The Audit Scotland report, ‘A review of free personal and nursing care,’ which was published today, argues that as the population grows older the demand for free personal care will also grow, meaning the policy will need better planning and more funding to sustain it.  

It found that in its first four years the free personal and nursing care policy was estimated to be £1.8bn, of which £1.2bn would have been spent by councils providing means-tested free care even if the policy had not been introduced. However, it states that in 2005/06 there was a funding shortfall of £63m in 2005/06, adding that unless more funding is allocated this shortfall is likely to increase inline with demand. 

Commenting on the report the Auditor General for Scotland, Robert W Black said that because of “limited information” at the time the Scottish Parliament did not receive sufficiently robust and comprehensive financial information and risk assessments, adding: “The Parliament should require this as a matter of course to enable it to properly scrutinise all major policy proposals.” 

Accounts Commission chairman Professor John Baillie continued saying that while the then Scottish Executive and Scotland’s councils succeeded in developing and implementing the policy within a tight deadline, there are still variations in implementation of the policy across the country that need urgent clarification. 

He added: “Councils and the Scottish Government should work together as a matter of urgency to clarify the current ambiguities and ensure FPNC is consistently applied across Scotland. Councils should also provide clear information to older people about what care they are entitled to under the policy.”

Responding to the Audit Scotland review Cabinet Secretary for Health and Wellbeing Nicola Sturgeon said that the SNP government has already pledged to ‘raise the bar’ in terms of the delivery of free personal care to vulnerable older people across Scotland. 

She continued: "Having looked back at the legislation, and the guidance given at the time of its introduction, the Auditor General found these to be ambiguous, leading to uncertainty and inconsistencies across local authorities. 

"This is exactly why we are working in partnership with COSLA to resolve issues such as eligibility criteria, waiting lists and food preparation.  These are the views we expressed in opposition and issues we are now working to resolve.” 

She said the report acknowledges that it was difficult to identify previous expenditure on free personal and nursing care in isolation of other costs, adding: "Where it estimates a suggested funding shortfall, his report looks back at the position in 2005-06.  More recent estimates are currently being considered by Lord Sutherland, which, when we receive his findings, we will consider with COSLA.  

"I have also asked officials to examine the basis for the expenditure estimates in the report - which are substantially revised from previous published figures - including the treatment of notional overhead costs.” 

"That information will be made available in time to be considered by Lord Sutherland's independent review before he reports back in March this year. 

In the meantime, however, she says that free personal and nursing care payments will increase in line with inflation from this April. 

Lord Sutherland, who is chairing the Independent Funding Review of Free Personal and Nursing Care in Scotland, said that the Review Group will consider the outcome of the Audit Scotland report closely. 

He continued: "I'm grateful to the Auditor General for bringing forward the timing of his report to allow us to consider the findings as part of our independent review. 

“The funding of long-term care is an issue that is relevant to all of us - as people who receive care or who might need it in the future, as carers and family members. 

“The evidence we have collected to-date confirms that issues relating to the funding of long-term care are complex and that specific aspects, such as Free Personal and Nursing Care, cannot be considered in isolation.” 

He said that while they will consider the findings of the Audit Scotland report closely, especially the revised financial data, he said that their review has a wider remit and so will look at not just previous funding levels but also how to ensure funding for the long-term care of our growing older population is sustainable for the future. 

He added: “Our timetable has been tight but we expect to report to Ministers, on schedule, at the end of March.  I would not wish to pre-empt the outcome of our work in any way by commenting further at this stage." 

RCN Scotland Director Theresa Fyffe welcomed the Audit Scotland report and endorsed its recommendations for clarifying current ambiguities in the policy. 

She said: "RCN Scotland supports the national policy of free personal and nursing care as an integral part of a mutual NHS. All those in need of professional support from registered nurses or health and social care support workers should receive high quality and timely services. Audit Scotland's report recommends that the Government and local councils should clarify the current ambiguities with the policy and ensure it is applied consistently across Scotland and we would endorse these recommendations. The Government should also provide clear information to older people on what they are entitled to, to end the current uncertainty.

"We also support the setting up of robust outcome measurements, to evaluate the effectiveness of this policy. Such measurements will clearly demonstrate the benefits to older people and the value and contribution that nurses make to delivering care.

"Audit Scotland says that 'free personal and nursing care needs to be better planned, managed and funded'. If this does not happen, we believe more older people will end up in acute hospital care: that's not what they want and would be a false economy for Scotland."

You can view the Audit Scotland report here.