A DECADE ago the policy of providing personal care for elderly people free of charge was hailed, proudly, as evidence that devolution would enable Scotland to follow a more socially inclusive path than the rest of the UK.
Within months of it coming into effect, however, it was clear that the number of people requiring care had been disastrously underestimated and local authorities, swamped by an unforeseen level of demand, were given emergency additional funding. In 2010-11, the cost of free personal care for the elderly was £450 million – against an original estimate of £110 million.
With an ageing population, that cost will continue to increase as the burden of funding it through taxation falls on a smaller proportion of the population. The potential for inter-generational breakdown was signalled by Colin Mair, chief executive of the Improvement Service, a partnership between local authority chief executives and council umbrella body Cosla, who pointed out that younger people repaying student loans and with high mortgages might well resent paying the cost of care for a previous "lucky" generation who received student grants, earnings-related pensions and occupational pensions.
This alarming projection was backed up by other social policy experts giving evidence to the Scottish Government's Finance Committee yesterday. From a warning that financial modelling showed it could take 23 years before the economy recovered to projections that in 20 years' time, more than one million Scots would suffer from hearing loss, 400,000 would be blind and the cost of dealing with fractures would increase by 43%, they provided unpalatable food for thought.
It is difficult to see how, faced with exponential future demand, free personal care for the elderly can be sustained. When Lord Sutherland, whose review of elderly care led to the policy, states that no policy should be protected until all the costs and benefits are critically evaluated, it is time to put free personal care under independent and rigorous scrutiny.
The continuing economic reverberations of the global financial collapse have altered the fiscal landscape. That does not mean we should abandon social justice but it does require a more nuanced approach to funding to ensure scarce resources are used to best effect. In the case of personal care, the very real benefits to individuals of remaining in their homes must be part of the equation, along with the saved cost of residential or hospital care.
We can no longer ignore the economic and the demographic realities. A sense of community responsibility runs deep in Scotland but so does a hard-headed approach to balancing the books. If the only way to ensure we can continue to provide free care for those who cannot afford to pay is to levy a charge on those who can, we must consider some degree of means-testing or increased taxes, perhaps on the estates of the deceased. If we are also concerned about inter-generational fairness we should also reconsider free bus travel for all over-60s. If we want elderly people to be well cared for we must take our heads out of the sand and find a way to pay for it all.
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