receive her “free personal care”. It began badly with the carer arriving one and a half hours after the agreed time for helping to bath and dress. Difficult experience had long taught my constituent that sticking to a careful routine was essential to the smooth running of the day so he had just dealt with it as usual. When they were on time the carers only came for fifteen minutes. And it was rarely the same carer. The longest came for three days, was just getting to know the household routine, but didn’t come back after that. Alzheimer’s sufferers in particular benefit from continuity of routine and carer.
Eventually my constituent phoned up and cancelled the service. About a year after this, he could no longer cope and his wife was found a place in residential care. However he feels strongly that had quality home care been available his wife could well have been able to stay at home for longer which he would have preferred (he now feels bereft of part of his life) and the cost to the council would have been much less.
Tales of the short time carers spend with clients and of frequent changes of carer are commonplace. The story in the local newspaper in Edinburgh this week of the brother and sister living neglected and in squalor when supposedly having carers come in for four short spells daily, while fortunately not commonplace, is nonetheless shocking. It is easy to see this particular case as a failure of management by the company providing the care and of monitoring of such contracts by the council. But I would argue this is a failure of a system that is in crisis.
“Free personal care” is hailed as one of the “jewels in the crown” of the Scottish way of doing things. But the reality of the last few years is that the quality of care has fallen and it is harder to qualify for a service.
The introduction of free personal care (by the Labour/LibDem coalition originally but carried forward by the SNP Government) did not in itself add a single penny into care of the elderly and disabled. What it did was shift responsibility for payment from those who previously had to pay (the least well off had free care before this) to the state – in other words to all of us as taxpayers. So it added to the amount of the Scottish budget needed for ‘care’ without adding anything to the quality or quantity of care. As numbers needing care grow (mainly because of the growth in the numbers of people aged 80+) the amount required just to stand still has increased.
Local authorities who provide the “free personal care” have in these years faced reduced budgets and no ability to increase their income by raising the council tax. Councils have faced this problem in a number of ways:
- By raising the ‘threshold’ for eligibility for care. Most only give help if people meet needs which are deemed substantial or critical. Help for ‘moderate’ needs (often that all important ‘preventative’ help) has disappeared.
- By raising charges for services which fall outwith the ‘free personal care’ definition e.g. housework services, alarm services.
- By trying to reduce costs by tendering of services. Here in Edinburgh the last administration (a LibDem/SNP coalition) took the decision to tender out two thirds of its home care services. It quickly announced that it had made substantial savings by so doing. Companies bid low to get the contract. So what gives? Hourly rates of pay, paid travel time for the carers between clients, and training. Caring has never been a well paid job, but it has become increasingly precarious. Not surprising perhaps that turnover is high and job commitment and satisfaction low. This helps to explain the experience of those where the carer is always changing and the standard of understanding of the client’s condition in poor.
All of this would be very familiar to anyone in social care or local government south of the border. The reality in Scotland is very little different despite our patting ourselves on the back that we have somehow solved the problem through “free personal care”.
This clearly demonstrates the fiction at the heart of the SNP Government. We aren’t living in a care nirvana and the screw is tightening further every year.
This lies at the heart of what Johann Lamont said in herrecent speech. Social care is just one of the policy areas where the reality on the ground is very different from the rhetoric.
But there isn’t one simple answer. The SNP have leapt on this with glee and announced that Labour will end free personal care (free bus passes, free prescriptions or whatever) and so harm “ordinary” people in Scotland. But people are being harmed by the system we have.
We have choices. We can keep “free personal care” but stop pretending it has solved the problem, and genuinely debate how we can restore the quality of service people need. That either means reducing spending somewhere else, or increasing taxation to pay for it. In 1997 the Scottish people didn’t just vote “Yes”; they voted “YES/YES”, the second “yes” being for tax varying powers. Since 1999 no Scottish administration has used this, and it appears that by inaction the current Scottish Government may have made it difficult to use this power. Having discovered the technical problem they have done nothing, it would appear, to rectify it. Would the Scottish people pay a penny on income tax to improve the quality of social care? I don’t know – but we need to start asking the question.
Similarly local authorities might want to put to their population the idea of raising council tax by a small amount to help improve care in their area. Council tax is a far from perfect tax (and there is a case for introducing a new higher band to make it more progressive) but that applies to the impact of the freeze as well as to the tax itself. Those eligible for council tax benefit gain nothing from the freeze, which is worth more to those in the higher rate bands than in the lower.
Alternatively we could end free personal care and restore means testing of this element of care services (remembering that much else – especially much residential care – is still means tested). This would free up some of the Scottish block grant to invest in improving the quality of services. A word of caution though: this wouldn’t be enough in itself to pay for all the improvement needed.
These are all choices. It doesn’t help the argument to frame it purely in terms of “Labour wants to cut your freebies”. For my constituent whose wife is now in residential care, and the old man in the newspaper story who has now died, it is far too serious to do that.
Nor does it help simply to assert that “all will be well in the best possible of all worlds” if Scotland had independence. Sorry, but these issues will still need to be faced. Moreover these problems are being faced by people daily now, by people who shouldn’t be having to wait until the Government eventually holds its referendum (and even with a “yes” vote, wait after that for all to be disentangled). They deserve a Government which is opening up the debate and taking steps to tackle the problems now!