THE “biggest shake-up of Scotland’s NHS since 1948” will see more middle-class pensioners charged for care they previously received for free in hospital.
The Scottish Government’s flagship policy of integrating health and social care will also boost the amount of public money being paid to the private sector each year.
Health Secretary Shona Robison will launch the new joint approach this week, with health boards and councils working together to reduce bed blocking and move patients out of hospitals more quickly.
MSPs unanimously passed the Public Bodies (Joint Working) Scotland Act last February, with integration plans for every area required to be submitted to Ministers by Wednesday.
The new Health and Social Care Partnerships then have 12 months to implement the reforms, ahead of the new system going live next year.
Under the proposals, more people are likely be charged for care they would previously have received for free in a hospital. Although personal care for the elderly is free, many other social care services in Scotland are means-tested and must be paid for.
Rachel Cackett, policy advisor with the Royal College of Nursing Scotland, said: “The core principle of the NHS is that healthcare is still free at the point of need, although we are bringing together social care where there are some charges and the NHS where there aren’t.
“We will have to see how this works, we don’t know but we need to be aware that there are charges within social care. That’s not going to disappear under integration but nor should it creep under integration.”
She also admitted the RCN still had other “concerns” about the integration plans, with all the different agencies still not working together as well as they are supposed to.
Last night, Scottish Conservative MSP Alex Johnstone said: “Everyone accepts with an ageing population we need to look at how best to fund and manage health and social care.
“But the Scottish Government has been very quiet about this development. If patients who previously received free care may now have to pay for it, the SNP should be making that explicitly clear.”
Meanwhile, the head of the organisation representing Scottish private health and social care providers will tell a conference in Edinburgh next month that integration will provide “opportunities” for the independent sector.
Ranald Mair, chief executive of Scottish Care, explained yesterday: “The Scottish Government has estimated that overall spend on health and social care for the elderly by the NHS and councils is in excess of £5billion a year.
“The biggest part of that is hospital provision, but around £1.2billion a year is spent on care homes and care at home. The independent sector probably receives around £750million a year.
“I don’t see that increasing dramatically in the short term, although I think there will be gradual growth as we spend more on home care packages, that pot may grow a bit.”
However, he added: “Its not the case we are in a period of rapid expansion, we are not. I don’t think its correct to say this is a recipe for big profits, nobody is making big profits out of care, far from it.”
Mr Mair also said the SNP had worked closely with the private sector to draw up the integration plans, with Scottish Care represented on many Health and Social Care Partnerships.
Around 660 of Scotland’s 940 care homes are run by the private sector, with Four Seasons, HCI, Bupa and the Church of Scotland as the largest operators.
There are also a growing number of private or voluntary care at home providers.
Jenny Marra, Scottish Labour’s Shadow Cabinet Secretary for Health said: “More care workers will inevitably be required as our population increasingly gets older and more care is needed.
“Labour’s strong preference is for this increase in provision to be staffed through local authorities so costs stay in the public sector.”
Health boards are describing the integration plans as “perhaps the most significant change to healthcare since the NHS was established in 1948”.
A Scottish Government spokeswoman said: “As is the case now, following integration, any person receiving NHS treatment will continue to get this free of charge and anyone receiving social care services will be subject to charging, based on ability to pay and at the discretion of their Local Authority.”