Policy responses and statements
- Name of organisation:
- The Scottish Parliament: Health Committee
- Name of policy document:
- 'Free Personal Care: Is it Working?' - Inquiry into Free Personal Care for the Elderly
- Deadline for response:
- 10 February 2006
Background: The Health Committee has launched an inquiry into implementation of the Scottish Executive's free personal care for the elderly policy. It will also be examining the Care Commission's inspection regime. In an innovative step to learn more about the practicalities of delivering care, individual committee members will be taking part in Care Commission inspections.
Free personal care for the elderly was one of the landmark decisions of the first Parliament. The Health Committee wants to see how it is working in practice, and whether it is delivering what was promised. The Committee will also be examining the work of the Care Commission in registering and inspecting care homes.
Members of the Committee are particularly keen to hear from ‘consumers' of free personal care, and their carers, to ensure that their views are given a voice in the inquiry. As well as an open call for written evidence, the inquiry will involve a number of other ‘evidence gathering' activities:
Inspections: Committee members will experience at first hand Care Commission inspections – four members will participate in inspections as observers to get an insight into the work of the Commission.
Case Studies: The committee is organising three case studies to examine the implementation of the care legislation on the ground. They will visit care facilities and talk to beneficiaries and providers of free personal care in East Lothian , Inverclyde and South Lanarkshire , and meet with the Highland Care Forum in Inverness .
Round tables: The Committee will be holding a number of ‘round table' sessions at Holyrood, inviting those with experience of the issues to discuss with the committee and each other their views and recommendations.
Research: The Committee is sponsoring research into the low take-up in Scotland of ‘direct payments' – a system which allows those eligible for care to control their own care services.
Scottish Parliament Health Committee
Care Inquiry Evidence
Submission by:
Royal College of Physicians of Edinburgh
Free Personal Care:
- Has free personal care improved conditions for those who receive it?
It has improved the situation for self-funding patients and their spouses. The actual conditions in Care Homes have not changed as a result of this legislation. Means assessment is still required for the board and lodging element and leads to delays in discharge from hospitals, but the perverse incentive to remain in (free) hospital care has been reduced. In many areas closure of long stay beds has been made easier. It is also apparent that the self-funding patients may be charged more than Local Authority funded patients - this results in a reduced benefit to the individual patient, but may result in them being placed in a nicer room.
Free personal care as a principle has gone some way to removing a previously unjustifiable “discrimination by diagnosis”. By this we mean that those with disabling and dependency-associated conditions, such as dementia and stroke, no longer have to pay for the health-related elements of their care. This places them on a par with patients with equally costly care needs due to more dramatic pathologies such as cancer and heart disease, who do receive free NHS care.
There was a heated debate prior to the introduction of free personal care regarding the definition of “nursing care”. The College welcomes the recognition that what matters is the totality of care for these frail and vulnerable individuals. A holistic and pragmatic approach should be maintained.
- In what ways is the legislation operating effectively?
It has greatly reduced disincentives for patients and their families in considering a move to a Care Home. Protection of the "inheritance" is less of an issue. It is perhaps less effective in supporting dependency at home.
The tendency for nursing homes to charge more for self-funding patients has reduced the benefit of the legislation. A national agreement for a model contract across Scotland would be a big advantage and prevent this practice.
The Local Authorities also clearly feel that the funds which they receive are insufficient to meet the costs - this may lead to delayed discharge in hospital. Differing Local Authorities face different demographics for elderly people and funding needs to reflect this.
- What improvements could be made?
The free personal care payment should be index-linked - it has not changed since its inception in 2002. This will lead to a gradual reduction in benefit over time.
It would also be a big improvement if there could be clear national definitions of what comprises personal care versus nursing care.
- Should free personal care be extended and if so, to whom and why?
This is a political question. Some would argue that all care for the elderly should be free - in which case it should be extended. Others feel it only benefits the well off and should not have happened at all. Recent press discussion has commented on the anomaly of an age cut-off. We support the arguments about free medical care and holistic nursing care noted above. The decision about extending personal care will depends on the prevailing political/moral view and the affordability for the country.
College Fellows felt that the remaining non-clinical questions on the care commission and direct payments would be better addressed by local authority social work departments, care homes, and individual recipients.
The Care Commission:
- Is there unnecessary duplication of care services inspection by the Care Commission and others, particularly local authorities?
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- What is the impact of the requirement for the Care Commission to be self-financing, e.g. escalating fees?
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- Is the registration system too complex and therefore having the effect of reducing the range of services and discouraging the emergence of new services?
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- Is it necessary to develop the complaints system to better protect those who make complaints against service providers?
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Direct Payments
- Why has the take-up of direct payments been so low?
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- What are the difficulties that those who receive direct payments encounter in operating the system? e.g. claw back of payments
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Thank you for your submission.
Please send to: careconsultation@scottish.parliament.uk
Details of Submission Provider
Name: Mrs L Lockhart
Position (if relevant): Team Leader, Fellowship Support Unit
Organisation: Royal College of Physicians of Edinburgh
Email Address: l.lockhart@rcpe.ac.uk
Mailing address (if necessary): 9 Queen Street, Edinburgh EH2 1JQ.
Copies of this response are available from:
Lesley Lockhart,
Royal College of Physicians of Edinburgh,
9 Queen Street,
Edinburgh,
EH2 1JQ.
Tel: 0131 225 7324 ext 608
Fax: 0131 220 3939
[10 February 2006] |
