Extending free personal care to under 65s: feasibility study

Section 4 : Findings From The Study

Views of the public and representative bodies

As part of the process of conducting this feasibility study, Scottish Government officials met with a number of representative organisations with an interest in social care and support, a number of campaign groups, and took part, together with COSLA, in a round table event with people who are in receipt of social care.

The Scottish Government received views from a number of stakeholders and members of the public to feed into this feasibility study. 96 responses were received, of which 83 were from individuals and 13 from organisations with an interest in social care.

Of the responses from members of the public, the vast majority were supportive of the extension of Free Personal Care to under 65s, and some noted that the policy was an important preventative measure, helping to delay or avoid the need for more costly residential or hospital-based care.

Many of the public responses, while supporting the extension, acknowledged the financial implications of extending Free Personal Care to under 65s.

Concerns were also raised around existing and future eligibility criteria, and ensuring that by extending Free Personal Care, there would not be a reduction in the overall care packages that individuals receive. During the round table meeting with representatives of Disabled People’s Organisations, a number of concerns were expressed around the balance of existing eligibility criteria, which currently target those with the highest levels of need, and are less focused on preventative care and support.

A number of responses suggested that the Scottish Government should address the extension of Free Personal Care to under 65s through legislation in order to ensure that there is consistent implementation by Local Authorities across the country.

Other responses called for better information on what Free Personal Care means and clearer communication of what a person is entitled to, and what services are provided by the Local Authority or health and social care partnership.

While those in the last 6 months of a terminal illness are entitled to free care at home, some respondents called for an increase to this period, with personal care being free to all those diagnosed with a terminal illness from the point of diagnosis, and with oversight from the Scottish Government to ensure that Local Authorities were following this policy.

Concerns were raised by some respondents about the potential levels of unmet need (people who would qualify for Free Personal Care if extended to under 65s, but who are not currently receiving social care).

In their response to the call for views to feed into this study, Parkinson’s UK stated that “Research from England suggests that there are high levels of unmet need for social care amongst people with Parkinson’s”. There are over 11,000 people with Parkinson’s in Scotland (although most of these are over the age of 65), of whom around half are estimated to be living with so-called complex Parkinson’s who are likely to require social care support, and that up to 80% of the care needed to people with Parkinson’s is provided by unpaid carers.

However, Parkinson’s UK representatives also made the point that people diagnosed with Parkinson’s disease are often reluctant to come forward to apply for social care, preferring to be cared for by their families. This may mean that while there is a high level of unmet need amongst people with Parkinson’s, due to the care provided by families and the majority of those with Parkinson’s being over 65, that may not result in a commensurate increase in demand for personal care.

Some respondents questioned the availability of a skilled essential workforce if Free Personal Care was extended to under 65s.

A number of respondents commented that extending Free Personal Care to all could contribute to the reduction of poverty, increasing disposable income for disabled people, encouraging greater social and economic participation in society, and closing the inequality gap.

Representatives of Disabled People’s Organisations highlighted potential unforeseen interactions with the existing charging system for social care should personal care be made free. It was suggested that if assessed as needing personal care, the additional income or income not being used towards the purchase of care could therefore be subject to the Local Authority taper rate for available income, potentially leaving the client with a smaller increase in available income than that intended by the policy.

Some respondents highlighted the need to ensure that any extension of Free Personal Care was implemented in a way that was complementary to wider policies, including Self-directed Support.

Representatives of DPOs felt that it would be important to ensure that a separate assessment and commissioning route did not develop for purely personal care. This would increase the burden on individuals and staff and potentially remove existing economies, e.g. where a Personal Assistant works to both personal care and other personal outcomes.

Views of Local Authorities and health and social care partnerships

Working with COSLA, and representatives of Chief Officers and Chief Finance Officers from Health and Social Care Partnerships, feedback was sought from Local Authorities and partnerships. As well as collecting information on their charging policies, income collected from charges and administration costs, Local Authorities and health and social care partnerships were asked for their views on both the opportunities and risks of extending Free Personal Care. The survey was sent to IJB Chief Finance Officers and Councils’ Directors of Finance for completion during July 2017. Responses were received from 29.

Respondents highlighted the fairness of moving to end the difference in treatment in respect of charging for personal care between people aged under and over 65. It was pointed out that some people who had previously refused personal care support due to its cost may now be able to accept the service, which could have a positive impact on their health and may support prevention. It was also noted that this measure would mean service users would retain more income that they could use to achieve their own outcomes, and improve their health and wellbeing.

The most consistent concern highlighted in the survey was that this change would lead to a loss of income towards the cost of care and support services, together with an anticipated increase in demand, which was hard to predict in advance.

On a practical level, it was pointed out that currently services are not routinely split into personal and non-personal care tasks. This would have to be undertaken for every service user. Together with an anticipated increase in demand this would impact on capacity and work-load in assessment teams. A clear majority of respondents considered there to be little potential for savings in administrative costs, given that most service users would receive a mix of personal and non-personal care, and therefore could still be charged for the non-personal element and assessments for income maximisation would still be beneficial for many clients.

Finally, a number of respondents argued that additional demand for services would mean the need to plan for an increase in the social care workforce, at a time when it was hard to recruit in some areas, and with competing demands from the expansion of the child-care workforce, and the impact of Brexit.

Interaction with the Social Security system

Following the recommendations of the Smith Commission report in 2014, the UK Government passed the Scotland Act 2016, which devolves further powers to the Scottish Parliament. The 2016 Act includes the devolution of a number of the social security and housing related benefits currently administered by the UK Government including Disability Living Allowance, Personal Independence Payment, Attendance Allowance and Carer’s Allowance.

The Scottish Government will take on the administration of these benefits before the end of this parliamentary term, and the first and guiding priority will be a smooth transition for people receiving benefits.

During the period of transfer, it will be necessary to ensure that any extension of Free Personal Care to under 65s does not create unforeseen or unwanted interactions with the existing social security system, ensure that clients are not financially disadvantaged by these changes and identify any potential negative impact on those in receipt of benefits.

Two areas of interaction between the extension of Free Personal Care and the social security system were highlighted during the work on the study.

1. Disability Living Allowance ( DLA) / Personal Independence Payment ( PIP) for self-funders in residential care

When Free Personal Care was introduced in Scotland in 2002, the UK Government ruled that self-funders in residential care would be considered to be double-funded if they were to receive both Free Personal Care payments and Attendance Allowance. The UK Government therefore withheld Attendance Allowance from these individuals.

As a result, the Scottish Government reviewed the payment rate for Free Personal Care, and increased it by the amount of the withheld Attendance Allowance to ensure that those care home residents did not lose out financially. Since 2002, the Scottish Government has continued to pay this additional cost, at an estimate of around £600m cost to the Scottish Government over the 15 years.

If Free Personal Care were extended to under 65s in advance of the full transfer to Scotland of welfare powers, there would be a risk that the UK Government would consider that self-funders under the age of 65 in residential care were being double funded if they were also receiving the care components of Personal Independence Payments ( PIP) or Disability Living Allowance ( DLA).

Around 120 people in Scotland are under 65 and self-funding in residential care and may therefore be affected by this.

• The weekly care component for DLA is: £21.80 (lower); £57.45 (higher); £83.10 (highest)
• The weekly care components of PIP are: £55.65 (standard); £83.10 (enhanced)
• The weekly mobility components of PIP are: £22.00 (standard); £58.00 (enhanced)

Assuming that all the 120 self-funders in residential care qualified for Free Personal Care, and UKG chose to withhold the care component payment, this would be equivalent to a loss in benefit income of around £520,000 per annum through the withdrawal of the care components of DLA or PIP from these individuals.

2. Carer’s Allowance

Under the UK Government’s current rules, Carer’s Allowance is paid to people over the age of 16 and not in full-time education (over 21 hours ), who care for someone for at least 35 hours per week, if the cared for person is in receipt of certain benefits. There is also a limit on the maximum income that the carer receives (after tax and some expenses) of £116 per week to be eligible to receive Carer’s Allowance.

The Scottish Government is increasing Carer’s Allowance (currently £62.70 per week) so that it is paid at the same level as Jobseeker’s Allowance (currently £73.10 per week). The Scottish Government plans to implement the increase, the ‘Carer’s Allowance Supplement’, from summer 2018, backdated to April of that year. The supplement will be paid in two, six monthly instalments.

It will be necessary to ensure that the extension of Free Personal Care does not have any unintended consequences on carers reliant on benefits.

Impact on social care workforce

In relation to existing users of personal care, an extension of Free Personal Care to under 65s would not impact on the numbers of care staff required to deliver services. However, if the introduction of Free Personal Care led to an increase in demand for personal care services then additional care staff would be needed to provide that.

Reports from the care sector already suggest that recruitment and retention of social care staff is challenging in some areas, and is likely to be exacerbated by Brexit. At the same time, the Scottish Government’s commitment to increasing the early learning and childcare entitlement to 1,140 hours per year by 2020 will require substantial increases in the workforce.

The Scottish Government is committed to improving social services and the quality of care, and recognises that attracting and retaining the right people, developing them in their roles and raising the status of the sector as a valued workforce is key to delivering this. To take this forward we will be working to develop and implement the social care section of the National Health and Social Care Workforce Plan.

We have taken steps to improve recruitment and retention in the social care sector, and make it a more attractive career option for those entering or staying in the sector. This includes work being taken forward by the Social Care Working Group, who are leading on a social care workforce project which will make recommendations to the Fair Work Convention. The Convention will utilise these in its role to advise the Scottish Government of how best to ensure the Fair Work Framework is implemented, and fair work practices are delivered, across the social care sector.

We are working with employers and through our delivery body the Scottish Social Services Council to deliver our policy on the development and regulation of this workforce to raise skill levels, improve outcomes for service users and increase public protection.

Alongside this, the Scottish Government has enabled, for the first time, adult care workers in Scotland to be paid the real Living Wage of £8.25 per hour from 1 ^st October 2016 and £8.45 per hour from 1 ^st May 2017. This will benefit up to 40,000 people.

The Scottish Government is also working with COSLA, care providers, people who use services and others to deliver a major programme of reform to adult social care, which will consider workforce issues and new models of care and support.

We will continue our work with our key stakeholders and partners on the Social Work Services Strategic Forum which is taking forward a range of shared actions aimed at supporting and developing the workforce.