BBC On The Record - Broadcast: 21.01.01

Film: David Grossman reports on the impending decision by the Scottish Executive to provide long term care free to the elderly and assesses the implications for Scotland and the UK.



DAVID GROSSMAN: Getting old ain't what it used to be. We're now living longer and stronger than ever before. The Paisley Piranhas is a Seniors ice hockey team, not for them a stroll in the park to feed the ducks. Believe it or not, some of the players crashing round the ice and are well into their seventies. In a society increasingly obsessed by youth, they prove that retiring from work needn't mean retiring from life. These players are obviously in splendid health, but one concern that worries us all is what will happen if we can no longer take care of ourselves. At the last election, Labour picked up votes from the middle classes by promising they'd no longer have to sell their homes to pay for long term care. Now though, the government at Westminster is pleading a lack of funds. Here in Scotland, Henry McLeish's Scottish Executive seems to have found the money. Mr McLeish's expected generosity is threatening to make Mr Blair look uncaring and miserly just before a General Election. DAVID HINCHLIFFE MP: I believe that the long term care issue will possibly prove in the very near future, to be another seventy-five p issue for the Labour Party and I worry about that because when people realise that we have this unfairness, we have this problem that won't be easily resolved, then there will be great pressure on Labour MPs in particular to do something about it. ACTUALITY GROSSMAN: Giving thanks for plenty at a retirement home in Edinburgh. Few issues are more emotive than how much of society's wealth is distributed to our oldest citizens. Tony Blair promised to end the practice whereby the only way the elderly could get long term care was to sell their homes. He set up a Royal Commission to look at how best to deliver on that promise. Headed by Sir Stewart Sutherland, an Edinburgh academic, the commission concluded that only the board and lodging element of care, the so called hotel costs, should be means tested. Everything else, it said, should be free. SIR STEWART SUTHERLAND: Right at the core of this was the belief that people who are in need should have that need met. This is basic in all of the up bringing I've ever had. It's basic in the way in which people in our country think, I have no doubt, meet that need. We don't for example say to somebody when they come in to hospital in need of a operation for lung cancer, how many fags a day did you smoke, this is your own fault. We actually see them as someone in need and we respond as a humane civilised society. GROSSMAN: In Scotland, health is one of the range of services now provided by the Scottish Parliament and Scottish Executive. When Scotland's first minister, Henry McLeish took office, he gave his backing to delivering the full Sutherland Commission recommendations, much to the delight of his Liberal Democrat coalition partners. Indeed all the parties in the Scottish Parliament agree with him. Scotland's health minister is due to make an announcement on Wednesday. MARGARET SMITH MSP: We've got a long tradition in terms of wanting to see good funding of public services and decent social services available to our population. And I think what the Scottish Parliament allows us to do is to actually feed in to the experts working in the fields, to talk to carers, to talk to professionals and say to them, if you have the money available to you and you now have a Parliament available here to make these things happen, how would you improve the services to the people of Scotland, how do you think we should proceed? And we've done that with long term care, we've taken the evidence, we've talked to the people involved and they're saying to us, go ahead, implement this in full. GROSSMAN: Such a move would be very popular in Scotland. Angus Gillon is a frequent visitor to the Edinburgh care home, where is father is a resident. The Reverend Blair Gillon may be ninety-four and retired from the church but he continues to study. What he can't do is take care of himself and paying for help is now eating away at his capital. ANGUS GILLON: In order to pay for his care, my father is using all his pension income, he's using the interest from the capital from the sale of his house and in addition, there is a small proportion of his capital, going simply to pay for him to reside here. Now, if any change were to come and some proportion of that were subsidised by the Scottish Executive, Scottish Parliament, or provided by the Scottish Parliament, I guess that that would make our lives and his life a little bit more comfortable because we could look further ahead to the future. At the moment he's becoming more dependent as you do as you get older and we're not sure what lies ahead. GROSSMAN: The prospect of having two different prescriptions for long term care north and south of the border puts Scotland's First Minister Henry McLeish in an awkward position. Tony Blair would far rather he opted for the same remedy as England and Wales - where spending on long term care has risen but is targeted on those most in need. The UK government fears that if Scotland goes ahead with the plan for free care, this fact will be lost, amid a flurry of unflattering comparisons to Scotland. But Edinburgh isn't Westminster. JOHN McALLION MSP: Oh Henry McLeish faces completely different political pressures from Tony Blair. We have the main opposition party, the SNP, pressing us from the left and they of course are demanding the full implementation of Sutherland. Even the Conservatives in Scotland are demanding the full implementation of Sutherland. And Henry really didn't have any political space to go to, other than agree with them because if he did then Labour would would lose out significantly in terms of the left of centre vote that tends to dominate in Scottish politics. GROSSMAN: Coming to see how the other half live - a coach-load of pensioners from the north-east of England on a visit to Scotland. This could become something of a promised land to pensioners from the rest of the UK. Although these visitors from the Durham Friendship Centre have come to see the famous buildings and beautiful scenery - they're also flashing a few admiring glances at the health-care system in Scotland. Another country where they do things differently. It's among people like this that the government could meet considerable hostility. If a day-trip over the border to Scotland reveals a health-care system that's managing to fund the full recommendations of the Royal Commission Report, there are plenty of voters in the rest of the UK who will want to know why they are apparently being left behind. FRANK HEDGES: If the Scots can afford it, then I'm quite sure that we can afford it in England. It can't be right that you pay into National Insurance for all your life, and then, because you have the bad luck to be somebody who needs long-term care, your small savings are eroded, completely eroded by paying for your long-term care. JOAN McELROY: I think it's very unfair. If they pay the same taxes as us, why can't we have the same benefit? And I don't see why I should have to sell my home to pay for care. I've worked hard to get a home and people who are on benefit all their lives are still going to get benefit, that I'm going to have to give up my home for. GROSSMAN: The reward for three hours on the bus is one of Edinburgh's finest views. The reward for a working life spent saving and paying taxes may now depend on the Blair government's distinction between types of care. In the future the NHS will only pay for nursing case, for example handing out medication. Other care, like help with dressing, will be called personal care and will be means tested. That's say critics, is completely unworkable. SIR STEWART SUTHERLAND: If it weren't so tragic, it would almost be a joke in the profession. How do you decide when a bath is a social bath and when it's a medical bath? It's absurd just to have to ask the question. But the current government plans will require that to asked and answered and charges made accordingly. They will have to set up a large bureaucracy to work out where the charges fall, who should pay, and then they've got to go and collect it. That will take a lot of money out of the actual provision of care into bureaucracy. HINCHLIFFE: I can see understandable anger, particularly where you are in the north of England, not that far from Scotland and over the border the policies are very distinct and different and in most people's perception a good deal fairer. I think that that will lead to pressure to bring about certain changes. It may indeed bring, bring about legal challenges at some point. GROSSMAN: A care assistant helps residents with their daily routine. The UK government's answer to the difficulty of drawing up legally robust definitions of nursing care and social care is to give that decision to nurses, so that for each case, an assessment would be made and the distinction not fixed but flexible. DR LIAM FOX MP: We don't have a problem with the government's judgement that there are better ways of using a large amount of money than extending the nursing care through to personal care, our worries with it are really with definition, on how, in terms of legislation, you can clearly define what is nursing care and what is personal care and how you would separate that out in practice. For example, would it create perverse incentives for nurses to actually say somethings were nursing care when they're really personal care, in other words, in order to make them free for patients? ACTUALITY GROSSMAN: Everyone likes a bit of a flutter - but Henry McLeish may well be gambling with his political future. He can't please both London and Scotland. He's already upset more than a few in Westminster by calling his Executive the Scottish Government. And the Scottish Parliament's already voted through an exemption from higher education tuition fees and is now finalising a huge pay-rise for its teachers. At Westminster, envious Labour MPs are beginning to grumble. HINCHLIFFE: There is already a good deal of concern among English MPs about the discrepancy between the funding levels and the ability for example, in terms of delivering community care packages between local authorities in England and local authorities in Scotland. I've personally raised this matter with the Chancellor who himself of course is a Scots MP, so he's a vested interest probably in retaining the advantage that Scotland's got. GROSSMAN: Henry McLeish though is a long way from winning any trophies. There's now speculation that he's about to back down under pressure from London. But that too would be risky. He needs the Liberal Democrats on side to control Parliament and many of them are now muttering darkly about breaking the coalition if he doesn't implement the Sutherland Report in full. For some of his own backbenchers the issue is now a matter of Scottish Labour's entire credibility. McALLION: Above all Henry McLeish has to be seen to be independent of Tony Blair and of the Labour Cabinet in Westminster and to be taking decisions because they make sense in the Scottish context, not because they make sense in the UK context. So that's a pressure that Henry's consistently under. Henry also has to take in to consideration that we are one party and we want to see Labour win as many Westminster seats as possible in Scotland. So we're not going to do anything stupid and foolish to put at risk Labour victories here in Scotland. But at the same time what would really put Labour victories at risk in Scotland would be the perception that the Scottish Labour Party was now run from London. If that perception started to gain ground in Scotland, Labour in Scotland would be in very serious trouble indeed. DR FOX: It was inevitable that they way the government pursued their devolution agenda, was going to lead to conflict between Edinburgh and London. We said all the way through, this was a recipe for conflict. It was a recipe for the potential break up of the United Kingdom and we're now seeing, when you've got the same party in power, in both the Scottish Parliament and Westminster that this tension is already arising, how much greater would that tension be if you had different parties in power and what would the consequences be for the country as a whole? GROSSMAN: It's hard to see how Labour can win. If Henry McLeish goes ahead with free long-term care now it will be embarrassing for Tony Blair and Labour in the rest of the UK. But if he doesn't, he'll risk humiliation and Labour could suffer at the polls in Scotland. The Royal Commission was meant to remove elderly care from the political melee, now devolution has put it right back in the fray.
NB. This transcript was typed from a transcription unit recording and not copied from an original script. Because of the possibility of mis-hearing and the difficulty, in some cases, of identifying individual speakers, the BBC cannot vouch for its accuracy.