Henry McLeish: The cost that Cosla cannot seem to comprehend

EVIDENCE suggests the Scottish public seem to have a better instinct for what is morally acceptable

Recent personal events have confirmed for me the validity of one of the most important and much-criticised policies for which I was responsible. Personal and social care, free at the point of need, is one of the big ideas of our times. It challenges us on the role of older people in our society, the priority we attach to the well-being and dignity of those who have dementia and other age-related diseases and the extent to which we as a society wish to invest in building a culture of care.

Unfortunately the publication of the thoughtful and informed Dilnot Commission in England on the care of older people came on the same day as the convention of Scottish Local Authorities (Cosla) outlined its quarterly assault on "free" personal care. Cosla would serve the interests of older people and the tax payer if they addressed the weaknesses in their argument.

First, the constant demand for more money doesn't ring true. The provision of care varies enormously throughout Scotland and more could be achieved if a higher standard of provision was cost-effectively delivered.

Second, local councils should now agree with the SNP Government that an integrated National Care system is the way forward. If Cosla's view about personal care is well supported by member councils then they should be reasonably content that a new body might be the best way to deal with the future.

Third, if finance is tight why does Cosla continue to support the monumental waste of money required to freeze the council tax? This is about more central control. It undermines local democracy, makes councils more dependent on government and benefits the wealthiest of council tax payers. The half a billion pounds this freeze is likely to cost in the years ahead could be spent on important social and health care priorities such as personal care. A few pence on your council tax bill or the best personal care for older people in the world? I know what my choice would be. Let us not confuse political and ethical choices with technical ones.

Finally, politics is about choice and priorities. At local level , why can't money be transferred from less important areas of spend to those which are more important? After spending 13 years in local government I can appreciate the difficulties, but it can be done. Councils could be more innovative, proving the worth of the "public good" and the limits to the market and being more creative in terms of delivery.

The prospect of one third of Scottish voters being over 60-65 in the years ahead may concentrate minds.Lord Sutherland in his excellent independent review of personal care said "free personal and nursing care is one proportionally small part of the costs of such demographic challenges" and "the adequate provision of personal and nursing care is now part of the way we want to live. We must therefore build it into the mainstream of our planning for the future and cease regarding it as the sole cost and consequence of demographic change"

Any debate has to consider the wider picture. Singling out free care makes no sense, distorts the importance of the debate and completely misses the point. The number of pensioners in Scotland will rise from 837,000 in 2006 to 1.36 million in 2031. In the same period the number of 85 plus will rise by 108 per cent and the number of 90 plus will rise by 216 per cent. The scale of the challenge is enormous and poses the important question of what kind of Scotland do we want to live in?

The issue won't go away. The debate about personal and social care is important. North of the Border we are not only far beyond England and Wales in provision of, but also in the quality of political understanding of age and the challenge this poses to society.

In Scotland, we do have personal and social care free at the point of need; it is popular, progressive and in policy terms we lead much of the developed world. Many critics north and south of the Border argue "we can't afford" personal and social care; "it's too expensive" or "the cost will escalate out of control" and more recently "it is untenable". Very little evidence to justify such comments has been produced.

For many of the critics, finance is undoubtedly being used as a smokescreen.

If there had ever been any doubt in my mind about the benefits of our approach in Scotland, the experience of my father confirmed the wisdom of the policy. My father had dementia and received two 30-minute visits each day and every day from his carers. They were a lifeline for him and as a proud and fiercely independent ex-miner he was able to exist in his own home for a much longer period than would have been the case.

Sadly, at the age of 87, he died in hospital after suffering a severe stroke. The point is an obvious one - shared by thousands of Scottish families - great care at home and great care in hospital is all about health, well-being, dignity and choice.

Why should the hospital part be paid for any differently from the home-care part?

The public are much smarter than we politicians think. Our political parties have allowed themselves to be brow-beaten into seeing virtues in privatising, commercialising, franchising or cutting services for the most vulnerable. Yet there are huge limits to the market in social and health care, and, in contrast, there is a much better case to be made for the "public good".The public seem to have a better instinct for what is morally acceptable and have little appetite for more private sector involvement.

President Obama uses the phrase "moral imagination" to describe the process of getting inside the minds and lives of people to gain a better understanding of their concerns, hopes and ambitions. Maybe Cosla and some other critics need to embrace this idea.

l Henry McLeish was Labour MP for Central Fife from 1987-2001 and served as First Minister of Scotland 2000-2001