In Tuesday’s Herald Stephen Naysmith reported on the increasing postcode lottery the elderly face when it comes to ‘free personal care’. The much heralded policy has been under-funded since the day it began and successive Scottish Government’s have failed to address this problem, even as the population ages. Instead of acknowledging the issues local authorities face, Health Secretary Alex Neil dismissed the report.

My response to Mr Neil’s criticism was sent to the Editor of the Herald earlier today, and follows below.

Dear Sir 

Alex Neil responded to the concerns raised in today’s (Tuesday 19th) Herald about social care by once again ‘closing down’ debate by referring to Scotland having ‘free personal care’ as if that had resolved all problems. 

The SNP are so busy patting themselves on the back about free personal care that they seem blind to the serious gaps in provision and quality which exist. 

‘Free personal care’ covers only a part of an individual’s care needs. It doesn’t cover the accommodation costs for those in residential care, nor, as the article made clear, does it cover substantial elements of the care needed for independent living. It doesn’t cover alarm costs (which in some areas is just a call to alert a relative, in others a mobile call out service), it doesn’t cover shopping or cleaning services (often no longer provided at all by councils ). 

Introducing ‘free personal care’ did not in itself deliver any additional resource to social care for the elderly and disabled. What it did was transfer some of the cost from those individuals who previously had to meet all or part of their personal care costs to the Scottish Government i.e. to the taxpayer. In itself not an additional hour of care was provided, while the ‘cost’ transferred reduces the overall amount available for other services. Many arguments can be made for ‘free personal care’ , including criticism of the costs and unfairnesses that means testing creates, but we shouldn’t be kidding ourselves on that we have in Scotland dealt with the ‘social care’ issue. 

All of this is taking place now in a time of increasing need for care services, and reduced council budgets. Councils have therefore had to respond through a number of mechanisms: 

1) Increasing charges for those parts of the service not included within the definition of free personal care

2) Raising the threshold for eligibility for care. Nearly all councils only offer services to those deemed to have ‘critical or substantial’ needs.

3) Reducing the time carers spend on ‘home care’ , with time slots of 15 minutes being common.

4) Trying to drive down costs by tendering out services to companies who can offer a price which ‘saves’ the Council (and therefore ultimately all of us as taxpayers) money , But this is only done by lowered wages , trimming overheads like training and not paying carers for their travel time between calls. All of this has effects on staff retention and the quality of service. 

Here is just one story of many in my constituency. A constituent told me 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 came for fifteen minutes . But 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 he phoned up and cancelled the service. About 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. 

We need a grown-up conversation about how as a society we provide and pay for care for those who need it. Complacency that ‘free personal care’ has solved the problem, or asserting that ‘all will be miraculously solved’ by independence isn’t that conversation.

Yours faithfully

Sheila Gilmore MP
(Edinburgh East)