Section A        The numbers needing Free Personal Care

There are no clear statistics about how many current beneficiaries of local authority social care between the ages of 18-64yrs, who receive services that could be defined as falling within the legal definition of personal care.  

Home Care Statistics 1

One understanding of the law is that personal care includes both personal care tasks and any “personal support” agreed within a care plan.    The Scottish Governments Social Care Statistics for 2016 help us identify this group of home care users.  According to this there were

  • 10,560 people between the ages of 18-64 years getting home care in 2016 (Table 4)
  • 3,650 people between the ages of 18-64 years getting direct payments in 2016 (Table 13)

This would suggest in the at least 14,210 people between the ages of 18-64 would be eligible for FPC. 

Home Care Statistics 2

A more narrow understanding of Free Personal Care is the current definition of only personal care tasks used by local councils.   Again, Scottish Government statistics help us estimate this lower number

  • In the Scottish Government’s Social Care Statistics for 2016, Table 9, it is estimated that there are 57,360 people over the age of 18 years living at home who need FPC
  • According to the FPNC Statistical Release for 2014-15 (Annex 6) there are 46,750 people over 65 years getting FPC.

The difference between these two numbers is an estimate of how many people (18-64yrs) may need FPC – 10,610

Residential Care

In addition to this anyone between the ages of 18-64yrs living in a residential care home who was a self-funder would be eligible for FPC.  We believe this to be negligible due to the different personal histories of those under 65 using residential care. 

Section B        Only Those Paying For It

One way of looking at who needs Free Personal Care is that only those who are currently paying charges both need Personal Care and are paying towards it.  As a result, there is no need to go into the wider range of statistics, we simply need to define what Personal Care is and ask Local Authorities who, of those paying charges, is covered by this. 

Section C        The Cost of Free Personal Care for Older People.

Currently the FPC scheme is paid in two ways.  First, , the Scottish Government makes a payment to local authorities as part of the annual financial settlement to cover the cost of those getting FPC from its services.   Second all self funders in care homes will receive a payment from their local authority of either £78 or £171 per week to meet the costs of FPC.

 
   


According to the FPNC Statistical Release for 2014-15, Section 3, the annual cost of the FPC policy was £482 million.    The following table shows the cost in previous years.

But not all of the £482 million is covered by the Scottish Government.    While the cost for self- funders may be additional, other services provided by local authorities would have had to be funded anyway.   

The contribution from the Scottish Government is no longer clearly identified.  It is rolled up in the General Revenue Funding.   As a result, it is not clear what the actual net cost of FPC to either the SG or local authorities.  The figures above simply give a total net cost to both parties.

Section D        Concerns about Cost Overruns in FPC

When FPC was introduced, the initial costs were higher than originally expected and this caused some political concern.  A number of studies were commissioned to see what had happened.  For our purposes, the 2008 Audit Scotland report is most helpful. 

Audit Scotland estimated that the first 4 years of the FPC for older people cost £1.8 billion.   £1.2 billion of this would have had to be spent by local authorities anyway.   The Scottish Government had already committed £500 million to this over the 4-year period.     The gap was £100 million or £25 million per year.  

£25 million is a significant cost but it is a relatively small element of the £450 annual cost of the service.  We believe that much of the concern was politically driven as there was little consensus within  the Scottish Parliament to this policy change at that point.  

There is much cross-party support for the extension of Free Personal Care.  So, while it is important to accurately gauge the cost of any new policy, the consequences of small errors may not be so great as in the past.  

Section E        Working out the Cost of Extension

The easiest way of working out the cost of extending FPC to 18 – 64 year olds is to look at three elements.

  1. How much do those who already ready get personal care pay for it.

The Local Government Finance Statistics LFR3 contains information of the different areas that people pay care charges.  It is not always clear though which are Personal Care or not. 

Equipment, Aids and adaptations are clearly identified and are not Personal Care, 

However, payments listed under Self Directed Support Options 1 & 2 may contain within it payments for personal care or payments for equipment.

We have included day care within the “personal care” definition as it clearly falls within the wider definition of “personal support” contained within the Public Services Reform (Scotland) Act 2010 (see Section F)


 The following table list one way of looking at the elements in LFR3 classified as Personal Care or Not.      

 

This suggests that at a maximum the  cost of FPC to those currently getting community based services would be £17.4 million.    This number could be reduced further but would require significant detailed analysis of each care package to identify specific items for classification as to personal care.

 

  1. How many self funders are there in residential care who would now be entitled to the £78 or £171 payments

The number of people  between 18-64yrs, who are self funder are negligible.  Most older self funders gain this status because of the value of their housing assets.   This will rarely be an issue for those with long term disabilities as they rarely own housing assets that can be released after entering care homes.

However it may be an issue for a small group of people who develop life limiting conditions later in life which require high levels of care.    Information from the Scottish Care Homes Census may help understand the age of self funders in residential care. 

 

  1. How many people who don't get services would come forward to ask for one if it was free and be able to get through the eligibility test

This is hard to estimate as in Scotland we have little more than anecdotes.  We know that people do walk away from social work services after they have been assessed as eligible for support.  However, there are no statistics about number of new assessments, in terms of eligibility criteria and subsequent service outcomes.  

We also know that local authorities are increasingly tight about the use of eligibility criteria and they are unlikely to allow more people through this system into care services just because of this change.   They would be still be responsible for the majority cost of services, as the government contribution would only cover the cost of making it free – not of providing the services.  This financial cost would act as a disincentive for council to offer more people services; unless access to such services become a civil right . 

We believe that local authorities are in a much better situation to comment on this number as they will have some understanding of the number who were assessed as eligible for social care, but chose to decline such, after the financial assessment.  

 

Section F – The Legal Definition of Free Personal Care

Two main pieces of legislation are used to currently define the duties of local councils in the provision of Free Personal Care.

Public Services Reform (Scotland) Act 2010

The legal definitions for both Personal Care and Personal Support are now contained in paragraph 20 of Schedule 12 to the Public Services Reform (Scotland) Act 2010

“[..] “personal care” means care which relates to the day to day physical tasks and needs of the person cared for (as for example, but without prejudice to that generality, to eating and washing) and to mental processes related to those tasks and needs (as for example, but without prejudice to that generality, to remembering to eat and wash); and

“personal support” means counselling, or other help, provided as part of a planned programme of care. [...]”

The Community Care and Health (Scotland) Act 2002,

This definition is then used in Section1 of The Community Care and Health (Scotland) Act 2002, Regulations as respects charging and not charging for social care.  This states

  • Subject to subsection (2) (a) below, a local authority are not to charge for social care provided by them (or the provision of which is secured by them) if that social care is—
  • personal care as defined in [paragraph 20 of schedule 12 to the Public Services Reform (Scotland) Act 2010] (asp 8);
  • personal support as so defined;
  • whether or not such personal care or personal support, care of a kind for the time being mentioned in schedule 1 to this Act; or
  • whether or not from a registered nurse, nursing care.

 

  • The Scottish Ministers may (either or both)—
  • by regulations qualify the requirements of subsection (1) above in such way as they think fit;
  • by order amend schedule 1 to this Act.

 

  • In paragraph (d) of subsection (1) above, “nursing care” does not include such social care as falls within any of paragraphs (a) to (c) of that subsection.

 

  • Subject to subsection (1) above, the Scottish Ministers may by regulations—
  • require a local authority—
  • to charge; or
  • not to charge,

for such social care provided by (or the provision of which is secured by) the authority as may be specified in the regulations;

  • where a requirement is made under paragraph (a)(i) above, specify the amount to be charged or factors which the authority must (either or both)—
  • take into account;
  • not take into account,

in determining any such amount; and

  • where a requirement is made under paragraph (a)(ii) above, qualify that requirement in such way as they think fit.

 

In addition, there is a qualification of requirement not to charge, which can be found in paragraph 3 of the Scottish Statutory Instrument 2002, no 303, The Community Care (Personal Care and Nursing Care) (Scotland) Regulations 2002

 

The requirement in section 1(1) of the Act, not to charge for social care of a kind mentioned in paragraphs (a), (b) and (c) of that section shall apply only where the person, for whom the local authority has a duty or power in terms of the 1968 Act or section 7 or 8 of the 1984 Act, is a person aged 65 or over.

 

(Emphasis added to show that all three parts of ‘social care’ should be seen as being free, not just ‘personal care’)

 

This seems to make clear that:

  1. ‘Social care’ is defined as, personal care or personal support (where it is part of an agreed care plan), or both
  2. Local authorities are not allowed to charge for social care as defined in a) above
  3. Scottish government MAY specify the amount (if any) of the charge; i.e. they have the power to do so.

 

Schedule 1 of the 2002 act itemises tasks under personal care, but does not specify where those tasks should take place.  So, one argument could be: if a disabled person needs help to go to the toilet (which is part of their care plan) this help is given without charge, irrespective of where that help is given, i.e. whether at home, in a shopping mall, or at a leisure event.

Therefore, while there is no schedule for items of ‘personal support’ in the 2002 Act; if a disabled person needs ‘help’ to go shopping, and if ‘going shopping’ is part of their ‘care plan’, then they need ‘OTHER’ help. 

So, under section 1(b) of the 2002 Act, and paragraph 20 of schedule 12 of the 2010 Act, people should not be charged for either part of ‘social care’; provided they are over 65yrs of age, of course.

This of course would apply to all “other help” provided as part of a care plan, which is within a planned programme of care.  

 

 

 

Ian Hood

On behalf of Scotland Against the Care Tax

(http://www.scotlandagainstthecaretax.com/)

 

APPENDIX 1

 

The following organisations are part of Scotland Against the Care Tax

 

Learning Disability Alliance Scotland                                             Glasgow Centre for Inclusive Living

Inclusion Scotland                                                                                The Coalition of Carers in Scotland

Scottish Campaign For A Fair Society                                            Lothian Centre for Inclusive Living

Sense Scotland                                                                                      Values Into Action Scotland

Self Directed Support Scotland                                                     Glasgow Disability Alliance

Pat's Petition                                                                                          Carers Scotland

Inclusion                                                                                                  C-Change

Black Triangle                                                                                         Equal Say

Quarriers                                                                                                 Neighbourhood Networks

The Richmond Fellowship Scotland                                               The Alliance

Carers Trust Scotland                                                                          MECOPP

Capability Scotland                                                                              Coalition of Care Providers Scotland

Enable Scotland                                                                                   Scottish Campaign for a Fair Society

Scottish Disability Equality Forum                                                  UNISON Scotland