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Charities laud Scotland's free personal care for elderly people

BMJ 2006; 332 doi: (Published 09 February 2006) Cite this as: BMJ 2006;332:322
  1. Bryan Christie
  1. Edinburgh

    The rest of the United Kingdom could learn from Scotland's experience of introducing free personal care for elderly people, says a report from the Joseph Rowntree Foundation. The report found that the policy had created a fairer system without undue extra public expenditure.

    The charity Help the Aged has responded by saying the report presents a very strong case for making free personal care available to all elderly people in the UK who need it.

    Scotland introduced free personal care—which involves help with such things as washing, dressing, and feeding—in 2001. Some leading Scottish politicians argued against it, claiming that it was an expensive policy that subsidised better off people, as poorer people already qualified for free support.

    No other part of the UK has followed Scotland's lead, but the foundation's report says there may be benefits in looking at the Scottish experience. The report is based on an independent assessment carried out by researchers at the University of Stirling.

    They found that the policy has produced a number of positive outcomes:

    Elderly people and their families consider that the new system is fairer and an improvement on the past

    It has not led to a reduction in informal caring—instead, carers have been freed to provide other forms of care, and it has helped maintain people in their own homes

    It has been particularly beneficial for people on modest means, especially women, and people with particular conditions, such as Alzheimer's disease.

    Although the costs of implementing the policy had exceeded the original estimates, they amounted to only 0.6% of the total budget of the Scottish Executive, the report says. The differences in cost between the Scottish system and what is provided in the rest of the UK are also not as great as had been assumed, because of differences in allowance payments.

    The researchers acknowledge that costs could triple over the next 50 years as the number of elderly people increases. However, they say that costs could be contained by providing more care at home, together with policies to promote a healthier old age.

    Christopher Kelly, chairman of the foundation's advisory group on long term care of elderly people, said: “It is clear that the arrangements in Scotland are an improvement on the past and regarded as fairer than comparable schemes for the rest of the UK.”

    Jonathan Ellis, policy manager at Help the Aged, said the report provides a very strong case for extending the policy across the UK. “It would put an end to the shambolic and hugely over complex system around who pays what for different sorts of care.”

    Financial Care Models in Scotland and the UK is available at

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