The case for free personal care: Learning from Scotland


Contrary to the headlines over years of petty and ill-informed sniping from opposition parties and the MSM, within Scotland, the personal care service here is seen as a model for adoption in Tory-abused England by the Institute for Public Policy Research.

‘While the NHS has been protected since the financial crisis, social care has faced significant funding cuts. This is having severe consequences in the sector. There has been a staggering 5 per cent drop in the number of people receiving publicly funded social care per year – totalling around 600,000 people since 2010 – despite an ageing population (Darzi 2018). The cuts are also beginning to impact on quality, particularly as a result of workforce pressures – with high turnover and huge staffing gaps. Meanwhile, provision in the sector is becoming increasingly unstable as a growing number of providers struggle to survive.’

Published on 23 May 2019, this IPPR report talks of a crisis in social care in England. There are several points at which the model developed in Scotland is mentioned as something that can be learned from. Though the report points to areas where the Scottish system can be improved, there are three comments we can take unreserved pride in:

  1. Whilst the government in England rejected the recommendations made by the Royal Commission on Long Term Care for the Elderly, largely based on cost, Scotland decided to implement them. This allows us to understand how this system might work in practise.
  2. Ahead of its introduction in Scotland many argued that free personal care would simply crowd-out informal care from family and friends. However, the evidence does not support this: there has been no reduction in informal care hours delivered in Scotland (Bell and Bowes 2011). Instead there is evidence that carers switched the tasks they perform from basic caring functions (eg washing or dressing) to emotional and social support (with greater flexibility about when this care was delivered). This is a particularly striking finding given that the evidence suggests that social and emotional support is the area of care in England that has suffered the most under austerity (Darzi 2018). This suggests that the introduction of free personal care could address this deficiency and significantly improve the quality of care in England.
  3. However, these cost increases could be offset further by the potential efficiency savings delivered by greater integration between health and social care. Some of these can be achieved as an inherent part of the system re-design. For example, the introduction of free personal care should make NHS continuing healthcare redundant which IPPR calculated could deliver an annual saving of up to £2 billion per annum rising to £3.3 billion by 2031 (see info box).4 There could be savings on attendance allowance (if it only becomes accessible to people in their own home as in Scotland).


3 thoughts on “The case for free personal care: Learning from Scotland

  1. Alasdair Macdonald June 3, 2019 / 8:22 am

    Point 2 gives the lie to the misanthropic arguments of the opponents of the social care provision when the SG under Henry McLeish was planning to introduce this scheme. Essentially, they were arguing that it is ‘human nature’ to feel imposed upon by having to help elderly and infirm family and friends, to be resentful. As most of us know, most people have feelings of love, compassion and a common humanity. We want to help elderly family members and friends because we love them and, when they were younger and fitter they helped us unconditionally.

    So much mainstream media reporting is predicated upon a really jaundiced view of human beings. I suppose it must come from being sent away to boarding schools and being looked after by nannies for most of their childhood. However, denying any common humanity helps weaken the socialsolidarity which can resist the greed of such people. ‘Union is Strength’ is a truism when it is entered into voluntariliy and altruistically.

    Liked by 1 person

  2. Willie Hogg June 3, 2019 / 8:54 am

    The present scheme in Scotland is funded from savings within the block grant and both this SG and the previous have done well to find the resources. If the English Government funds an English equivalent then the block grant should be raised by a consequential amount, but I bet it isn’t,

    Liked by 1 person

    • Alasdair Macdonald June 3, 2019 / 1:18 pm

      There is no ‘English’ Government. I suspect that you are being ironic about the role of Westminster with regard to the governance of England.

      If Westminster allocated additional funding for Care in England then Northern Ireland, Scotland and Wales would be entitled to aditional funds as ‘Barnet consequentials’

      The fact that there is no government of England, per se, is a problem unrecognised or, more probably, ignored, by Westminster. If there were a government for England, then it would go some way to clarifying in the minds of many people in England that England and the UK are different entities and more might understand why many people in Ireland, Wales and Scotland are seeking independence. A Government of England, elected in a manner similar to Holyrood and located somewhere in the centre of England, would probably begin to switch the imbalance in power and resources between England and the South East and the rest of England. It is this gross inequity of funding which has fostered a lot of the sincere grievance which led to the Brexit vote in the North an Midlands of England being so high. To a large extent the ‘take back control’ was a howl of frustration, but the loss of controlwas not to Brussels but to financial services in the City.

      Labour, even more than the Tories (or the Brexit Party), is the BRITISH Party. It is that which has done for it in Scotland and, is, increasingly, causing questioning in Wales. While Momentum has brought a surge in membership of Labour in England, it still has not articulated any detailed policy of redistribution of power within England. It still pines for the ‘dirigiste’ powers of Westminster/Whitehall. But those operating Westminster/Whitehall are operating it for the benefit of the financial and land-owning clique who have always helfd the bulk of power and who, eventually, have always brought down Labour governments.

      Unless Labour thinks seriously about constitutional reform, including voting, it will not bring lasting change to the increasingly gimcrak entity they imagine as BRITAIN.


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