Free Personal Care

This is the first of two subjects mentioned in Gordon Brown's speech today that I think are worth commenting on.


In broad terms I welcome this. It will make arrangements in England closer to those which have existed in Scotland since 2001.

One of the best reports on how things have worked in Scotland was in July 2007 from the Joseph Rowntree Foundation:

     Free personal care in Scotland: recent developments

     •   Press Release
     •   Summary
     •   Full Report

The first thing I would note is that providing free care for 350,000 of the "most needy" is likely to leave a substantial number of "less needy" people in the same position as they are now.

This is a graph of those receiving home care (as opposed to residential care) in Scotland:


40,000 in a population of 5.1m is 7.84%, and the number must have increased in the last four years. In contrast 350,000 in a population of 51m is 6.86% I'm not entirely sure of all the swings and roundabouts concerning entitlement in England as compared with Scotland, but it seems obvious that a smaller percentage of English people will benefit.


Now, as the changes in Scotland were introduced when Labour were in government there, it seems reasonable to ask why it has taken so long for UK Labour to change their minds on the issue. For me, the announcement that this is to be free is quite astounding given Labour's position only a few short months ago. This is from a BBC report in July:

Ministers are looking to revamp the way the £6bn social care pot is divided up.

The current system targets the poorest. And while they will still get extra help under the plans, the government is proposing to extend the state's contribution to everyone. But in return it wants to bring the public on board as direct contributors to the system.

Ministers ruled out raising taxes and instead put forward three options whereby the state provided a basic package and the public contributed the rest. This could either be done through paying any costs themselves, taking out insurance or introducing a compulsory fee.

BBC, 14 July 2009

As Labour's U-turns go, this is one of the most remarkable. "Free" can only mean that it is going to be paid for out of general taxation. The details are sketchy right now, but the reports are that "less than half" (£400m according to the BBC) of the £870m over two years will be found from the English NHS budget. As no-one is now talking about compulsory fees or insurance, it must (unless there's some nasty small print) mean another £470m or so will be new money from the Treasury.

And this of course will benefit both Wales and Scotland, as we will get a Barnett Consequential on this new money.


So the big question for us is what will happen in Wales. Plaid's position is quite clear. This is from our 2007 manifesto:

Free Care

Plaid believes in securing free care provision for older and disabled people, in principle and as an aim. We reject the distinction between nursing and personal care. Intimate personal care can not be described as optional or a matter of convenience for the patient. By linking entitlement to care given by nurses, the current funding structure leads to older people and disabled people being denied appropriate care thereby causing preventable health deterioration and often hospitalization.

We set this out as a two-stage process: first to cap and then to scrap care charges for the elderly.

And we did manage to get at least the first part of that commitment into the One Wales Agreement. Local authorities will only be able to charge a maximum of £50 a week for home care services, a change announced in June.

The Barnett Consequential on what was announced today will enable us to do more. It will work out at roughly £27.5m over the two years. But to make Council-provided domiciliary care free for all the 14,000 people in Wales that use it (assuming they all pay £50 a week) would cost a maximum of about £70m over two years.

So we will still have tough choices to make, and especially given the general constriction in our Block Grant over the next few years. But remember that England's "most needy" old people needing care will only be a fraction of the "all" that Plaid is aiming for.

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David Cornock said...

Will there be a Barnett consequential? Initially the money is coming from existing health and local government budgets in England

MH said...

Yes David, the second part of the funding wasn't clear to me when I wrote the post yesterday. So there won't be a Barnett Consequential.

On the other hand, I'm left wondering just how local authorities are going to afford it. They might get more money from central government to help pay for it—and then Wales would get a proportion of that. But with the benefit of a night's sleep I now think that it's a hollow promise that can't be financed (at least as currently outlined) in a sustainable, long-term way.

Hence my update today.

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