JEANE Freeman may have told the Holyrood health committee earlier this week that, “We did not ignore care homes”, but the Scottish health secretary also conceded that had she known then what she now knows, “maybe I would have taken different views”.

The decision, taken jointly by the UK governments, initially to concentrate on the capacity of hospitals and the NHS was understandable. It was based on modelling that suggested 80 per cent of the UK population could become infected and that four per cent might require hospitalisation, amid scenes from Italy and Spain showing their health systems at the point of collapse. But it now looks as if the decision to divert people into care homes without testing has contributed to a huge spike in potentially avoidable deaths in care.

For the past five weeks, the greatest number of Scotland’s deaths presumed to be coronavirus-related, have occurred in care homes – amounting to just under half of all fatalities. Yet while hospitals have reduced the number of overall deaths to below the five-year average, the figure for care homes, though not all will be related to the virus, remains significantly higher – 17 per cent higher for the most recent period.

The First Minister’s statement that a public inquiry into the crisis will, amongst other things, examine this discrepancy is welcome, but it should be only a part of a much broader reassessment of the care sector. To be fair, the Scottish Government has already encouraged the Integration Joint Boards, which deliver state provision for those who cannot fund their own care, to produce long-term models, and attempted, through the Care Inspectorate and Public Services Ombudsman, to improve the complaints system.

But there remains a sizeable gap between local authority funding (estimated, across the UK, at 5-10 per cent less than total costs), currently bridged by the differential between costs for self- and state-funded residents, which in Scotland is around 38 per cent. That unsustainable differential provides no incentive for investment in capacity, and especially not for new care places focused on the state-funded sector.

Care is expensive and it has been clear for decades that those costs will only increase with an ageing population. Politicians have been reluctant to grasp this nettle; merely to meet the current real costs of local authority provision, let alone expand to what is needed, would require at least £1 billion more a year across the UK. That means tax rises, greater personal contributions or some other system, such as care insurance. As Theresa May discovered to her political cost when, to her credit, she attempted to address these stark realities, none of these are popular suggestions.

The grim toll of the current crisis ought to concentrate minds on a comprehensive and fundamental review that would consider all options. We need to examine exactly what level of care we are able to provide and how it is to be funded, as well as measures, such as community projects, early interventions or tech solutions to reduce pressure on the sector.

These are not easy choices and will inevitably involve either greater personal costs or increased taxation. But it is an issue which will only become more pressing. The praise and assurances of support from politicians of all stripes now need to become specific proposals for material improvement.

A fitting tribute

There has been a gratifying response to The Herald’s campaign for a memorial cairn and garden to commemorate those who have died during this crisis. A place of remembrance and tranquility that is, appropriately, communal and outdoors, seems to have chimed with many and brought an outpouring of support. We’re grateful for those who have already volunteered resources, support and ideas for the project, and welcome any further suggestions. If you would like to get involved, you can do so at