Community Care

– in the Scottish Parliament at 2:35 pm on 14th February 2001.

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Photo of Lord David Steel Lord David Steel Presiding Officer, Scottish Parliament 2:35 pm, 14th February 2001

The next item of business is a debate on motion S1M-1639, in the name of Margaret Smith, on behalf of the Health and Community Care Committee, on the committee's inquiry into the delivery of community care in Scotland, and an amendment to the motion.

Photo of Margaret Smith Margaret Smith Liberal Democrat 3:14 pm, 14th February 2001

I am pleased—as convener of the Health and Community Care Committee—to lead on this debate on our report into community care. At various points during the past year, the Parliament has discussed the report as we have undertaken our inquiry. I will obviously speak in support of the motion in my name.

The committee's report has already had quite an impact inside and outside the Parliament. I believe that it has played its part in delivering improvement and change in an important policy area that we all care about.

Even after the Executive rejected the arguments for free personal care last autumn, the issue did not go away. In no small measure that was because, after a year's work and after taking evidence from all the main stakeholders, politicians of all parties unanimously signed up to the committee's report and to the implementation of free personal care. Some of us who began that investigation were at that time convinced in our hearts that the implementation of the Sutherland report was fair, good and right. It became clear over the months of investigation that it was also the best thing to do to deliver a better service. That came through in the evidence from all the stakeholders.

As well as effecting change, the work of the committee has been appreciated by people throughout Scotland. The Confederation of Scotland's Elderly wrote to me recently. They said:

"We write to record our thanks and that of all Scotland's elderly for your excellent report, which recommends the implementation in full of the Sutherland Report on long-term care for the elderly. It vividly reflects the virtues engraved on the mace - compassion, wisdom, justice and integrity - the action of this committee shines like a beacon."

I have told my mother to stop writing to me at work.

I assure members that that was written not by my mother, but by pensioners who reflect the views of pensioners throughout Scotland. Many others—pensioners, dementia sufferers, professionals and carers—have written to me since the committee published its report and following the debates on the issue in the Parliament.

The committee worked in partnership and as a team and, as the leader of that team, I have a number of people to thank. They include the former deputy convener of the Health and Community Care Committee, who is now the Deputy Minister for Health and Community Care, Malcolm Chisholm; the committee clerks, who are Jennifer Smart, Irene Fleming and Joanna Hardy; our Scottish Parliament information centre research staff, who are Murray McVicar, Morag Brown and Murray Earle; and our two advisers, who are Professor Alison Petch and Dr Gordon Marnoch. It is most important that I thank the people from the organisations who gave evidence to the committee and those who shared their experiences with us as we visited community care projects and facilities, carers and service users throughout Scotland. Their testimonies filled us with the enthusiasm and determination that we needed to carry on with our work. Their evidence led us to call for free personal care, across the parties and unanimously, and to make recommendations that I believe will lead to better community care services. I would also like to thank Sir Stewart Sutherland personally and on behalf of the committee for the support that he has given me and the committee over the past months.

Finally, I thank my committee colleagues. What can I say about them? What am I allowed to say about them? They represent the spectrum of political backgrounds in the Parliament, not only across parties but also—from time to time—within their parties. Just as organisations' evidence was overwhelming in pointing to the need for free personal care, so the unanimity among colleagues from different political persuasions was powerful in its own way. The committee's members worked hard and well; they set aside their differences—as well as their recesses. They rolled up their sleeves, delved into a complex and emotive issue and did so with intelligence, good humour and integrity. It has been a privilege to work alongside them. Having embarrassed the committee members suitably, even those who have managed to escape from the committee, I will move on to the substantive issues.

It is unfortunate that the Executive felt the need to lodge an amendment to my motion. [MEMBERS: "Hear, hear."] The wording of the motion was given unanimous support at the committee last week and the report was unanimous. The amendment is unfortunate and unnecessary—but I believe that it is no more than that and that it should not deflect the Parliament from the course of action that it has set itself. The amendment allows us to focus on, yet again, only the single issue of free personal care. That is a shame. If the Executive has substantive problems with any of the report's recommendations, I look forward to hearing them. It would have been helpful to have had any such problems outlined in the amendment. The amendment is also unfortunate because there is now a high degree of genuine cross-party unanimity on the issue.

The Sutherland commission's report was about more than personal care, and the Health and Community Care Committee's report is about more than the Sutherland report. I make no apologies for being one of those who, over the past year, has talked endlessly—so unlike me—about free personal care.

I make no apology for believing the evidence that we heard from the professionals, the service users and the carers. I make no apology for seeing the events of the past few weeks as good news for Scotland's elderly and for Scotland's Parliament.

I hope that today's debate will focus on some of the other strands in the community care web—believe us, it is a tangled web. Several key themes emerged during the year that we spent taking evidence; those are reflected in our report. The vast majority of the Sutherland recommendations have been accepted and are being acted on by the Executive. I would like to welcome the commitments that were made in October and again last month by Scottish ministers. In October, Susan Deacon announced substantial extra funding for community care—funding that will rise to £100 million in 2003-04. She announced that joint working—joint managing and resourcing of community care services—would be in place by 2002. She also announced measures to improve the availability of respite, aids and adaptations and additional home care and rapid response packages. All those announcements were welcomed by the committee and by members in the chamber.

In January, those announcements were followed by further commitments to joint and holistic needs assessments—as outlined in the chief nursing officer's report—and the introduction of proposals to implement free personal care for all. The Executive has set up the care development group and will consider the means with which to implement change. The time for talking is over and, as the motion says, now is the time for action.

The events of the past few months and the work of the committee and the Executive have taken us part of the way along a journey towards free personal care and, beyond that, to greater dignity for our pensioners and others. Over the next few months, the development group, the Health and Community Care Committee and the Scottish Parliament will finish the job of implementing free personal care and will complete the community care jigsaw. Members should make no mistake—one way or another the job will be completed. The development group will produce conclusions in August to form part of a bill on long-term care. That bill will be scrutinised by the Health and Community Care Committee as well as by every member in this chamber—in which there is a majority in favour of free long-term care. If we do anything other than implement free personal care, the people of Scotland will never trust us again and they will be right in that.

It is clear to all of us who considered the issue that several key difficulties lie between us and our goal. There is a great deal of work to be done. Sutherland did not have all the answers and neither do we. As a committee, we decided unanimously against putting a timetable on our final recommendations, partly because when work has been completed on what needs to be done and how it needs to be done, we will be in a much better position to grasp when it can and must be done.

The excellent news is that, despite the amendment, the Parliament is moving forward together down that path. There is a high degree of unanimity and central to that is the belief of the Parliament that the service user is at the heart of every change in the community care system. Our report states that our

"concern has been to put the individual and their needs at the heart of the Inquiry and to explore how structures, resources and services can best be structured to respond to these needs."

The Scottish Health Boards Network told us that

"There is still a tendency to fit people into services rather than fitting services around people."—[Official Report, Health and Community Care Committee, 6 September 2000; c 1138.]

We want a system in which people are not only given fair and equitable access to quality services irrespective of where in Scotland they live, but where we can gauge the level of unmet need, from aids and adaptations to respite care. We welcome the news that the care development group will examine current service provision and identify gaps and duplications. It cannot be right that people pay different amounts for the same services in different parts of Scotland. We welcome the fact that the Executive is working with the Convention of Scottish Local Authorities to investigate such an unfair example of postcode prescribing. We also welcome the fact that the Executive will take reserved powers to issue guidance on charging for councils if necessary. Services should be supplied on the basis of need, rather than on the basis of a person's address.

The committee discovered a general view that service delivery throughout the country is distinctly patchy. That led us to call for a more systematic national approach. We felt strongly that there is a real need for systematic change in Scotland's community care services to assist in the fair distribution of services and in their financial planning. We highlighted the needs in the areas of prevention and convalescence: the work that is done in rapid response teams to avoid hospital admission or intensive home care packages following discharge. Members were able to see such schemes around Scotland.

Those comments echo the proposals that were outlined by the Executive in October. We must remember that all the work—in the committee, the joint future group and the Executive—was being carried out at the same time. We have all been moving towards an end point, but we are taking slightly different approaches to reach the same end.

We need a work force that is properly trained. We also need services that are based on the individual. We appreciate that that will depend upon the good will and skills of our community care work force, but we believe that they will continue to rise to the challenge. We are keen to see social work service provision available round the clock, and a more holistic approach to assessment and care. We welcome the development of the role of generic care workers, who combine home and health care tasks. We are keen to see greater multidisciplinary training for all sectors of the work force. We recognise that our proposals involve the need for work force planning. Multidisciplinary team working is a fact of life, and the sooner members of staff are trained in that and take that training as a matter of course, the better for future services.

The Health and Community Care Committee also feels that there is a need for greater funding of community care in future, so we welcome the announcements on extra funding that were made in October and January by the Minister for Health and Community Care. Several submissions highlighted the fact that local authorities were failing to spend up to grant-aided expenditure on care of the elderly and community care services, with children's services being a particular drain on social work budgets.

While evidence suggested that the total sum that was being spent on community care was inadequate, it also highlighted the lack of a systematic method of calculating community care expenditure. Horrifyingly, current systems not only fail to record what is being spent on community care, but they fail to record what should be spent. The Executive's commitment to the introduction of best-value criteria should be welcomed as a step in the right direction in examining current deployment of resources. It has said that it will introduce legislation that will facilitate single funding streams. Generally speaking, we are looking to build a new community care service in which every service is based on best-value evidence and best practice. That view is shared by the joint future group.

We felt that resource transfers lacked accountability and were a continuing source of mistrust across professional boundaries, and that further work should be done on quantifiable targets. We also highlighted some of the difficulties that face the voluntary sector in community care.

It is clear that a great deal of work must be done to break through the community care funding fog, and to allow professionals to work together in a more integrated way. Against a background of a funding imbalance between community and institutional care, we would like to see a further shift of people into the community, and to see the total funds that will result from the closure of long-stay beds being released for community care services, with joint agreements agreed prior to closure. There should be a full audit of the remaining capital resources that will be released through hospital closure. There is a need for greater funding clarity.

That is a major area for further work if we are to deliver the best use of Scotland's community care pounds. The Health and Community Care Committee calls for a full audit of funding needs and available resources, which would allow the production of a national financial framework for community care services. I am pleased that the Executive's response to the committee's report agrees that that is the way forward. The delivery of community care services should be a national priority, and the Executive should signal that through the production of a national service framework for community care services, which should be monitored annually.

Ultimately, financial accountability, national standards and quality services are delivered locally and it is necessary for us to look at local organisations. The Health and Community Care Committee feels that there should be local freedom to decide on the best means of care delivery. However, we set that against a clear belief that a single body should be responsible for budget holding and the planning and commissioning of community care services, as opposed to the current situation in which health boards, local authorities and primary care trusts are all involved. The evidence that was given to us was not clear-cut on which of those organisations should be the single body or, indeed, whether there should be a joint board. We are aware that the Executive has been working on this issue. We want a single point of entry to the service for users and their families and we want staff to be encouraged to work together by systems, organisations, funding and training.

We hope that the needs of citizens who require community care services will be met in a way that gives them dignity and a good quality of life. Our report touches on the importance of appropriate housing and planning, as well as on social and health care.

We were reminded often by the evidence that we took that we were working on behalf of thousands of Scots who cannot speak for themselves. Some are elderly, some are disabled, some suffer from dementia, and some care for loved ones in terrible situations, but all of them rely on community care services. We speak for them—our committee has listened to their voices. I believe that we have produced on their behalf a piece of work that will change their lives for the better and give our elderly a brighter and fairer future.

I commend the report to the Parliament, and I sincerely hope that colleagues on all sides of the chamber will support it.

I move,

That the Parliament notes, and calls upon the Scottish Executive to act upon, the recommendations contained within the 16th Report 2000 by the Health and Community Care Committee, Inquiry into the Delivery of Community Care in Scotland (SP Paper 219).

Photo of Malcolm Chisholm Malcolm Chisholm Labour 3:30 pm, 14th February 2001

Susan Deacon regrets that she cannot be present today; she is attending a meeting with UK ministers in London to discuss CJD-related issues. I am sure that all members recognise the importance of that.

In the community care debate on 16 November 2000, I said that I looked forward to the Health and Community Care Committee's conclusions. I also said that I was sure that not only would those conclusions contribute to our thinking about policy, but that they would intensify our determination to drive forward change with urgency and focus. I have not been disappointed and I congratulate the committee on its report. I welcome the themes that are highlighted and the direction of travel that is mapped out. I hope that we can go forward together to accelerate the progress that must and will take place.

The report is not just about community care resourcing, standards, organisation and service delivery in general—it has specific reference to older people and to mental health. I am pleased to reaffirm that older people are a top priority for the Executive, and to restate that mental health is one of the top three clinical priorities of the NHS in Scotland. Both matters are certainly at the top of my agenda for the coming months.

The report talks about three aspects of resources: first, the overall amount; secondly, the balance and distribution of resources; and thirdly, the bringing together of resources in a single funding stream.

We agree that, as the report states:

"There is an imbalance in the proportion of funds directed to support people in their own homes as compared to residential or nursing home care."

That is why the heart of the three-year investment package that Susan Deacon announced on 5 October 2000—which will rise to £100 million a year in 2003-04—was a massive expansion of care for people in their own homes, including intensive home care, rapid response teams and more short breaks. That is why she also announced £5 million for this financial year for additional equipment and adaptations, on top of the £19 million extra this financial year to deal with delayed discharges, which the committee highlighted.

The announcement that was made on 5 October meets the demand for above-inflation increases in community care funding and more than meets the concerns of the Convention of Scottish Local Authorities about what it described to the Health and Community Care Committee as a £20 million under-resourcing of community care. However, the extra resources are not the end of the story. On 24 January, Susan Deacon announced that additional resources for long-term care would be a top priority for the Administration.

All those measures require the co-operation of local government. The new resources are being given on the basis of local government's delivery of agreed outputs. I agree with what Margaret Smith said about local government. In the new Scotland, local government cannot turn its back on the clearly stated priorities of the Scottish Parliament.

On the third aspect of resources, to which I referred a moment ago, I welcome the committee's recommendation that

"Mechanisms should be created to ensure that single funding streams and delegated responsibility are put in place in all areas."

Our response makes it clear that

"The Executive will shortly be consulting on legislation which will facilitate single funding streams and will allow us to ensure that all areas adopt this practice. We propose to bring forward this legislation as quickly as possible in the form of a Long Term Care Bill."

Other recommendations about single assessments, joint equipment stores and strategic care management are related to that central proposition. We welcome those recommendations and will ensure that they are acted on.

The care development group will advance some resource and service issues. I am sure that members of the Health and Community Care Committee will welcome the fact that their adviser, Professor Alison Petch, is a member of that group.

Without reading out the care development group's whole remit, I remind members that we shall examine existing service provision to identify gaps, deficiencies and duplication that might need to be addressed. We shall examine the current deployment of resources from all funding streams for the care of older people and make any recommendations for change that are thought to be necessary.

Centrally, we shall draw up proposals for the implementation of free personal care for all, along with an analysis of the costs and implications of doing that. As Margaret Smith's speech made clear, that was a central recommendation of the Health and Community Care Committee's report. I quote the two key sentences from the report:

"Clearly the decision to make personal care available free of charge means money is no longer there to be spent on other aspects of community care. However, the Committee received strong indications that this is an important issue of principle for the people of Scotland."

That encapsulates perfectly that free personal care is right in principle, but that it does have an opportunity cost.

Photo of Duncan Hamilton Duncan Hamilton Scottish National Party

The minister omitted to mention the part of the remit that says that part of the role of the care development group would be to provide a clear definition of what is meant by personal care. Will the minister tell us what is unclear about the definition in Sutherland and whether he supports that definition?

Photo of Malcolm Chisholm Malcolm Chisholm Labour

We need to translate the principle of Sutherland—which we accept—into an applicable, understandable and doable system of charging and non-charging. That relates also to the part of the care development group's remit on working with the chief nursing officer's group to develop a person-centred, holistic, needs assessment process. We accept the principle of free personal care—the definition in Sutherland is broadly right, but we must translate it into a clear assessment tool so that we can have a system of charging and non-charging. Sir Stewart Sutherland recognised that as much as we do.

My reference to a system of charging and non-charging relates to the fact that housing and living costs are paid for even under the Sutherland recommendations. That takes me to the committee's recommendation that steps should be taken to ensure uniformity throughout Scotland on charging for the provision of support services. As we indicated on 5 October, we support the initiative by COSLA to develop guidance on charging policies to deal with inconsistency and—crucially—we shall take a reserved power in the proposed long-term care bill to ensure that progress is made.

There are several other aspects in the report that I cannot deal with in detail, but in my remaining two minutes I want to refer to several other important areas. First, the Health and Community Care Committee

"wishes to ensure greater consistency in the quality of services."

Its report acknowledges the central role in that regard that will be played by the Scottish commission for the regulation of care, which will be set up through legislation when the Regulation of Care (Scotland) Bill completes its progress in the summer.

The Health and Community Care Committee also states that we should always be

"informed by evidence based best practice".

Members will know that we accepted the recommendation of the joint future group that we should improve the collection and dissemination of good practice. I take this opportunity to thank the members of the joint future group for all the work that the group has done. Members will know that there is considerable overlap between the recommendations of the joint future group's report and the recommendations of the Health and Community Care Committee.

Photo of Mike Rumbles Mike Rumbles Liberal Democrat

On that point, I understand that the Executive objects to the motion that is before us and has lodged an amendment simply on the grounds that the committee should not call for action. However, the Executive—as the minister has pointed out—is already acting on the recommendations. I do not follow that logic. Will the minister explain it?

Photo of Malcolm Chisholm Malcolm Chisholm Labour

Mike Rumbles should appreciate that the normal purpose of a motion on a committee report is that the Parliament notes it. This is the first time that the Executive has welcomed a committee report in an amendment. I hope that Mike Rumbles and others acknowledge the positive response that I have given to the Health and Community Care Committee's report.

Members should step back from the report and think in general about how legislation is made. If they think that every last detailed recommendation should be adopted as policy by the Executive, they are taking an untenable position. I more or less support the whole report, but we are being asked to implement every last detail.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

If we are to follow the logic of the minister's argument, will he tell us which aspects of the report's recommendations he does not agree with and does not intend to implement?

Photo of Malcolm Chisholm Malcolm Chisholm Labour

That is very much in the detail. For example, I could point to recommendation 44, which concerns the involvement of social work in the training of GPs in their post-graduation year. I am told that that would be difficult, given existing time restraints. That illustrates a detail. An Executive cannot be bound by every last detail of a committee's report. It is perhaps important that I should have dealt with interventions. No doubt, I will come back to them. I wanted to say something about mental health but, as my time is up, I shall perhaps do so in my winding-up speech.

I move amendment S1M-1639.1, to leave out from ", and calls upon" to end and insert:

"and welcomes the recommendations contained within the 16th Report 2000 by the Health and Community Care Committee, Inquiry into the Delivery of Community Care in Scotland (SP Paper 219) and further notes the announcement made by the Executive on 25 January 2001 and the establishment of the Care Development Group regarding the care for older people."

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party 3:40 pm, 14th February 2001

I start by welcoming the Health and Community Care Committee's report. As someone who joined the committee at a very late stage of this piece of work, I pay tribute to all the members of the committee, including my colleagues Kay Ullrich and Duncan Hamilton, who are both so committed to the report that they have come out of health retirement to speak in today's debate. It is also appropriate to thank the committee's support staff—the clerks, the advisers and the research staff—without whom no work of this nature would be possible. It is important that the Parliament recognises their work.

The Health and Community Care Committee has placed a comprehensive report before the Parliament. It is a report that has been tremendously well received by a range of groups and individuals across Scotland, and it is generally recognised that the report's recommendations, if implemented, will greatly improve the delivery of community care in Scotland, guarantee the dignity of people in their later years and vastly improve the experience of service users and their carers.

It is also appropriate to acknowledge that the world has moved on quite significantly since the report was published. That is because the Executive has already moved to implement a great deal of what it contains. Statements on 5 October 2000 and 24 January 2001 and the Executive's response to the report of the joint future group have all acted to move those issues forward. The Executive deserves credit for the fact that so much of what we are discussing today is already work in progress.

I do not have time to talk in detail about all the report's recommendations. The convener of the Health and Community Care Committee has already touched on many of those recommendations, including those relating to resources and financial planning, work force planning and training for staff. I associate myself with Margaret Smith's comments on all those areas. They are all extremely important recommendations, which I hope will be fully implemented by the Executive.

In the relatively short time available, I would like to highlight and make special mention of just a couple of the report's recommendations. First, I want to comment on the recommendations that relate to joint working and joint resourcing. Although I joined the committee at a very late stage of the report, I have read carefully through the evidence presented to the committee. What strikes me about that evidence, among other things, is that time and again the committee heard how the fragmentation of service delivery and budgets at local level, the lack of co-ordination and the disputes between health boards and local authorities detracted from the quality of care provided to individuals and, too often, led to situations in which vulnerable individuals fell through gaps in the system. I know that the Executive has already committed itself to taking action on that area, but it is important to emphasise that action is urgently required. I was glad to hear Malcolm Chisholm assuring us again that the long-term care bill will be introduced as soon as possible.

The second area that I want to touch is the quality of care provided to older people. I make particular reference to the report's recommendation that calls for the commission for the regulation of care to be funded adequately to do its job properly. If there was ever any doubt—and I do not think that there was—about the importance of establishing a commission for the regulation of care to regulate and inspect the quality of care that people receive, it would surely have been dispelled by reports in last weekend's press that a fifth of elderly people in care are not being fed properly. That revelation certainly horrified me and I am sure that it horrified everyone else in the Parliament.

The funding of the proposed commission for the regulation of care is an issue that is exercising the Health and Community Care Committee in its consideration of the Regulation of Care (Scotland) Bill. The proposal to make the commission self- funding by 2004-05, which would inevitably lead to an increase in registration fees for service providers and users, is causing a great deal of worry. I hope that the Executive will give further consideration to that issue—the minister may want to touch on that in his summing-up.

I turn now to the Executive's amendment, which causes me some considerable concern. I understand that the Executive's rationale in lodging the amendment is that committee motions are normally take-note motions while Margaret Smith's motion on behalf of the Health and Community Care Committee goes further. Let me make two preliminary points on that argument. First, it should be for committees to determine the terms of their own motions. Secondly, it sets a bad precedent in the Parliament that committees should never call upon the Executive to act on the recommendations that are contained in committee reports.

However, what really concerns me is that the Executive amendment appears to go much further than simply seeking to turn the motion into a take-note motion. Instead, the amendment seems to take us back headlong into the debate on personal care that dominated all our thinking only two weeks ago. The minister talked about issues such as training. The fact is that the terms of his amendment single out the personal care recommendation. He cannot get away from that fact.

If the Executive is committed—as Henry McLeish says and as Malcolm Chisholm has repeated in the chamber today—to the provision of free personal care for all, why is there so much reluctance to allow the parliamentary majority in favour of that to be expressed in a vote on an unambiguous motion? Why not vote for a motion that calls on the Executive to do what the First Minister says it is committed to doing anyway: providing personal care free to all on the basis of assessed need?

The Executive must accept that in lodging the amendment, it raises the suspicion that there is a difference between the committee's recommendation—free personal care for all as proposed by Sutherland—and the Executive's position. If we add to that the fact that Susan Deacon has, yet again, passed up an opportunity to state for the record that she is committed in principle to the implementation in full of Sutherland, we can all be forgiven for having some doubts in our minds today.

The amendment leaves open the possibility that the Executive will bring forward proposals on free personal care—which, let us remember, is all that the statement on 25 January committed it to doing—but that those proposals will in some way fall short of the full implementation of Sutherland, for example, by changing the Sutherland definition of personal care. That may not be what the First Minister envisages but, reading the amendment, it seems to be the intention of Susan Deacon and Malcolm Chisholm to leave themselves a get-out in respect of fully implementing the Sutherland report.

Photo of Malcolm Chisholm Malcolm Chisholm Labour

I am genuinely mystified. I will try for the next hour to understand the basis of that argument. When I was asked whether I had any reservations about details of the Health and Community Care Committee report, I signally said nothing whatever about personal care. Let me also correct Nicola Sturgeon. We have not said that we want a take-note motion; we have lodged an amendment that says that we note and welcome the report, which goes further than any Executive response to a committee report has ever gone.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

Welcoming it might be better than noting it, but it is still not quite as good as acting on it. The minister said that when he talked about things in the report with which he did not agree, he concentrated on things like training. The fact is that the amendment focuses on the personal care recommendation.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

It talks about the emergency statement on 25 January, which dealt solely with personal care. The amendment again raises the possibility that the Executive's position on personal care might differ from the position of the Health and Community Care Committee.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

Not just now, as I am summing up.

The motion gives the Parliament the opportunity yet again to vote for what we all say we believe in. If the Executive means what the First Minister says it does and what Malcolm Chisholm has said again today, I cannot for the life of me understand why it has any difficulty in voting for the motion as it stands. I hope that people in the chamber will vote for the unamended motion and do what Margaret Smith described as speaking for those who cannot speak for themselves. The report will, if implemented, improve lives. For that reason, we should embrace it unreservedly.

Photo of Mary Scanlon Mary Scanlon Conservative 3:50 pm, 14th February 2001

I thank Margaret Smith for proposing the Health and Community Care Committee report so competently. I also commend all the members and staff involved.

I have a distinct feeling of déjà vu about this debate. This Parliament once again has the opportunity to vote for free personal care as defined by Sutherland. It is the strength of the committee structure in this Parliament that we worked in partnership and put care in the community before party politics in reaching conclusions and producing recommendations in our report.

I again put on record my respect for Margaret Jamieson and Duncan Hamilton, as we worked together on our visit to the Western Isles. People were probably surprised that we were able to work together positively and put health first rather than knocking political spots off each other.

Against that background, I consider the Executive's response and its amendment today to be disrespectful to the cross-party Health and Community Care Committee and divisive in the workings of this Parliament. People in Scotland have a right to expect us to put their health first. They will not thank the Executive for its wrecking amendment to the unanimous, cross-party consent on this issue.

Photo of Mary Scanlon Mary Scanlon Conservative

I am just getting started.

Apart from the ill-judged amendment, which only adds to the confusion over personal care for the elderly, I also find the Executive's responses to our recommendations insulting, especially those related to the joint future group. The Minister for Health and Community Care had to set up her own group—chaired by the then Deputy Minister for Health and Community Care, Iain Gray—to reach its own recommendations. That group ran parallel to the Health and Community Care Committee report and allowed the Minister for Health and Community Care to overshadow and fudge the committee's recommendations.

The committee's motion only

"calls upon the Scottish Executive to act upon, the recommendations contained within the 16th Report 2000".

I hope that all the elderly in Scotland are listening today, because the Executive could not even do that. Anyone in Scotland who thinks that the Scottish Executive is committed to free personal care for the elderly has been seriously misled; the Executive cannot even agree that it should be called upon to act upon the report recommendations.

The only commitment that we have received in this Parliament is a commitment to the provision of free care to include those dementia sufferers with the greatest need and the establishment of a development group on long-term care, which will consider a new system of assessment and criteria. As things stand, the elderly in Scotland will not receive one ounce more of free personal care than anywhere else in the United Kingdom.

Photo of Malcolm Chisholm Malcolm Chisholm Labour

Surely Mary Scanlon realises that the Executive's amendment has nothing to do with free personal care. As I said in my speech, all the amendment does is point out that the motion is asking us to implement every detail of 45 recommendations. Our response to the Health and Community Care Committee report is more positive than any other Executive response to a report in the history of this Parliament.

Photo of Mary Scanlon Mary Scanlon Conservative

If that is the case, perhaps Malcolm Chisholm will clarify that point when he sums up.

Why does the Executive have to refer to the care development group, which was set up to define personal care, and why, as Nicola Sturgeon said, does it have to refer to the debate on 25 January, which was all about that definition. If the Executive has nothing to hide, why does Malcolm Chisholm not come clean and say honestly what its commitment to community care is?

Photo of Mary Scanlon Mary Scanlon Conservative

I want to move on.

When Stewart Sutherland was asked by Malcolm Chisholm in the Health and Community Care Committee whether he envisaged any difficulties in implementing the definition of personal care, Sutherland replied:

"If I were in charge of the money, and had a mean mind, I would say that expenditure could be reduced by defining down personal care, and eliminating certain things."

In response to Malcolm Chisholm, Sir Stewart went on to say:

"The haggling that will go on will be over how personal care is defined."—[Official Report, Health and Community Care Committee, 31 May 2000; c 961.]

How right he was, because that is the position in which we find ourselves.

When the committee discussed personal care, it was always the issue of personal care according to Sutherland, as it was the only definition that members knew. It was not the haggled-down, narrowed definition that Susan Deacon might give us in nine months' time. When the First Minister replied in relation to this issue, he said:

"If it quacks like a duck and waddles like a duck—it's a duck."

If we must relate personal care to ducks, will the minister assure us that we are talking about the Sutherland duck, not the Deacon duck? Furthermore, I ask him to stop ducking this very serious issue. Although Jim Wallace might consider that to be a very silly semantic point, it represents the life and soul of dignity and respect in old age. That said, I welcome the Executive's commitment on our recommendations 10 and 25 which relate to a single funding stream and budget-holding body.

I want to raise the issue of bedblocking that both Kay Ullrich and I have mentioned so many times in the past two years. Last week, 18 of the 24 female patients in the medical assessment ward of the Royal Victoria hospital in Dundee were waiting to be placed in residential wards and in home care, which means that 75 per cent of the beds in the ward were blocked, with the patients receiving inappropriate care. That is why we are so passionate about this issue, and why we will keep raising it over the Parliament's next two years.

I also seek further assurances on our 13th recommendation. The committee found that it was difficult to audit-trail the community care pound, and I ask the minister for a simpler and more transparent guide to the funding of community care services. The Conservatives support the Health and Community Care Committee's motion. I am very sorry that the Executive found it necessary to lodge its despicable amendment, which we will not support.

Photo of Des McNulty Des McNulty Labour 3:58 pm, 14th February 2001

The central issue of this debate is not just the Health and Community Care Committee's report, which is important and which has, along with the Sutherland report, made a major contribution. The vital issue is actually what is being done for elderly people. The statements on 5 October and 24 January represent a very considerable shift towards many of the committee report's recommendations, particularly on intensive home care, and on the introduction of respite care and increased aids and adaptations for elderly people.

When I dealt with older people's needs in local government, it was very often the small things such as respite care and the need for an aid or adaptation that proved vital for elderly people as they made their lives more bearable. Very considerable steps have been and will be made in that direction. Elderly people will receive their share of both the additional £2.4 billion that the NHS will receive and the £1.6 billion that is being invested in local government. Such changes are important.

I listened with some interest to Mary Scanlon's comments. I know that the Conservatives in this Parliament believe in a year zero approach; however, many people in Scotland have long memories about what happened to health and local government services in their 18 years in power. Many of the people who bore the impact of those policies—

Photo of Des McNulty Des McNulty Labour

No, I am short of time.

Many of the people who bore the impact of those policies were elderly people—our pensioners, who were neglected and disadvantaged by what was done. The fact that we are going to spend money and make resources available for elderly people is important. That fact is in this document and is at the forefront of the Executive's philosophy.

A vital dimension of that policy, which is mentioned throughout the report, is the effective management of those resources. The issue of care for elderly people is not only about cost constraints, but about finding more effective and challenging ways of dealing with people's needs. It is not just a case of professional inputs; there must also be proper inputs from the clients and patients whose needs are being met. Importantly, there must also be inputs from carers. Their comments are among the most striking in this report.

Carers and users of services are saying that services could be better provided within the resources that are available. It is important that the philosophy that is brought forward is one of shared responsibility, shared objectives and common working between the different agencies. Moving from a dual funding stream to a single funding stream will wipe out some of the perverse incentives that exist.

Every member who has spoken so far has talked of the importance of personal care. The introduction of free personal care is an important step forward. However, it is vital to ensure that that progress is sustainable. There is no point in introducing a principle that cannot be funded or properly adhered to. We owe it to elderly people to ensure that whatever is done gives them confidence that their needs are going to be met.

When I read the Sutherland report and some of the answers that were given by Stewart Sutherland to the committee, I have considerable reservations about some of the funding calculations that he has made. I think that what is being proposed will cost a lot more than £110 million. I am therefore grateful that Malcolm Chisholm, together with his colleagues, will consider the way in which the Sutherland proposals can be implemented—the nuts and bolts of the matter. Elderly people want to know the answers to those kinds of questions. If they are to get anything more than a pig in a poke, we should address such questions instead of the kind of trite nonsense that we have heard from the Opposition.

Photo of Kay Ullrich Kay Ullrich Scottish National Party 4:02 pm, 14th February 2001

This report is a good example of the important work that is being undertaken by the committees in the Parliament. In addition to taking written submissions and oral evidence, we went out, as Mary Scanlon said, in small cross-party groups. We visited nine different areas to witness at first hand the work that is being done on the ground in delivering community care services. Those visits to the coalface allowed us to see for ourselves not only the problems that are being encountered, but the many examples of good practice and innovation that are employed by workers at all levels and in all disciplines. Unfortunately, I have time to highlight only a few areas of concern that have arisen from our investigations.

The issue of the inconsistencies in resource transfer was raised by several witnesses. In its submission, the Association of Directors of Social Work noted its concern over the variation throughout Scotland in levels of the transfer of resources from health boards to local authorities. Evidence showed variations from as little as £5,000 per long-stay bed closed to the more realistic sum of £23,000 per bed closed. On a visit to a local authority in Ayrshire, Margaret Jamieson and I discovered that, in one case, resource transfer still had not taken place months after the total closure of a long-stay hospital, leaving a cash-strapped local authority to pick up the funding while negotiations dragged on.

Resource transfer should not be used as a financial mechanism, as it encourages division and acrimony among people who should be working together in the interests of service delivery. For the immediate future, mechanisms must be put in place to ensure transparency and rid our local authorities and health boards of the climate of suspicion and the us-versus-them attitude that currently exists.

Photo of Kay Ullrich Kay Ullrich Scottish National Party

I do not have time.

I will end with the issues that were paramount in all the submissions and, indeed, in all the visits. The first is the desire that the Sutherland report be implemented in full. We can only hope, given the minister's absence, that she has changed her position from that given in response to the Health and Community Care Committee's report. Quite frankly, that response fell far short of providing non-means-tested personal care.

The other area of great concern is the lack of appropriate funding to Scottish local authorities. There was evidence about that lack in submission after submission. The ADSW and numerous local authorities admitted that many cash-strapped authorities are forced to divert the indicative funding for community care into other areas of social services.

Will the Executive now acknowledge that community care is grossly underfunded? Will it stop answering questions by saying that it is up to each local authority to determine its spending allocations? Will the Executive accept that, as it passes the buck, some of the most vulnerable people in the country are in the midst of it all: the frail elderly, those suffering from mental illness and with learning difficulties, not to mention Scotland's vast army of carers, who save the country no less than £3.4 billion each year.

Lastly, in the light of Lord Hardie's judgment in the case of McGregor v South Lanarkshire, which is no longer sub judice, will the minister state what steps have been taken to ensure that Scotland's local authorities now have sufficient funding to fulfil their obligations—clarified by Lord Hardie's judgment—to immediately place in long-term residential or nursing home care all those who have been assessed as requiring such care?

I commend the report to Parliament and urge members to support it.

Photo of Alex Fergusson Alex Fergusson Conservative 4:07 pm, 14th February 2001

The contents of this excellent report show quite categorically that the well-being of our citizens and the health of our nation can come before party politics or in-built dogma. I commend the committee on the depth of the report, on the consensus achieved in drawing up the report and on making community care a priority for the Scottish Parliament. The public perception is that the report is purely about Sutherland, as has been stated, and it is perfectly easy to understand why.

Last year, at the height of the fuel crisis, I had the privilege of addressing more than 1,000 pensioners who had struggled to get to Edinburgh and had marched to their rallying point at the National Gallery. I said to them that the full implementation of Sutherland had less to do with health and care than it had to do with dignity, and that dignity was not an issue over which any pensioner should have to demonstrate. I congratulate the committee on its recommendation that the dignity of care of the elderly be restored. Sadly, I remain unconvinced of the Executive's resolve to implement that section of the committee's report. That feeling is only strengthened by the nature of the amendment that the Executive has chosen to lodge.

As others have said, however, the report is not purely about Sutherland. I have particular sympathy for the recommendation that the budgets for health and for social services should be amalgamated into a single budget. That single budget, if properly administered, would provide clear accountability, remove artificial distinctions between health and social work and ensure that the services work in a unified way to provide what is best for the patient at the time it is required. Ensuring such a unified service as opposed to the fragmented and disjointed one that exists all too often today would speed up both assessment and service provision as well as ending disputes over which agency pays for different aspects of the patient's treatment. In other words, that should provide a better service at a better value. It would also excise the practice of bedblocking, which has resulted in some 3,000 patients being kept in NHS beds when they should be in community care. That is double the number that there was three years ago and takes up almost 8 per cent of the average number of available staff beds in our hospitals. Bedblocking is ludicrously expensive and any initiative to end it should be grasped with both hands.

As a member of the Rural Development Committee, I am particularly pleased that the report pays considerable attention to the mentally ill, the disabled and those with learning difficulties because, in rural Scotland, those people face even greater problems than do their peers in urban areas. I am particularly concerned about such situations as one in Dumfries and Galloway that was recently brought to my attention. There, residential facilities are being closed and patients are being placed into often unsuitable housing in surrounding communities.

Although I understand the intentions behind such moves, I am not convinced that the policy has been properly thought through. Residential facilities have previously been a training ground for people's eventual return to the community, with appropriate support. The worst-affected patients remain in the residence, which becomes their home and, in a sense, their family. To close that home without putting the savings back into increased support services seems to be utter folly. We are surely past the days when financial savings come before patients' interests. If policy is properly thought out, the two can go together. All that is required is a little joined-up thinking. The committee's report encourages just that.

Still on Dumfries and Galloway, I cannot miss the opportunity of mentioning the consequences of that council's policy of externalising its care homes. Within two years, that policy led to a 68 per cent decrease in the number of patients referred to private nursing homes—from 186 in 1999 to only 60 last year. It has affected costs in the externalised homes, which enjoy a guaranteed 100 per cent occupancy rate and about £420 per patient per week, as opposed to approximately £260 per patient per week in a private home. In short, it has led to discrimination against private care homes. I believe that the minister needs to ask serious questions to get to the bottom of that inequality.

The Executive must not think that this debate on the Health and Community Care Committee's excellent report is the end. I hope that it is only the beginning, and that the Parliament will take every opportunity to ensure that the Executive puts into practice the committee's recommendations.

Photo of Mike Rumbles Mike Rumbles Liberal Democrat 4:11 pm, 14th February 2001

I had not intended to speak in this debate until I saw the Executive's amendment. It is an inept, crass amendment. In my view, it is more about control freakery than free personal care. It is inept because it has allowed some people—as has already been demonstrated in this debate—to throw doubt on the Executive's commitment to implement the Sutherland recommendations. I have no doubt about the Executive's commitment to implement free personal care for the elderly and I am sure that nobody on the Executive benches has any doubt about that either.

Photo of Malcolm Chisholm Malcolm Chisholm Labour

I am having genuine difficulty following the course of this argument. Does Mike Rumbles accept that the Health and Community Care Committee's report has 45 recommendations and that the motion asks us to carry out and implement—in detail—every one of them? It has nothing to do with free personal care for the elderly.

Photo of Mike Rumbles Mike Rumbles Liberal Democrat

If you would let me get more than a few seconds into my speech, minister, I will answer that point exactly.

The committee's motion reads:

"That the Parliament notes, and calls upon the Scottish Executive to act upon, the recommendations" of the committee's report. It most certainly does not call for implementation of every recommendation—it says "act upon".

The point that I made when I intervened on you earlier, minister, is that you, or rather the Executive—this is the stupidity of it—is already acting on the recommendations of the committee's report. The amendment is crass and stupid: it only gives succour to the people who want to stir things up and say that the Executive is not interested in full implementation of Sutherland, or wants to squirm out of its commitment.

This is a parliamentary issue and I am taking issue with the Executive. Malcolm—the minister—said in his speech that he hopes we can go forward together. I have never known a way of going forward together that involves saying that the committee's recommendations cannot be acted upon.

Photo of Mike Rumbles Mike Rumbles Liberal Democrat

I have only another minute.

The effect of the amendment is to say that the committees can do all their good work—and a tremendous amount of good work went into the report; it is terrific; it is marvellous; and the Executive is already implementing much of its recommendations—but, oh no, do not let the committees dare suggest to Parliament that the Parliament requests the Executive to act on anything. The committees can go and lodge take-note motions—that is fine—but the Executive is saying, "Don't you dare overstep the mark." As far as I am concerned, this is a parliamentary issue about the importance of the committees and their freedom to make up their own minds about what they think is important to put before the Parliament.

When I saw the amendment, I wanted to make this speech. I have absolutely no intention of supporting the Executive's amendment in this afternoon's vote and I wanted to put on record my reasons for that.

Photo of Patricia Ferguson Patricia Ferguson Labour

I remind members that speeches should be addressed through the chair.

Photo of Irene Oldfather Irene Oldfather Labour 4:15 pm, 14th February 2001

I am a little disappointed by the way the debate is going. I put on record the fact that I, like Mary Scanlon, enjoyed working on the report in the committee. I believe that the committee is right to be proud of it.

There is not enough time today to discuss the detail of the report, so I will address two matters: supporting elderly people at home and the need for joint working. The committee rightly addressed joint working as it tackles problems in the system and identifies difficulties in such areas as the nutritional needs of the elderly.

Much of the debate and much attention over the past few weeks has focused on the personal care element of the report. It must be remembered that free personal care will not only benefit those in residential accommodation but, along with the other home care support packages that have been announced recently, allow more elderly people to stay in their own homes.

Kay Ullrich spoke about her visits to the coalface. One reason I am passionate about the principle of free personal care, which I am glad the committee and the minister support, is the case of my constituents, Mary and James, who have been married for more than 60 years. Mary is an 85-year-old who is wheelchair bound because of arthritis and James is her 87-year-old carer. Unfortunately, over the past few years, James has had bouts of poor health, which have resulted in eight admissions to hospital, most recently for pneumonia. Despite all the policies that are in place—rapid response teams, augmented care, budgets for aids and adaptations—at no time have Mary and James been able to obtain assistance to support them at home. Therefore, the report is one of the most important documents that the Parliament has produced and I am proud of the committee's work.

I believe that we have won the argument today. I am delighted that the First Minister has set up the implementation group to examine how to introduce free personal care. In many cases, free personal care will prevent admission to residential care and keep old people in their own homes.

Another important and related matter, which concerned me greatly in the committee's evidence-gathering sessions, is the nutritional needs of the elderly. A great deal of press attention has been given to that subject recently. Committee members will recall that we regularly returned to it during the questioning of witnesses. We cannot underestimate its importance.

The report rightly says that community care is wider than our traditional perception of health and social care. As well as caring for elderly people, we have a responsibility to keep them healthy. A well-balanced diet is no less important for elderly people than it is for the rest of us, yet health promotion is seldom aimed at the elderly.

A problem is that no agency seems to accept responsibility for addressing the nutritional needs of the elderly. We need to get together to ensure that joint working is implemented. The committee was keen to highlight the lack of co-ordination in the delivery of services in areas such as the nutritional needs of the elderly. The committee recognised that good food and a healthy diet are a long-term investment in keeping our old folk healthy and that they help to prevent admissions to hospital and residential care.

I am very pleased to have played a part in producing the committee's report.

Photo of Patricia Ferguson Patricia Ferguson Labour

There are three members who wish to speak. If all three restrict their speeches to about three minutes, I will be able to accommodate them all.

Photo of Duncan Hamilton Duncan Hamilton Scottish National Party 4:19 pm, 14th February 2001

Thank you, Presiding Officer, even if I have only three minutes.

I welcome the report. I welcome its tone and the background to it, which was consensual and cross-party. The report is reassuring as it shows that committee reports are intended not simply to flag up issues but to call on the Executive to do something, as Mike Rumbles rightly said. The report is specific and I think that most of its specific proposals will receive support from all parties.

As I have such a short time, I will address the central issue of personal care. I do so not because I want to gripe or be down on the Executive, but because there is agreement in all other areas. I genuinely believe that the minister has an opportunity today to end the debate once and for all.

As the minister will remember from his time as a member of the Health and Community Care Committee, almost all of the 100 or so submissions the committee received agreed on one issue: the implementation of free personal care. Everyone, including the Opposition parties, accepts that the development group is going to develop proposals to implement free personal care. The definition of personal care is key: what do we mean by free personal care and what do we mean by personal care?

I intervened during the minister's speech to ask him why part of the development group's remit is

"To provide a clear definition of what is meant by personal care".

I also asked the minister what was unclear about the existing definition, but he did not answer that point. I ask him again: what is unclear about the specific definition in chapter 6, page 68 of the Sutherland report? With which part of that definition does he disagree? Will any part of the Sutherland definition disappear from that of the development group?

Mike Rumbles said that the minister's prevarication gives the Opposition the opportunity to stir up the debate again. If the minister stands up today and tells us that, as an absolute baseline, each of the components on page 68 of the Sutherland report will be contained in the development group's definition of personal care, and if he gives us a commitment that he will not support anything less than the definition proposed by Sutherland, I in turn will give Mike Rumbles a firm commitment that I will not raise the issue again in the Parliament.

We could end the debate this afternoon, if the minister would give that commitment. If he does not give that commitment—neither he nor his boss has done so thus far—what does he expect other members to do? As the debate means everything to every party and every member, does he expect us to take it on a whim that the Executive will deliver? If he will not give that commitment, it would be entirely irresponsible of the Opposition parties not to continue to press him.

John Swinney asked Henry McLeish to end the argument during First Minister's question time. Perhaps the First Minister did not wish to do so amid the uproar of the theatre that First Minister's question time has become, but in the quiet calm of a cross-party consensual debate on health, the minister could end the argument and I urge him to take the opportunity of doing so when he sums up the debate.

The Health and Community Care Committee produced a good report and the chamber supports the minister for some of the Executive's attempts to implement some of the report's proposals. I emphasise in particular the proposals on organisational change and on a single funding body. Members of the committee will recall the exceptionally good evidence that we received from a Northern Irish body that made the point that pooled budgets, joined-up thinking and transparency are the way to go. We agree on those proposals and I ask the minister to remove the sole remaining point of disagreement when he sums up.

Photo of Rhoda Grant Rhoda Grant Labour 4:23 pm, 14th February 2001

I welcome the Health and Community Care Committee's report.

In my speech, I will concentrate on rural areas. Everyone knows that the provision of institutional care is expensive—it costs a lot of money to build a building and thus it is not possible to build care homes in many of the sparsely populated areas in the Highlands and Islands. Many couples who have been married for 40 or 50 years have to be parted so that one of them can go into care because the other cannot look after them any more. Friends are moved out their communities and are no longer able to keep in touch.

The people of Ullapool may have thought themselves quite lucky when Westminster Health Care decided to build a nursing home there. The home was beautiful and many elderly people thought, "That's where I'll go when I need care. It will keep me close to my family and friends." Unfortunately, the nursing home that people in Ullapool quite rightly perceive as their own is now under threat. They have tried to get help from different agencies, such as the health service and local councils, to get funding or to examine other uses for the home, which is not anywhere close to full—it caters for only a small number of people—but they have had difficulty getting help and many people cannot quite understand why agencies are not able to work together. It is difficult enough when we are dealing with a community-owned venture, but the difficulties are greater when we are dealing with a private venture.

People in Ullapool look to the south and to the facilities that are available in Lochcarron. They are amazed by the Howard Doris Centre, which has nursing beds, care beds, general practitioner beds and convalescent beds, and which provides day care and respite care as well as housing and sheltered housing services. The people of Ullapool wonder how such a facility could be developed. The answer is that the people of Lochcarron were lucky—they had a trust fund and were able to use that money to draw down money from health boards and local government. It seems that the only way communities can get the care they need is by having their own money. The people in Ullapool do not have their own money. We need to tackle those issues.

Rural areas are unable to sustain a separate nursing home, a separate care home and a GP-led centre with GP beds. Everything has to be put together. Many agencies have looked at other ways of dealing with rural areas and problems. The Church of Scotland, for example, has travelling respite for dementia carers. People set up in a village hall, provide a nurse to look after dementia sufferers and give carers a day, or less than a day, off. That gives carers a chance to shop or get some sleep.

Crossroads is under stress: it has more requests for help than it can cope with.

Photo of Rhoda Grant Rhoda Grant Labour

We need to look at different ways of helping people in rural areas. I could say a lot more, but I will finish on that note and let the final speaker in.

Photo of Patricia Ferguson Patricia Ferguson Labour

Thank you for your consideration.

Photo of Christine Grahame Christine Grahame Scottish National Party 4:26 pm, 14th February 2001

I thank Rhoda Grant.

I want to focus on the urgency with which the minister should act on this quality report. He should not proceed with his amendment.

Everyone would endorse the right of every older person to remain in his or her own home in the community for as long as is practicable and for as long as he or she so chooses. There is, however, a difficulty in the circumstances that prevail in the real world. Incontrovertible evidence of that lies in the simple example of home helps. The number of home helps in the Borders alone dropped by 260 between 1997 and 1999. In Scotland as a whole, the fall was some 9,000 during that period. Who on earth is looking after older people in their homes? Who gets their messages and cleans for them? All that is part of preventive care.

In Scotland as a whole, there are some extra health visitors, but not many—and because they are tending to more clients, they are seeing each client less often than before. There were fewer than 300 additional district nurses for Scotland in 1997 to 1999. They, too, have more clients and less time.

I could not contribute to this debate without mentioning day care centres, which are crucial to maintaining people in the community. They offer preventive care. They allow people respite while a partner with, for example, dementia is taken into the day care centre two or three days a week. Most of those centres are run on a voluntary basis and have to scramble around for funding. There are 585 of them in Scotland, providing nearly 19,000 places. I know that, in 2002, the Scottish commission for the regulation of care will assume responsibility for regulation and inspection of the centres, but will the Executive provide funding to accompany that regulation?

In a debate in this chamber in November last year, Mary Scanlon made the point—with which I agree—that 10,000 elderly people had been assessed for aid and adaptations and 10,000 were awaiting assessment. No finance was available. A total of £5 million of expenditure has been announced, but what kind of dent has that money made in those figures? Those figures represent real people. We want to keep them in the community, but we do not have the services they need. If we add to all that the removal of lighting services, tucking in and sleepover cover, we get a pretty grim world in which to be elderly and frail.

Around 3,000 Scots die each year from cold-related illnesses—a figure that compares very badly with our Nordic neighbours—and a total of 70,000 live in severe poverty. We now have a report, resulting from the national nutritional audit, that tells us that 29 per cent of people in long-term care are undernourished. That is proof, if proof were needed, that there is no place like home. However, that home requires real support and funding. The report clearly underlines that. A rich nation such as Scotland should be ashamed of those statistics.

Stamped all over the committee's report—and the national nutritional audit report—are three words: "For urgent attention". That is why the Executive should act on the committee's report, and not simply take note.

Photo of Donald Gorrie Donald Gorrie Liberal Democrat 4:29 pm, 14th February 2001

I have a high regard for Malcolm Chisholm. In the unlikely event of my ever being asked to form a multi-party administration, he would certainly be in it. Therefore, any criticism that I may make now is not personal.

To the high command who are skulking in their rooms watching the television coverage of this debate, I say that it is the intention of the Liberal Democrat group—apart from the two members who have indicated otherwise—to support, through gritted teeth, the amendment. [MEMBERS: "Why?"] Sometimes in politics, the bigger the mess one's side has made of it, the more important it is to rally round. [Interruption.]

Photo of Donald Gorrie Donald Gorrie Liberal Democrat

Having said that, we must learn from the way things have been conducted. It is extraordinary that there seem to be—allegedly—different doctrines as to whether a motion lodged by a committee just has to say "take note of" or is allowed to say anything else. There is evidently some sort of code that, like the highway code, people do not actually read and so do not know about. That should be clarified—the sooner the Parliament gets a grip on that, the better.

Photo of Mary Scanlon Mary Scanlon Conservative

I suggest to Donald Gorrie that when in a hole and digging and digging it is better not to continue digging but to go into reverse and do something positive for the elderly in Scotland.

Photo of Donald Gorrie Donald Gorrie Liberal Democrat

The intention is to do something positive for the elderly in Scotland. The sad thing is that we all agree on that yet we have got ourselves into a ridiculous muddle via a piffling amendment. First, we must clarify the rules of the Parliament to make it quite clear what committees can and should not do. The doctrine that no committee can ever ask the Executive to do something is not something I subscribe to.

Secondly, there must be some intelligence and common sense in the powers up there that organise our destiny. Whether business managers, ministers, civil servants or whoever—I do not know who they are as I do not operate at that exalted level—somebody is up there organising our affairs and consistently making an absolute muddle of everything. The unerring and consistent skill with which our lords and masters kick the ball into our own goal is quite frightening. It is about time they got a grip.

Photo of Duncan Hamilton Duncan Hamilton Scottish National Party

Since the member has just outlined his disagreement with the principle and the detail of the Executive amendment but said that he will vote for it, perhaps he will tell us why.

Photo of Donald Gorrie Donald Gorrie Liberal Democrat

Because the Liberal-Democrat position was agreed at a meeting at which I was not present and I go by the rule of playing for the team, even if they have got it wrong. That is the short answer. The longer answer is that we have made a mess of it this time and we must take this opportunity to get things right next time.

Despite what Malcolm Chisholm says, it would have been possible for the Executive to accept the motion and for Malcolm or whoever was speaking to say that there are some things the Executive is still looking into, and paragraph whatever about training we do not accept, and so on. I can go to church and sign up to the 10 commandments but say that I reserve the right to retain my envy of other people who have a decent head of hair. That does not mean I have to reject the whole bloody thing—if you will pardon the expression.

The performance of our team has been deplorable. It has removed the possibility of a more consensual debate and of talking more about things other than free personal care, such as care at home; housing adaptations; the absence of clarity about what is spent and should be spent—the finances are a muddle; the importance of a single point of control of budgets; the fact that there are too many short-term projects; the fact that morale is very low because nobody controls the money; the fact that there is a bias to the institutional sector; the fact that there is trouble in the voluntary sector; the fact that there are not enough day care centres—all of which are covered in the committee report.

The more we all go out into the real world and discover that the world as described in official Government reports does not exist, the better. The real world is quite different. This fiasco should lead to our having a better grip on things in the future. If the situation remains as it is, there will be very serious consequences.

Photo of Ben Wallace Ben Wallace Conservative 4:34 pm, 14th February 2001

When I was in the Guards, when challenged by visitors about our tendency to iron and polish everything, we used to have a saying: "bull baffles brains". Over the past year, the Executive has clearly applied that saying to the committee recommendations and the Sutherland report by amending, twisting words, leaking and confusing all who venture along the path of Sutherland. The Executive hopes that it will be left alone and that people will get bored with the subject. We will not get bored with it and we will continue to fight and stand by our position, as have the other parties—except our friends the Liberal Democrats.

Photo of Ben Wallace Ben Wallace Conservative

Apart from Margaret Smith, of course, who has always stood by her principle on the matter, which is something for which she should be rewarded.

Do members remember the new First Minister's exclusive interview in The Sunday Times just after he came to office? Or Malcolm Chisholm's words in the committee? Some of them have been quoted today. We have been reminded of the fears about bickering over personal care. All those concerns have been justified.

We have had enough Executive rhetoric. Today, we are debating a motion that a committee report be acted upon. The report is clear. It is a cross-party report without minority additions, but for some reason the Executive has lodged an amendment—it could not resist it.

Photo of Ben Wallace Ben Wallace Conservative

No.

I wonder which member of the Executive could not resist lodging the amendment. Perhaps it was Iain Gray—I am glad to see that he has come back to his seat—who has argued vociferously against Sutherland and free personal care on the point of principle that it would help only well-off pensioners. He stuck to that, although he might be part of an Executive that is promising—but has not yet carried out—a U-turn on that very principle. Perhaps it was Nora Radcliffe, who spoke on personal care in September and said that we should wait for Westminster before we act.

Photo of Ben Wallace Ben Wallace Conservative

Nora Radcliffe is shaking her head. Perhaps she has changed her mind. Does she disagree with me? I can quote her on waiting for Westminster.

Des McNulty refutes the financial position. Not one organisation has sent me or represented to the committee a refutation of the financial position of Sutherland—nor has the Executive. One would have thought that the Executive, which is very good at briefing, spinning and letting things out, would have let it be known immediately if it had evidence to refute the financial position. It has had months and months to do so.

Des McNulty probably does not recognise the effect of the second Griffiths report, which allowed the extension of the provider-purchaser role in community care. That is the position that his Executive maintains.

Mike Rumbles's question was why did the Executive need to lodge its amendment. Having read through the Executive's response to the committee report, it seems that there is a clear reason. Out of 45 recommendations, the Executive disagrees with two. One is UK reserved, so I think we can let it off with that. It objects to the recommendation on GP training, although it seems to disagree on the ground of difficulty. The recommendation with which the Executive really disagrees, though, is the Sutherland definition of personal care. That is the key.

The Executive's response to the committee's recommendations showed that there is not one difficult position in which it is in conflict with us. Duncan Hamilton is right to say that the committee will monitor progress. The key question is whether the minister and the Scottish Executive agree with the definition of personal care as set out on page 68 of the Sutherland report. It is a yes or no question. That is all it takes.

When I joined the Parliament, people said that Donald Gorrie is a man of principle—a good man who always speaks up. What an excuse Donald Gorrie gave: "If I'm in a hole I'll keep digging because perhaps I will come out in Australia." With that attitude, perhaps Donald Gorrie should carry on until he reaches Australia. We are not answerable to the people up there in the higher echelons—we are answerable to the electorate. We are answerable to the people who deserve and demand proper care for the elderly. When Donald Gorrie votes a certain way today because of the group rules and the decision made in a meeting that he did not attend, he should think about that. I can tell him that we will remind the people who demand the care that the elderly deserve that it was Donald Gorrie who decided it because he was not in a committee room on a certain day. I have lost any respect that I ever had for the position that he sometimes maintains.

Today, we are discussing a report that is unambiguous; it is a cross-party report that makes good recommendations. I would have been proud to support it, as would the whole Parliament, had it not been dirtied by an Executive that is not straight with the truth. I hope today that members of all parties will read the report and act on it—and then we will be able to move on to other priorities.

Photo of Shona Robison Shona Robison Scottish National Party 4:40 pm, 14th February 2001

What a fine mess the Executive has got itself into this afternoon. It is the equivalent of causing a fight in an empty room. It is remarkable. As Margaret Smith and others have rightly said, it is unfortunate that the Executive has found it necessary to seek to amend the motion.

I am not sure whether the Deputy Minister for Health and Community Care found Donald Gorrie's speech helpful. From his facial expression, I think that he probably did not. Most of us found it astonishing when Donald Gorrie said that it was important to win the vote because his side had made a mess of things and that members of the coalition parties needed to rally round to bail out the minister. That was a damning indictment of the relationship between the parties in the coalition. What did it say about the Scottish Parliament's principles of openness and transparency? Where is the openness and transparency in that, and where are the principles? What Donald Gorrie said was absolutely shocking; it is disappointing that it came from someone who usually makes eloquent speeches in the Parliament.

In many ways, the words "act upon" are the most important in the motion. We have done the talking and now it is time for action. We want the minister to tell us how and when he will implement all the committee's recommendations—many fine recommendations from a fine report—such as that we should have adequate resources. Although the Executive has provided additional resources, which I welcome, we have a long way to go. We must make sure that money is spent where it is supposed to be spent. A single funding stream should be established to make the best use of those resources—Kay Ullrich's point about resource transfer was well made.

We must ensure that GAE is spent on the elderly and not plundered for other areas. We must ensure that essential services, such as home help services, are adequately funded to meet need. The 30,000 home help hours that have been lost, which I have mentioned on a number of occasions, are a resource that must be restored. I hope that the minister will indicate that that will be done.

I am pleased that the recommendation to deal with inconsistent charging policies will be acted upon. Better co-ordination between agencies is equally important. Improved service quality will be advanced in great strides by the Regulation of Care (Scotland) Bill, which will establish the Scottish commission for the regulation of care and end the nightmare of malnourished elderly people in our care homes, as highlighted in the weekend's press. I share Nicola Sturgeon's concern about fees. I hope that the minister will address that issue.

The Health and Community Care Committee report clearly recommends free personal care. If the Executive did not want to raise doubts about its commitment to personal care, it should not have lodged such an inept, crass and stupid amendment, as Mike Rumbles described it. The minister tried to argue that it was an attempt to welcome the report, but he could just as easily have done that by ending the amendment before "and further notes", because what is further noted is the announcement on 25 January that proposals on personal care would be produced.

The wording in the amendment reopens the debate on what the Executive is committed to. If the minister did not want that to happen, he should not have lodged such a badly worded amendment, so he must take responsibility for the tone of the debate. The report contains many good recommendations and I was looking forward to a positive debate, because we all assumed that the matter was closed. The minister is the one who has chosen to reopen it today, so he should take responsibility.

At this morning's Health and Community Care Committee meeting, the minister refused to provide a definition of personal care or to endorse the definition provided by Sutherland. His refusal to do so adds weight to my previous remarks.

The Executive's history on the subject of free personal care, the minister's reluctance to define personal care this morning and in today's debate, and the Executive's amendment to the motion mean that the minister can hardly blame members for being more than a little sceptical and concerned about the Executive's commitment to implement free personal care for all of Scotland's elderly.

Photo of Malcolm Chisholm Malcolm Chisholm Labour 4:46 pm, 14th February 2001

I would like to deal with some of the substantive issues of the report that I did not have time to cover in my opening speech. I hope that I will have time to do so and to respond to several of the points that have been made about the service issues that the report raises.

Before I do so, however, I am afraid that I will have to address the issue of motions and amendments. My usual calm unflappability has been sorely tested by some of the words that have been flying around the chamber this afternoon. Without criticising my colleagues, I could probably claim to have made the most positive Executive response ever to a committee report. I made it clear at several points in my speech that, of course, the Executive is acting upon the vast majority of the recommendations—in some cases because we have arrived at the same conclusions, albeit by a different route. However, it is absolutely clear that we cannot act upon every recommendation in detail, in this case or in general. Whatever Mike Rumbles says, that is what the wording of the amendment means.

Photo of Malcolm Chisholm Malcolm Chisholm Labour

I will take an intervention in a minute.

An issue of principle is involved. No one has supported the committee system of the Parliament more than I have. I am committed to the partnership between committees and the Executive that was embodied in the founding principles of the Parliament. However, calling for every recommendation of a report to be acted on in detail is not part of such a partnership approach and does not reflect the spirit of partnership. That is not the way to make legislation in the Parliament.

Photo of Malcolm Chisholm Malcolm Chisholm Labour

I object to the fact that speakers have misrepresented that reasonable procedural point time and again.

Photo of Malcolm Chisholm Malcolm Chisholm Labour

The debate has been turned into one that is solely about personal care, which I never said was the reason for my amendment.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

The minister is being somewhat disingenuous. If he simply wanted to substitute "welcomes" for "act upon" to give himself room for manoeuvre on minor details, why did the amendment not stop before the words "and further notes"? In the words after "and further notes", the minister singles out personal care. He raises the suspicion that there is some difference between the Executive's position on personal care and the position in the committee's report. If that is not the case, why are the final lines of the amendment necessary? That is the issue that the minister has created and has been unprepared to address this afternoon.

Photo of Malcolm Chisholm Malcolm Chisholm Labour

I would have thought that Nicola Sturgeon knew that the care development group will not only make proposals for the implementation of free personal care, but consider many other important issues, some of which I referred to. I am genuinely amazed at how any member can object to the work that the care development group will do and to its being referred to in an amendment. I fail to understand the basis of the arguments that have been made and I do not want to spend any more time on the issue.

Photo of Malcolm Chisholm Malcolm Chisholm Labour

I want to move on to the substantive issues. If I have time, I will take an intervention, but I will not give up time that should be for talking about mental health and services for the elderly to pursue the dancing on the head of a pin that we have seen this afternoon.

I remind the chamber that the report deals with community care in general, services for the elderly, and—very important—mental health services. It is appropriate that we pay attention to that. The report recommends that there should be 12-monthly reports on the mental health framework. For the first time, there will be an annual report—which will soon be on the web—from the mental health and well-being support group, which has been monitoring the implementation of the framework. The report also recommends that there should be mental health crisis services in each area. I remind members that we discussed the development of crisis services in "Our National Health: A plan for action, a plan for change". According to the framework, there ought to be a mental health crisis service in each area. However, there is sometimes dispute about the nature of that service, which is why it is crucial to involve the users of services in the definition of crisis services.

Another recommendation concerns the need to ensure the development of equitable access to information services and to individual and collective advocacy. I refer again to the health plan, in particular chapter 5, which is on involving people. Because of earlier discussions, I do not have time to quote from it, but it contains considerable detail about how we intend to proceed with the plan in general terms to give patients and users a stronger voice and to involve people and communities in the design and delivery of health services. In particular, it outlines how we will develop the agenda of more patient and user information and the obligation on all health boards to ensure that there are integrated and independent advocacy services.

We share Mary Scanlon's concerns about delayed discharges, which is why the attack on delayed discharges has been a key priority for local authorities and health boards during the winter—that will continue. Kay Ullrich made a related point about money to deal with people who are waiting to go into more appropriate accommodation. "Appropriate" is the key word for community care. We agree with the Health and Community Care Committee that we especially want more home care; however, in some cases, we also need more residential care. That is a call on resources—in the care development group, we will consider all the calls on resources for elderly people. During the debates on community care, I have consistently said that, while we want to develop free personal care, we have to consider all the other service developments simultaneously. That is precisely what the care development group will do—for some unaccountable reason, members have a problem with the reference to that in the amendment.

Nicola Sturgeon referred to the recent report on nutrition for the elderly. We were very concerned by the findings of that report and, as a matter of urgency, we are acting on those findings. Page 28 of "Our National Health: A plan for action, a plan for change" details the specific action that we are taking to address that problem. I refer to recent work by the chief nursing officer, who has gone round every health board area in Scotland to address the issue. In addition to that, the Clinical Standards Board for Scotland will monitor nutrition as a core care standard. The Scottish Health Advisory Service will pay particular attention to nutrition in its inspections. Last but not least, the commission for the regulation of care will be responsible for the first inspection against national standards of nutrition and other crucial aspects of care standards.

I am sorry that I had to spend so much time on the procedural point at the beginning, but I conclude by reminding Duncan Hamilton of what I said in response to his question. Of course we accept in principle the Sutherland view of personal care. Indeed, in certain details we may be able to go beyond it—perhaps, for example, sitting with or assisting dementia sufferers should be included in the definition. The key point is that we accept the principle, although we have to work on some of the details. However, as I said to Duncan Hamilton, the more fundamental challenge is to translate the principle of Sutherland into an applicable, understandable and doable system of charging and non-charging—that is precisely what we will do, along with achieving other objectives that we have outlined. I hope that members welcome the care development group.

I am sure that the members of the Health and Community Care Committee will especially welcome the fact that their adviser, Professor Alison Petch, will be on the group.

Photo of Margaret Jamieson Margaret Jamieson Labour 4:54 pm, 14th February 2001

In winding up the debate, I place on record the Health and Community Care Committee's grateful thanks to Jennifer Smart and her team of clerks who service the committee. I also thank the Parliament's research staff and the advisers on the 16 th report of the committee, Professor Alison Petch and Dr Gordon Marnoch, for assisting the committee during the 10 long months of the inquiry. Without them, I doubt that we would have been able to produce such a professional report.

Assistance was also provided by many others in many different ways and from unusual quarters. I am glad that Alasdair Morrison, the Deputy Minister for Enterprise and Lifelong Learning and Gaelic, is in the chamber. He certainly ensured that the visit to the Western Isles that Mary Scanlon, Duncan Hamilton and I undertook went without difficulty. I certainly hope that Alasdair's political progression—or that of Duncan and Mary—is not affected by the fact that we were all in the same boat. Indeed, we were certainly in a very small boat on one occasion, when we went from Barra to South Uist. I may have used some unparliamentary language, because I was terrified.

Photo of Kay Ullrich Kay Ullrich Scottish National Party

I was not fortunate enough to be on that trip to the Western Isles and I do not suppose that Margaret Jamieson is going to tell us exactly what happened between her, Mary Scanlon and Duncan Hamilton. Can she assure us, however, that the girls were at least gentle with him?

Photo of Margaret Jamieson Margaret Jamieson Labour

Many things can be said about me, but we certainly ensured that Duncan was kept in his rightful place.

On behalf of Duncan Hamilton and Mary Scanlon, I record our grateful thanks to Alasdair Morrison, the Western Isles Health Board and Western Isles Council for their hospitality. It would be remiss of me not to mention that wonderful night out in Stornoway courtesy of Runrig. Mary Scanlon is absolutely wonderful at obtaining free tickets and I thank her very much.

I also thank each and every member of the Health and Community Care Committee for the work that they undertook in questioning the many individuals and groups that provided evidence to the committee. If they had not undertaken that background work, we would not have been able to produce such a report. We are also indebted to the many witnesses who shared with the committee their experiences, some of which were of a very personal nature. It would not have been possible to provide such a detailed report without them and I thank them again.

It is no accident that the committee report takes the view that flexible, person-centred services should be available 24 hours a day, seven days a week and 52 weeks of the year to those who require the services of the care work force.

Reference has been made in today's debate to a significant number of evidenced-based good practices found throughout Scotland. Please forgive me if I refer to those practices again. They include devolved joint budgets, rapid response teams, augmented care services, integrated care services, care and repair schemes, aids and adaptations, and joint funding of posts. That is not an exhaustive list, but an example of the commitment to moving forward on a voluntary basis.

Much can be achieved for service users across Scotland. Like many members of the committee and those who have contributed to today's debate, I welcome the committee's extensive report and I commend it to the Parliament.