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Blog: Free personal care in Scotland - Prof. David Bell

Read the blog article from Prof David Bell. The following text is an excerpt:

Title: Free personal care: What the Scottish approach to social care would cost in England

The 1998 Royal Commission on Long-Term Care recommended that the government should meet the costs of personal care in the UK. It argued that since cancer care is available free through the NHS, the same should apply to Alzheimer’s disease. This recommendation was contentious: opponents argued that it was unaffordable. It was rejected in England and Wales, but the newly created Scottish Parliament saw an opportunity to provide a distinctive approach to long-term care policy and proceeded to introduce free personal care (FPC) in 2002.

So is the Scottish system of FPC a worthy policy aspiration for the rest of the UK? Let’s look at how it works.

Scottish funding for personal care in care homes

The challenge of funding a care home place in Scotland is not substantially less than in England.

In care homes, people aged over 65 assessed as requiring personal care receive a weekly payment of £174 to cover personal care costs; a further payment of £79 is made to people who need nursing care (FNC). These payments are made by local authorities and funded by the Scottish Government.

However, when the policy was introduced, the Department of Work and Pensions decided that cash support from local authorities for personal care breached its rules for Attendance Allowance (AA). Therefore, care home residents in Scotland who are eligible for personal care are ineligible for AA (currently worth £85.60 at the top rate).

For self-funders, average care home fees in Scotland in 2016 were £798 (1) per week without nursing care and £860 per week with nursing care. Therefore, self-funding care home residents in Scotland, like those in England, face a considerable challenge to meet care costs. FPC allowances in Scotland only meet around 25% of the weekly costs of a residential care home. In England, people requiring nursing care receive £158 weekly for the standard rate and £218 at the higher rate. Further, care home residents in England are eligible for AA.

So what does the challenge of funding personal care look like at a population level? The cost of FPC in care homes to the Scottish Government is made up of weekly payments to around 10,000 self-funding care home residents who would otherwise have to pay full fees. Including the weekly charge for those requiring nursing care, the total cost was £134m in 2015-16. Total spending by local authorities on care homes in the same year was £667m. This was mostly for publicly funded residents; FPC and FNC spending accounted for less than 20% of the total. 

Read the full article on "The Health Foundation's" website

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