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08th May 2017

Free personal care in Scotland

Free personal and nursing care was introduced by the Scottish government in 2002. It was heralded at the time as an innovative and landmark development for the people of the country. Unfortunately, it appears to be struggling to deliver the promise of free care for everyone when they need it.

What is free personal and nursing care?

A person requiring care who is referred receives a formal assessment of their care needs. The formal assessment looks at the person's needs under several headings, e.g. support for personal hygiene and continence, food and diet, mobility, counselling and medical support, and personal assistance. The target is to provide the assessment within six weeks of the initial referral. When some form of care is identified and provided, the government will pay a fixed amount to the care provider to cover the care or nursing costs. Accommodation and other costs will not be covered in this way.

Current difficulties

The charity Age Scotland has released a report of research which reveals that many older people have to wait an unreasonable time beyond the target of six weeks to have their assessment carried out.

Additionally, they give figures to show that even when the assessment has been carried out, there can be lengthy and unacceptable delays in identifying and providing the care or nursing service which has been assessed as needed. Astonishingly, one person was found to have to wait over 18 months for care following an initial assessment.

The charity showed that 4000 elderly people who required nursing and other personal care waited longer than 6 weeks. Over the last three years, they found 8600 cases where people waited for longer than 6 weeks to have their care provided.

What are the causes?

A policy officer at Age Scotland suggests that councils are deliberately making people wait because of budget and resource constraints. They found that some people have been told directly that the free personal care could not be provided to them because the council had simply run out of money. Delays in providing the needed services, it is claimed, is a deliberate strategy to match resources with continuing and increasing demand.

In parts of Scotland, it was found that some applicants suffered seven and a half months delays.

The effects of these delays can be catastrophic for the person concerned. As the charity pointed out, people may try and make do in the interim and as a result, suffer further injury or disability thereby increasing the severity of their situation.

It can also contribute to the bed blocking crisis: delaying some hospital discharges contributes to increasing delays in providing accident and emergency services, or in some cases delaying vital surgery to individuals until a post-operative bed is available.

Obviously, older people who need such assessment are at their most vulnerable. It is very concerning that a proportion of these people are not receiving the promised free care when they need it, but are put at increasing risk instead.

How to deal with it?

The local authorities admit that there is a problem, that funding resources are not keeping match with the ever increasing demand of an ageing population with multiple care needs.

Age Scotland is urging the government in forthcoming local and national elections to give a higher priority to Social Care provision. One possible scenario is that if there are unacceptable delays in providing social care assessments, it should be possible for assessments to be outsourced to care providers. Obviously, this would need careful arranging and monitoring: but there is a precedent in social work assessments for the process of adopting children. Private adoption agencies are now able to carry out part of the required assessment to allow the adoption process to continue.

The Herald Newspaper in Scotland stated that:

‘The Government continues to insist: “Free personal and nursing care is ensuring that we can offer older people the support they need”, but admits Age Scotland’s survey suggests one in 20 suffer significant delays.

Age Scotland says “Delays in payments can make the obligation to free personal care a theoretical rather than a realistic entitlement”. It could be time for a degree of honesty about the entitlement to this flagship Government promise.’

For the sake of the large and increasing number of people needing support, this is a humanitarian issue which should not be political: it must receive the highest attention to resolve it by all concerned.

*All information is correct at the time of publishing

Tony Clarke

Scottish Care Inspectorate Specialist

Tony began care work as a care assistant in care of the elderly here in Scotland in the 1970s. He very much enjoyed promoting activities, interests and good basic care. After a gap to gain a social work qualification, he worked in management of care services, latterly as a peripatetic manager which gave him experience of a wide range of services.

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