Scottish independence: All eyes on Scotland this Thursday as vote could change face of Scottish care

The care sector has largely been quiet on the issue of Scottish independence, yet the vote this Thursday is set to have a huge impact both on older and disabled people and the care providers themselves.

Welfare, benefits, pensions and social care support could all change and big care home providers face the prospect of operating care homes in two completely separate countries.

Social care in Scotland is already a devolved matter with health services delivered by Health Boards across Scotland and social care by local councils. These arrangements will not be changed by Scotland becoming independent.

One in five Scots have disability or long-term health condition

Yet funding all this costs a lot of money as older people make up a high proportion of people in Scotland and health needs are a priority. The last UK census revealed that one in five of Scotland’s population say they have a disability or long-term health condition.

Interestingly, the polls are showing that younger voters in Scotland tend to be a lot more pro-independence than older people , with older women, who tend to live longer and are more likely to end up in a care home, particularly reluctant for Scotland to leave the United Kingdom.

One explanation for this is that older people and especially older women, are less likely to take risks.

Tony Banks, founder of Balhousie Care Group, the biggest Scottish care group, believes older people have been put off by the No campaigners “scaremongering”. He also attributes their reluctance to vote Yes due to “older people having grown up when the British Empire was great and not liking change.”

Disabled people feel disaffected

In August, Disability Agenda Scotland, a consortium of six of the nation's largest disability charities, found nearly three-quarters of disabled people didn't feel engaged with the forthcoming referendum.

Yet people with disabilities could be hugely affected by how the vote goes, according to Billy Watson, chief Executive of SAMH (Scottish Association for Mental Health), who said: “For people with a disability, the outcome of the referendum could have profound and far-reaching implications, touching on the services that they depend on much more than most Scots. Services such as health, social services, welfare and transport, for instance.”

Independence would bring complete financial autonomy and this would make a difference according to Mr Banks of Balhousie Care Group, as Scotland currently is limited in the services it provides to the elderly and disabled by the budget it is given by the UK Government.

“We believe if we got independence our care services would be better protected by decisions being made in Scotland,” he says.

“Health is devolved but we get a finite amount to spend so the Scottish Government has to prioritise where it spends its money.”

Campaigners at loggerheads over NHS

Pro-independence campaigners argue that gradual privatisation of the NHS in England will soon start affecting Scotland. Professor Allyson Pollock, professor of public health research and policy at Queen Mary, University of London, says “the NHS in Scotland may not be suffering these changes, but funding for the NHS in Scotland is allocated through the Barnett formula, so any reduction in NHS funds in England translates into reduced funding for Scotland”.

She believes “policy differences between Scotland and England are growing. Education, long term care and NHS are key examples of where Scotland takes a different direction on policy, but remains under the stranglehold of the Westminster Treasury. A Yes vote in the referendum would free Scotland from this stranglehold, and allow politicians in Scotland to control public finances as well as NHS policy.”

However Labour leader, Ed Miliband, has warned that independence would place the NHS under greater threat, as the Bank of England Governor said Scotland would have to find an extra £21bn of cash reserves if it wanted to use the pound informally, so Scotland’s NHS could face budget cuts.

Mr Miliband told voters: “Be in no doubt what this means. Over £1bn a year would be the NHS’s share of those cuts, the equivalent of 36,000 nurses. That is the real threat to NHS.”

If Scotland does get independence, Mr Banks says: “We need to ensure the care sector is properly funded and that we have a road map showing how it will go forward”.

Independence will 'give care providers more of a voice'

He believes independence will give care providers in Scotland more of a voice as a bonus for him since Scotland took the reins of health and social is that “ministers and Government officials have become a lot more accessible and I have been able to have meetings with people that I would never have had if social care was still being administered by England”.

Currently, people in Scotland get free prescriptions and free nursing care if they need it, so effectively home care is free and if you are in a care home, you just have to pay for your accommodation and food not your personal care.

In terms of things changing if Scotland goes it alone, Mr Banks says: “We have had a personal assurance from the health minister that things will remain the same”.

Uncertainty over the future of Scotland’s currency and whether it would be part of the EU could sway many voters.

Banks such as RBS have caused consternation by declaring they will move their headquarters out of Scotland and relocate to London if it gets independence.

Pensions and savings company, Standard Life, whose customers are largely south of the border, has also said it will move out of Scotland if people vote for independence and supermarkets said they anticipate higher prices.

Analysts are warning that an independent Scotland could bring higher taxes and higher costs for businesses, however the SNP has pledged to cut corporation tax by three per cent.

Corporate tax cut could encourage more investment in care homes

This could lead to more care providers wanting to invest in care homes in Scotland as it will be cheaper, according to Ranald Mair, chief executive of Scottish Care, which represents care providers in Scotland.

On the downside, independence will lead to complications for large care providers with homes in both Scotland and England, as they will have to set up different accounting process to deal with different pension and tax systems.

But Four Seasons, which has over 400 care homes across the United Kingdom, insists this won’t be a problem.

“We already operate under the separate regulatory regimes in England, Scotland, Wales and Northern Ireland. It wouldn’t make any significant difference to our investment or business development strategy. There are very few cross border placements and it is difficult to see that there would be any impact on them as it is Scotland’s intention to continue to use the pound as its currency,” said a Four Seasons spokeswoman.

Independence could see elderly take a back seat initially

Mr Mair of Scottish Care admitted he is “slightly concerned that if there is independence, the next two or more years will be caught up with the task of establishing an independent country and there will be less attention focused on the care of older people”.

He believes the driving force behind some people’s desire for Scotland to be independent is a dislike of the Conservatives rather than nationalism. “I believe the vote on Thursday will be very close but whatever happens the general business of caring for people will continue with the devolved arrangements. Our worry at Scottish Care is that independence could see care take a back seat while they are setting up an independent country”.