5,000 pensioners are forced to wait for free personal care

Key quote

"I think the Executive and COSLA are in denial about whether this policy is working or not." - David Manion, chief executive of Age Concern Scotland

Story in full

ALMOST 5,000 pensioners are on waiting lists for free personal care across Scotland, it emerged yesterday, in the latest controversy to hit the Executive's troubled flagship policy.

Most of the cases, 4,005, are waiting to be assessed by councils to decide what support they should get, while the remaining 709 have been assessed but are being made to wait for the actual services.

In some local authorities, pensioners are facing an average delay of four months from first requesting care to delivery.

The figures - taken from a snapshot in February this year - highlight the difficulties the Executive has found in rolling out its free care system effectively across the country. Many local authorities claim they do not have enough money to implement the policy, some are refusing to cover the costs of food preparation and at least one, Argyll and Bute, has admitted it simply cannot afford to meet the costs of free care for some of its residents.

Now it has emerged pensioners are being told to wait for free care services in 21 of Scotland's 32 councils, with Dundee, North Ayrshire, and Argyll and Bute among those with the biggest waiting lists.

A spokeswoman for Edinburgh city council, which showed a particularly high number of people on its waiting list, claimed it had used different criteria to other councils in recording whether a case was on its waiting list, but she was unable to provide any other figures for comparison.

David Manion, the chief executive of Age Concern Scotland, said long waiting times not only caused distress to pensioners and their families, but could end up costing councils money. "Where people are not getting free personal care packages quickly, that puts a great strain on a family as a whole and the probability of people having to re-enter the health care system would be very high.

"So, this watching of the cash will only shift costs. It won't appear on [the council's] budget but it will appear on someone's budget somewhere. I think the Executive and COSLA [the local authorities' umbrella body] are in denial about whether this policy is working or not."

Lewis Macdonald, the deputy health minister, stressed that the figures represented a snapshot from one day in February and did not show how long people were waiting or whether there were any special circumstances in each case.

But the figures were produced on the same day as the Scottish Parliament's health committee published its report into free care for the elderly, which concluded there were major financial problems that needed to be sorted out.

Euan Robson, a Liberal Democrat member of the committee, said: "I know the frustrations some people can suffer from at the end of their lives - that they can't do the physical tasks they used to take for granted like shaving, going to the toilet or moving about, particularly when they are still mentally active. There will be also be frustrations for relatives, friends and carers of elderly people who are not receiving the benefits of free personal care, or having to wait for it. But this is a problem of implementation, not policy."

The committee found at least 20 of Scotland's 32 councils had not enough money to implement the policy and will have to take cash from other services to meet the shortfall.

Some of the problems identified by the committee were acute: South Lanarkshire received 8.4 million for last year but says it needs 15.8 million to cover the costs. Shetland received 358,000 and says it needs nearly six times that.

But some are coping well. Angus Council received 3.375 million and estimates it will spend less than that, while the Western Isles expects to underspend by more than 1 million.

A senior local government source said some councils had been guilty of underestimating their costs and were suffering as a result. He said: "There have been higher care costs than councils anticipated, the care needs of the population have been greater and there has been an element of underestimating the amount needed."

Ministers have always insisted they gave councils exactly what they asked for to fund the policy, and they see no need to increase funding.

Mr Macdonald said: "Councils are given substantial funding to provide community care services and we expect them to use this to deliver high-quality care for older people. It is up to individual councils to decide how money is allocated".

Roseanna Cunningham, the SNP convener of the health committee, acknowledged that the Executive had provided all the money necessary to meet the initial demands of councils but said serious problems and shortfalls had emerged that had to be addressed. She said the Executive had to commission a thorough review of the funding arrangements and introduce a series of changes to force councils to adhere to the policy.

The committee warned that some councils might be deliberately delaying assessments simply to save money and called on ministers to close this loophole.

Ms Cunningham stressed that the free-care policy had been broadly successful and had provided greater security for the elderly, freed up health service resources and allowed more old people to stay in their homes. But she warned the system was being threatened because of financial confusion and the problems councils were experiencing in trying to fund it properly.

The committee recommended:

• A thorough Executive review of the finances of free care for the elderly;

• An end to the legal loopholes that allow councils to "ration" free care;

• Ministers should make clear that services such as food preparation are covered by the policy, setting out new guidelines for councils;

• The Executive should set a formula for the rate of increase in funding for the service in the future, possibly by inflation;

• Ministers should make it impossible for councils to delay assessments for financial reasons, either by backdating all claims or enforcing a deadline for assessments;

• Ministers should not proceed with the roll-out of free care to under-65s with particular needs until the problems of the over-65s have been sorted out.

Eric Jackson, the social work and health spokesman for COSLA, said local authorities had been hit with higher than anticipated costs.

He said: "While some increase was estimated and budgeted for, this level of increase could not have been, and puts pressure on the policy, but we must not let this undermine the policy as a whole."

Mr Jackson defended the operation of waiting lists around the country, arguing that they were allowed by the Executive "as long as they are actively managed".

However, he stressed that councils were willing to work with ministers and the parliament to make the system operate more effectively.

Donald Hirsch, a special adviser to the Joseph Rowntree Foundation, which has produced an analysis of the overall funding of long-term care in the UK, said: "The difficulties in delivering [free personal care in Scotland] highlight the fact that it is not a complete solution.

"We can see from the Scottish case that extra public support for care is much appreciated, but we need now to think about how to deliver it consistently."

McCabe declines to face MSPs on key policy

TOM McCabe, the finance minister, refused to appear before a committee to give evidence on the Executive's key policy of free care for the elderly, it emerged yesterday.

Mr McCabe had been invited to give evidence to the Health Committee during its investigation of the issue.

As he is the Cabinet minister responsible for finance and public service, MSPs on the committee wanted to question him about the financial problems being experienced by councils trying to implement the policy.

But Mr McCabe declined to appear and instead the Scottish Executive sent Lewis Macdonald, the deputy health minister, to answer questions on the issue on behalf of the Executive.

Mr McCabe's decision not to attend angered MSPs on the committee, particularly as the Health Committee was investigating one of the Executive's key policies.

It was also the first investigation by a Holyrood committee into a piece of existing Executive legislation.

Roseanna Cunningham, the SNP convener of the committee, revealed yesterday that Mr McCabe had declined to appear.

Ms Cunningham refused to criticise Mr McCabe, merely stating: "It seemed it was considered not appropriate for the finance minister to come to the health committee."

But Nanette Milne, a Tory MSP on the committee, was more forthright.

She said: "Free personal care is one of the Executive's flagship policies and it is extremely disappointing that it could not send the minister responsible for funding it to appear before the committee's inquiry."

And Shona Robison, the SNP health spokeswoman, said: "This is just another example of the Lib-Lab Executive attempting to shirk responsibility over its failings.

"Over 4,000 elderly Scots have been waiting for assessment of free personal care.

"It is no wonder that Mr McCabe didn't want to turn up and face the music.

"It is time for the Lib-Lab Executive to show some leadership by ending postcode lottery for care and delivering the level of care that the elderly people of Scotland deserve."

Mr McCabe insisted last night he had not intended to "snub" the committee by declining the invitation. A spokesman for the Cabinet minister said: "Lewis Macdonald was asked to cover all issues that might emerge on free personal care.

"That is standard Executive practice. One minister will represent the Executive at a committee, even if it is a cross-cutting issue, and deal with all the issues."

The spokesman added: "It was standard practice, it was not intended as a snub."

It may be standard practice for the Executive to send just one minister to a committee but on something as sensitive and important as this inquiry into free care, it is surprising that Mr McCabe did not accept the invitation himself.

MSPs were obviously disappointed by Mr McCabe's decision not to accept the health committee's invitation.

However, Ms Cunningham did not feel it necessary to start a battle with the Executive on this issue at this time by compelling the minister to appear.

HAMISH MACDONELL

'It's only a sixth of what we need'

SHETLAND Islands Council says it needs almost six times as much money to fund free care for the elderly than it has received from the Scottish Executive.

The local authority was given 358,000 to pay for free care in 2005-6. But it claims it needs a total of 2 million to make the policy work.

However, a spokeswoman for the council insisted that the shortfall was not entirely the council's fault.

She said the council was trying to care for the elderly at home and this was proving very successful, with many more people being kept out of residential homes.

But she said that this came with massively increased costs, because of economies of scale, and this had not been anticipated by the council in advance.

Two authorities in surplus

TWO councils managed to anticipate the costs of free care for the elderly and will end up in surplus.

Angus Council asked the Executive for 3,375,000 and will end up spending 3,369,000 - a surplus of just 6,000. Western Isles council predicted the policy would cost 3,500,000 to implement but expects to only spend 2,344,382 - a saving of 1,155,618.

All the initial estimates were based on forecasts prepared for the councils on the number of elderly people in each area and how much each person would need in personal care costs.

The accountants at Angus Council appear the most accurate in the country while the Western Isles Council simply over-estimated the extent of its care costs.