Independence, Demographics, and Medicine: the future of care in Scotland

Let me take you forward in time a few years. Five, ten...who knows, exactly? But there's been a referendum, and Scotland is now independent from the United Kingdom of Bugger Off Scotland (or whatever it's going to call itself. A Royal Commission on the subject has been set up, and is expected to report in 5 years).

As a proud Scot, currently exiled in not-so-leafy London suburbia, I head back home, back to the future, in my wheelchair-accessible De Lorean. What support can I expect as a disabled resident of newly independent Scotland? And how long can that support realistically last?

The manifesto of the Scottish National Party (SNP) would seem as good a place to start as any - the SNP, the first party to secure an overall majority in the Scottish Parliament since it was established in 1998.

The previous SNP-dominated coalition introduced free personal care, and there was a commitment to continue this in their 2011 manifesto. The independent Sutherland review, published in 2008, addressed concerns about differing use of criteria and waiting lists between different local authorities: a postcode lottery, in fact.

All well and good. But is the reality as good as the rhetoric? And the money to fund the personal care, and the free prescriptions, has to come from somewhere.What other services will be plundered to pay for personal care? Will the currently able-bodied majority continue to accept this allocation of funding?

Under independence, Barnett formula funding from Westminster ceases. Before we wrested back sovereignty, Scotland's funding from central government depended on a complex formula. It was devised in the 1970s, and was never intended to last long: the intention was to ensure that any change in public expenditure in one area leads to a change in public expenditure in other areas proportional to their population.

A higher amount per capita was allocated to Wales, Scotland and Northern Ireland (listed in increasing amounts) than to England, but the advantage was eroded over time, If, for instance, an increase in expenditure of 4% was needed in real terms to keep up with inflation, the grant was only increased by 3%. This means that in fact the budget was reduced.

In my newly independent homeland, this will no longer be a issue. But equally, we will no longer be gaining the advantage of a larger grant than we are contributing in taxation. As our chancellor writes his first budget, now needing to raise taxes as well as spend them, he will have to have an eye to his party's previous promises about care. Will he have to increase taxes above what we were previously paying as part of the UK? Would that be acceptable to the population?

The Scottish lifestyle is notoriously poor: for those who're not aware of it, I'm spending my time at the moment giving an enthusiastic demonstration for my neighbours in the aforesaid suburbia. Smoking, drinking, fatty foods - including of course the famous deep fried Mars Bar. (I've never had one. Honestly and truly.)

Since the late 1990s, Scotland has had a falling population, and a growth in the proportion who are old or "oldest old" (usually taken as those aged 85 and above). In 2008 around 98,000 Scottish residents were 85 or more, most of them women, and it's projected that by 2033 there will be 259,000. A huge increase.

Disability is more likely with age, and more likely in those of us who have indulged in an unhealthy lifestyle. While some of those over-85-year-olds will undoubtedly be hale and hearty, and see me off the planet, many of them will be or become disabled and need residential or home care. There's a huge personal care bill just round the corner for the new Scottish parliament.

At the same time, there are more younger disabled adults, because of improved medical care. Children who would previously have died at birth or as babies now survive, disabled. People have major accidents or illnesses: thanks to modern medicine they don't die, but join the disabled population.

And medical care itself becomes ever more expensive, as new drugs, new equipment and new procedures are developed - not to mention the costs of some of the people above needing time in hospital, in intensive care wards, in rehabilitation centres and so on. All money well spent, of course. But it's money that a few decades ago wasn't spent at all.

While of course governments may change policies and spending priorities in the face of fiscal realities (hard stare at ConDem coalition government), free personal care has been such a tenet of the SNP's faith that it's hard to see how they could drop it and retain any credibility at all (hard stare at Dem bit of coalition).

So what does the future hold for me in the land of the mountain and the flood? Well, I'll be getting free prescriptions and free personal care - at least at first. But I might well be paying more in taxes for the privilege.

My heart longs for an independent Scotland. My head says...weel, ah'm no juist sure!

Edit: Goldfish alerted me to this excellent post about free personal care: what is included and what is not. It shows eloquently that a large proportion of care needs are not included under the current definition.