Health Secretary Nicola Sturgeon said: 

“We are working on a strong presumption – supported by the landlords, and underpinned by our contingency arrangements – that older people will not be moved.  The welfare of all the residents will be maintained with minimum possible disruption. 

“The Scottish Government is working with COSLA and other partners such as ADSW [Association of Directors of Social Work] and SCSWIS [Social Care and Social Work Improvement Scotland] to ensure continuity of care for all residents in Southern Cross care homes in Scotland.

“This formal announcement signals the start of a process to break up the southern cross group on a consensual basis, it does not mean that the business has gone into administration, or that any care homes will close in the immediate future.”

The background to this statement is the announcement on Monday of this week that Southern Cross is to transfer all of its care homes to other operators.   

The Scottish Government has issued two revised codes of practice under the Adults With Incapacity (Scotland) Act 2000.

Code of Practice for Continuing and Welfare Attorneys.  The revised code can be found here.

Code of Practice for persons authorised under intervention orders and guardians.   The revised code can be found here.

The Adults with Incapacity (Scotland) Act 2000 was introduced to protect individuals with incapacity and to support their families and carers in managing and safeguarding the individuals’ welfare and finances.

“The Report of the Commission on Funding of Care and Support” was published last week.  Although this report looks at the situation in England, and was commissioned by the UK coalition Government, the issues raised and the recommendations made are of direct relevance to us here in Scotland.

Extracts from the four key findings:

1. The current adult care funding system in England is not fit for purpose and needs urgent and lasting reform.
2. The current system is confusing, unfair and unsustainable.  People are unable to plan ahead to meet their future care needs.  Eligibility varies depending on where you live.
3. A major problem is that people are unable to protect themselves against very high care costs.   The current availability and choice of financial products to support people in meeting care costs is very limited.
4. Most people are realistic about the need for individuals to make some contribution to the costs of care in later life, but they want a fairer way of sharing costs and responsibility between the state and individuals.

Extracts from some of the main recommendations:

1. To protect people from extreme care costs we recommend capping the lifetime contribution to adult social care costs that any individual needs to make at between £25,000 and £35,000.   We think £35,000 is an appropriate and fair figure.
2. Not everyone will be able to afford to make their personal contribution, and those currently just outside the scope of eligibility for means-tested support are not currently protected.   To address this, means-tested support should continue for those of lower means, and the asset threshold for those in residential care beyond which no means-tested help is given should increase from £23,500 to £100,000.
3. Those who enter adulthood already having a care and support need should immediately be eligible for free state support to meet their care needs, rather than being subject to a means test.
4. Universal disability benefits for people of all ages should continue as now.
5. People should contribute a standard amount to cover their general living costs, such as food and accommodation, in residential care.   We believe a figure in the range of £7,000 to £10,000 a year is appropriate. [1] 
6. In reforming the funding of social care, the UK Government should review the scope for improving the integration of adult social care with other services in the wider care and support system.   In particular, we believe it is important that there is improved integration of health and social care.  [2]

Estimated cost

The estimated cost of these proposals is £1.7bn per year rising to £3.6bn by 2025.

Two examples from the Report may help explain how this would work in practice.  

Example 1:

Alice lived alone in her own home worth £180,000.  She had dementia and needed to go into a residential care home when she was 83 for the last 5 years of her life.

Under the current system

Alice’s daughter needed to arrange for Alice’s home to be sold in order to be able to use the money to pay for Alice’s care.   Alice had to pay for all her care and living costs in full until she died, spending £165,000 from her pension income and housing wealth.

Under Dilnot

Alice would initially need to contribute in full to her care and general living costs.  After two years she would have contributed £35,000 towards her care and reached the cap.   From then on, the state would pay Alice’s annual care costs of £18,500.  Alice’s general living costs would be paid out of her pension income.  Alice would be able to keep 80% of her wealth.

Example 2:

John has a stroke at the age of 85.  He could no longer manage at home and entered a care home costing £28,500 a year.   He lived in the care home for four years before he died.  Prior to this, he lived on his own, in a house which he owned outright and was worth £140,000.  He had £220 a week from his own pension and the state pension.

Under the current system

John had to contribute all his income except for £22.60 a week and use his housing assets to pay for his care.   He continued to pay for his care in full until he died, spending £74,000 from the value of his home.

Under Dilnot

John would pay the first £35,000 of his care costs and after two years he would reach the cap and then receive all his care without charge.  He would continue to contribute £10,000 a year towards his general living costs.  This would be done through his pension income.

John could choose to use his housing assets to pay for the £35,000 (taking out a deferred payment from the local authority), and still have £105,000 left, three-quarters of his wealth.

Reaction to this report in England

UK Government Ministers responded cautiously.  The health secretary, Andrew Lansley, described the Dilnot report as “an immensely valuable contribution” but warned that the UK Government needed to “consider carefully” the “significant costs” of reform.

Age UK welcomed the proposals. [3] Michelle Mitchell, Charity Director at Age UK, said: “Age UK welcomes the Dilnot Commission recommendations, which set out a clear blueprint for the long term sustainable reform of social care.

The Guardian said:  “Life is littered with potential financial catastrophes, from costly-to-treat illnesses to house fires, but in most cases the risks are pooled, whether through the state or the insurance market.    When it comes to care those with more than £23,500 are on their own, facing potentially unlimited liabilities.   The results are dire.  One in five retirees will clock up costs of more than £100,000.  Some 20,000 people are forced to sell their homes every year.  So Dilnot’s plan is very welcome as a way of staving off ruin for an unlucky minority.”

The Daily Mail took a different view: “The £35,000 doesn’t cover charges for bed and board; those could reach £10,000 per year.  And anyone wanting more than bog standard levels of care will pay extra.  So the middle classes will still face massive costs – while those on benefits will pay nothing.”

 Conclusion

This is a good and more importantly a timely report that points to the questions that we in Scotland also need to ask and answer.

In my next article I will look at latest thinking on this issue in Scotland and in particular what our main political parties said prior to the recent Scottish General Election.

James Aitken
Legal Knowledge Scotland

The article from the Scotsman can be found here.

The Scottish Government have published research looking at various methods of charging for development within the planning system in order to fund infrastructure.  Five different models were considered including a ‘blanket’ system similar to the Community Infrastructure Levy used in England.

Although the research determined that all five models were options for Scotland, the ‘blanket’ system was criticised for being short on certainty and not necessarily being tangibly linked to site developments. The models deemed to have the greatest potential were (1) the ‘measured charges’ model which bases the charge on the “infrastructure call” made by the development and depends on up front financing being available for specific phases of the development with payment of the charge being made at the point of build or on unit sales and (2) the ‘negotiated model’ i.e. the present section 75 contribution approach.  Also considered were a ‘central model’ (i.e. state funding for infrastructure) and an ‘innovative model’ which included various approaches such as Tax Increment Financing (TIFs) and Local Asset Backed Vehicles (LBVs).

The full Report is available from the Scottish Government here.

An independent report into elderly care in England, commissioned by the UK Government and headed by Andrew Dilnot, has been released today.

The Dilnot report recommends that a person’s lifetime contribution towards his or her social care costs in England should be capped at £35,000.

The report also recommends that the means-tested threshold in England, above which people are liable for their full care costs, should be increased from £23,250 to £100,000.

The Dilnot report can be found here.

Two of Scotland’s leading economists warned that frontline services such as education and social care will lose out to Edinburgh’s troubled trams project as they raised serious doubts over every single aspect of the funding proposals.

Professor Arthur Midwinter of Edinburgh University Business School told The Herald the council’s plans to raise the extra £173 million needed are “full of questionable assumptions and there is risk in every element”.

In a scathing attack, Professor Arthur Midwinter of Edinburgh University Business School told The Herald the council’s plans to raise the extra £173 million needed are “full of questionable assumptions and there is risk in every element”.

The report from the Herald can be found here.

A former Glasgow city councillor has been banned from making solo visits to his elderly mother in a care home run by Southern Cross after complaining about her treatment.

The report from the Scotsman can be found here.

The chairman of BMA Scotland, Dr Brian Keighley, has questioned whether society can afford the cost of treatments designed to prolong the lives of terminally-ill patients for weeks or months, given the current pressure on health service budgets. Dr Keighley said in some cases tens of thousands of pounds were spent on drugs to extend cancer patients’ lives for relatively short periods He added that such treatments should be looked at ‘critically’ and that for life-prolonging treatments costing thousands of pounds, ‘useful’ longevity, should be the criterion for decision-making.

The article in the Scotland on Sunday can be found here.

A new report, Quest for Quality by the British Geriatrics Society (BGS), has highlighted the fact that up to 400,000 vulnerable older people resident in care homes are frequently denied access to routine NHS healthcare because they live in care homes. The inquiry found many often cannot get access to GPs, therapy services, out of hours services or specialist dementia services such as memory clinics.

The report can be found here.