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The cost of care

Brian Taylor | 14:57 UK time, Tuesday, 29 June 2010

New stats out today confirm the increasing cost of the policy frequently trumpeted as one of Holyrood's flagship achievements; free personal care for Scotland's frail elderly.

The increase is particularly steep with regard to providing free care for those remaining in their own homes, reflecting a trend towards such care.

The cost of that has more than doubled since initial implementation of the policy.

Two caveats to that general picture. The year on year increases in the latest figures are relatively contained: up 0.2% for self-funding residents in care homes and up 3.7% for home care clients.

Secondly, the money devoted to providing free personal care at home might, arguably, be forestalling people from entering residential care and might, arguably, depending on individual circumstances, be thus forestalling other costs upon the public purse.

However, in simple terms, the budget line for free care has increased sharply and much of this is expenditure which previously did not fall to be met by the state at all.

It is new spending. Additional spending.

It seems at least possible that the independent review of spending commissioned by the Scottish government may question such expenditure.

Spending attention

At that point, ministers and Scotland collectively have to decide: is this spending sufficiently vital to Scottish well-being that it must be sustained, despite budgetary cuts?

That applies not just to free personal care.

Indeed, such spending only attracts substantial attention because it is novel, because it is recent.

Such choices could properly be made by ministers and Scotland collectively with regard to all budgetary lines of expenditure.

It strikes me that, in the fact of "unavoidable" cuts (to quote the chancellor), there are two broad strategic options facing Scotland.

We (and, again, this is a collective, not purely ministerial, decision) can shave a fixed percentage off all (or most) Scottish spending.

Alternatively, we can take a close look in the independent review and beyond at whether certain expenditure within departmental remits is merited at all.

Strategic consideration

The former can claim fairness - at least in the rough sense of equal pain (with the exception of health spending which is, apparently, to be spared.)

The downside is that, with such an open-ended approach, it is eminently possible that the "wrong" bits are cut: the axe falling upon vulnerable, front-line services.

The latter can claim discretion in that there is an element of strategic consideration, pre choice.

In practice, a blend of the two must be pursued. With the (now challenged) exception of the NHS, John Swinney will apply cuts generally, on a widespread basis.

That is inevitable, given the extent of the economies being demanded by Danny Alexander (who is meeting MSPs today) and his colleagues.

Within that, however, there will be a search for budgetary lines which can be erased entirely.

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