What is the row about?
Essentially, about devolution and self-determination. The Scottish Executive (or "government" as it has suggested it might like to be called) has to decide whether to implement in full the recommendations of the Sutherland report on long-term care, in contrast to England where ministers plan only partial implementation. Breaking ranks with Westminster could be a popular move for first minister Henry McLeish and his Labour administration among Scottish voters; but it could lead to an intolerable strain on relations with his party leader Tony Blair, who is opposed to the move.
What is the Sutherland report?
The royal commission on long-term care, to give it its proper title, was set up by the newly elected Labour government in December 1997. Headed by Sir Stewart Sutherland, vice chancellor of Edinburgh University, its report was published in March last year and recommended that all nursing care should be free, wherever it was provided, and that personal care, such as bathing, feeding and dressing, should also be free according to assessed need. The report rejected private insurance and compulsory social insurance schemes, and concluded that the estimated cost of between £800m and £1.2bn should be met by general taxation.
Why was it not implemented in full in England?
Westminster ruled out implementing the Sutherland report in full on the grounds of cost. Instead, as part of the NHS plan unveiled in July, health secretary Alan Milburn pledged to increase spending on care for older people by £1.4bn. All nursing care will be provided free by October 2001 and an extra £900m spent on home care services, a new intermediate care service, with rapid response teams to cut hospital admissions, and 5,000 rehabilitation beds for people leaving hospital.
In addition, the value of the homes of older people moving into residential and nursing homes will be disregarded from means-testing for up to three months and the capital limit for eligibility for local authority funding raised to £18,000.
But Scotland has gone its own way?
Yes and no. Initially Scotland looked set to follow England. A package of measures in response to the Sutherland report similar to that in England was announced by Scottish health minister Susan Deacon in October.
But shortly after being elected first minister, following his predecessor Donald Dewar's subsequent untimely death, Mr McLeish made the Sutherland report a key plank of his new administration, claiming he recognised people's concerns and wanted to "move forward" on it. Most interpreted this as Scotland going it alone and introducing free personal care. In November, the Scottish parliament's health and community care committee added fuel to the fire by calling for personal care to be provided on the basis of need and for the parliament to make a commitment to finding the extra funding.
Has Mr McLeish since been backtracking?
After his initital comments on long-term care, there have been numerous reports of mounting pressure on Mr McLeish from Tony Blair and Gordon Brown, who are anxious that Scotland should not have a different policy from England and Wales in the run-up to a general election. Blair is said to fear that full implementation of Sutherland in Scotland could fuel similar demands from pensioners south of the border and the spectre has been raised of a vast influx of better-off English people keen to take advantage of the possibility of free personal care in Scotland. In recent weeks, McLeish has been subtly playing down the whole issue. He has consistently denied he ever said he would implement the report in full.
Why should Scotland be any different?
Because it can, basically. The whole point of devolution is that the devolved legislatures in Scotland and Wales can allocate their spending according to local priorities and needs. It is up to the Scottish parliament to decide what it does with its annual budget of £20bn - let alone its tax-raising powers which have so far not been used - and the estimated £110m needed to introduce free personal care is not seen as a major problem.
There could also be some justification because Scotland has a far stronger tradition of publicly-provided social welfare and a higher proportion of elderly people living in poverty - in 1999 some 175,000 Scots pensioners qualified for income support because their income was too low.
What happens next?
The Scottish Executive working group which will look at extending the number of people who qualify for free personal care will not report for six months - conveniently after the most likely date for the next general election. But if a Labour government is re-elected, it will then be forced to bite the bullet and take a final decision on implementing Sutherland. Pressure has been mounting consistently from all sides to implement the report in full. But even if the cash is found, a two-tier system throughout the UK is unlikely to be acceptable politically.
