Caring Choices in Scotland

It is five years since Scotland introduced the policy of free personal care for older people. The fifth Caring Choices event was held in Edinburgh to hear direct from older people, carers, providers, funders and commissioners of social care about their experiences of free personal care. Around 60 delegates attended, the majority being older people and carers.

The new funding system has won widespread approval in Scotland, but participants at the event voiced a number of concerns about how the policy is working. For instance, there remains considerable confusion among the public about what exactly is on offer from the state and a lack of understanding of how ‘free personal care’ operates and what services are covered. This is exacerbated by the big variations between local authorities in the implementation of the policy, leading to widespread complaints that a ‘postcode lottery’ still exists for older people’s care. Local authorities control the eligibility criteria for care and decide the size of a care package an individual needs, leading delegates to complain of unequal access to care and support across Scotland.

In a country with very varied geography and population densities, there can also be a problem of lack of choice regarding service options and delivery, especially in rural areas. In particular, older people sometimes do not have options for housing, with a shortage of care home places in some areas and generally a lack of flexible, accessible housing for those older people who want to continue to receive support in their own homes.

Despite the shortcomings, there was consensus among participants that the policy of free personal care, which currently accounts for around 1 per cent of the total Scottish Executive budget, is affordable in Scotland, although this proportion is projected to double over the longer term because of demographic trends.

Equity of service provision, better information, value for money, sharing innovative developments, and higher service quality emerged as the main issues that now need to be addressed if the policy is to achieve its goal of independence and well-being for older people. These issues were strikingly similar to those raised at the Caring Choices events in England, demonstrating that people’s main concerns often go beyond the question of the funding model. There are no easy solutions to the challenges, but it was agreed that putting the individual at the centre of the equation will be the key.


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