Can Scotland offer Boris Johnson a model for social protection reform?

At the Davidson home in Motherwell, near Glasgow, Tom, 57, who has Down syndrome and Alzheimer's, got out of his wheelchair and placed on his bed to be washed and changed.

Local care support workers, Meg Murray and Jane Watson, first adjust a custom harness, then tie it to a winch next to the bed, chatting all the time with Tom who isn't 39; is no longer able to speak but is visibly relaxed and satisfied with his charge.

"We have become very close to him," said Murray. His older brother Billy, who has cared for him since the death of their parents, added, "If it weren't for them, I don't think my brother would be here; it would have been in a house and i don't think it would have lasted. It is best in a family environment. "

Free personal care, including help with activities such as dressing, washing and eating, but excluding tasks such as "shopping and sponging", is a policy typically Scottish. In England, which has chosen not to introduce the system, social protection is means-tested and the debate on how to fill the gaps in an increasingly worn-out system has been going on for over 20 years.

Boris Johnson, the British Prime Minister, has bet considerable political capital on finding a way to "fix" the underfunded system, setting it as a priority on his first day on Downing Street. The free personal care model in Scotland could provide a model for his government.

The different priorities of the Scottish and English systems are manifested in a widening of the spending gap. Figures published last year by the Health Foundation, a charity, have shown that public spending on adult social care in England has increased from £ 345 per person in 2010/11 to £ 310 in 2016/17 .

The data also showed that in 2010/11, adult social care spending per person was one third lower in England than in Scotland. By 2016/17, the gap had increased to 43%.

A joint report from the Health Foundation and the King’s Fund, a think tank, found that in 2020/2021, the additional funding required to introduce free personal care in England would be £ 7 billion. In 2030/2031, it would have increased to £ 14 billion.

Johnson said no one should have to sell their house to pay for care. But he has not yet specified how he would get there. Health Secretary Matt Hancock on Friday invited MPs and peers to send their ideas for system reform and promised that "structured discussions" to find a way forward would start in May.

Superficially, the Scottish model does not meet the Prime Minister's objective of protecting homes. Since residents of Scotland remain responsible for the 'hotel' costs of a care home, they can still be landed with large bills if they have to spend years in residential care. For owners, meeting them will often involve the sale of their most precious asset.

Yet the Scotland program has dramatically reduced the number of people forced into the job, according to David Bell, professor of economics at Stirling University and authority on the long-term care system duration of Scotland.

The nursing home population in Scotland "has not changed, roughly in the past 20 years (although) the population has aged a lot," he said. "When you receive home care, your home is not in danger. It is when you enter nursing homes that you face these huge costs. "

Dennis McLafferty, who runs services for frail and elderly adults as part of the North Lanarkshire Health and Social Care Partnership, said a few years ago local authorities decided to no longer manage their own homes. care. "We have more or less withdrawn the residential care market," he said.

Rather, the money released was used to provide more home care to the local population – the region, with Orkney, now has the lowest common proportion of over 65s in nursing homes of all Scotland.

One lesson for England is that the smooth work between the two parts of the system – health and social care – may have been as crucial as free personal care in keeping people there or returning them as quickly as possible if they enter the hospital.

Funding for the North Lanarkshire partnership combines money from the NHS and social care budgets, creating a shared incentive to reduce the time people spend in hospital. He ordered the care of the youngest Mr. Davidson.

Despite some striking cases in England where the NHS and local councils have come together to provide better care, this remains far from the norm south of the border.

“For us, it is this notion that a person in a hospital belongs to the community. . . and we have an obligation to help that person get home, "said McLafferty.

The impact of an underfunded social care system is still felt in the NHS of England, where many older people end up occupying hospital beds because they do not have the support they need to get home, which contributes to longer waiting lists.

Missed wait times targets and delays in discharge from the hospital are also hallmarks of life north of the border. Gordon McNeish, consultant or senior doctor in the emergency department at Monklands Regional Hospital, said: "There are definitely still problems and I don't think free personal care is the panacea for being."

However, when Dr. McNeish compares his experience to that of his English colleagues "there seems to be an advantage at the back of the hospital with exits" ensuring that patients "circulate and are not blocked in a department".

A question that arose on a large scale when the austerity of the public sector was on the horizon a decade ago was whether free personal care – as well as other typically Scottish policies such as free prescriptions – may survive funding cut after 2010.

So far, the answer is yes – but the pressure on public finances is constant.

In 2002 the Scottish government set aside around £ 114 million to cover the cost of free personal care. In 2017, local authorities spent £ 381 million to provide these services, an increase of 38% since 2008-2009.

However, the scheme is now part of the Scottish identity and politicians can change it at their own risk.

“Initially it was the policy of Lib Dem and the Labor Party, then when the SNP entered, they continued. So there is a great political will to continue with this and I think that the fact that it was extended last year to under 65s shows its commitment, "said Mr. McLafferty.