We had considerable discussions during stage 2 on fees for the regulation of services and how they should be set. Section 20 provides for ministers to set maximum fees and section 42 provides for ministers to pay grant to the commission. The bill does not say anything about the relationship between the two or about what proportion should be fees and what should be grant.
When we consider what the fee level should be, we will take into account all relevant factors, including the effects that registration fees have had on the care market in the previous years and the likely effect of further increases. We will take a range of factors into account in deciding what the balance between income from fees and central Government grant should be. Self-financing remains the general policy and that will be the case at the outset for the registration of those services that are to be regulated for the first time, including private doctors and dentists and home care agencies. However, we will ensure that that policy does not cut across objectives in other areas, including the need for a flourishing care home sector. The rate at which self-financing is achieved will therefore vary for different care services.
In coming to a view on the level of fees for 2004-05 onward, ministers will be interested in the views of service providers. We have always consulted providers and others on proposed changes in registration fees and, as I agreed at stage 2, I am
Amendment 76, in Shona Robison's name, would require the commission to have regard to
"the anticipated impact of fees on service provision and service providers" and to any representation from local authorities, health boards or other interested parties. That would not be appropriate. It is for ministers to consider the impact of fees on the sector. Amendment 24 will provide the mechanism to allow them to do that effectively. For the commission to reconsider the issue in setting its fees would be pointless and would require it to carry out its own consultation.
Amendment 77, in Mary Scanlon's name, would empower the commission to charge a single registration fee where more than one care service is provided in an integrated way. There is no need for the amendment. Section 20(3)(b) already empowers the commission to charge a nominal fee or to waive the fee altogether. We will be providing the commission with guidance on the circumstances in which it may wish to waive fees, and the example in amendment 77 would be one such instance. We also have the power to prescribe by order circumstances in which fees are not to be payable and we will do so if it proves necessary to clarify the issue. There are also technical difficulties with the amendment. The words "operated" and "charge" are not used in the bill—although I accept that I have used them in explaining these matters—and there would have to be appropriate clarification of what is meant by "integrated manner".
I move amendment 24, and ask that amendments 76 and 77 be not moved.
As the minister said, fees have been one of the most contentious issues since the start of the bill process. The Health and Community Care Committee heard one witness after another say that the Executive's stated objective that the Scottish commission for the regulation of care should be self-financing would mean a huge increase in fees and therefore a huge burden on care providers, particularly those in the voluntary sector. At present, fees cover only 17 per cent of the cost of registration, yet the minister wishes to adopt a system that will be 100 per cent funded by fees. The system will not provide one extra pound for care services. Instead, the minister will set up a little-needed paper-chase around a fees system.
The minister told us that funding to local authorities will be increased to cover the cost of the increased charges that providers will levy to
The fundamental point is that the same pot of public money that goes to local authorities will be used to fund the commission, so why not fund the commission directly and prevent the recycling of public money, which loses value each time that it is recycled? We have yet to hear an adequate explanation of the policy.
I recognise that amendment 24 will allow ministers to consider the potential effect of fees, but that does not go far enough. Amendment 24 is not strong enough to reflect the overwhelming views of the witnesses who gave evidence to the Health and Community Care Committee—in a democracy, after all, we are supposed to listen to such people.
Amendment 76 would strengthen section 20 by stating that, when the commission sets fees, it should have regard to the
"anticipated impact of fees on ... service providers".
Given that the commission will have day-to-day contact with service providers, it will be in a better position to know the impact of fees than ministers might be.
The basic principle of amendment 77 is similar to that of amendment 75. Amendment 75 was about registration; we are now discussing fees. During stage 2, the minister's reply to the question that that principle raises was that, when a care home provides another level of care, a reduced fee for one service would be appropriate. This morning, we received further reassurances on that.
I welcome the reduction or the waiving of fees when a service can reasonably expect to attract only an unusually small number of clients because of its geographical location. As an MSP for the Highlands and Islands, I welcome that, particularly for remote and rural areas such as Sutherland.
The minister says that the commission's decisions should not take account of the financial circumstances of any provider. I understand that we will debate that matter more fully when we debate the amendment to delete section 24A. However, surely we must take account of the fact that quality cannot be divorced from funding, costs and council referrals. With little or no increase in funding and reduced referrals, care providers cannot achieve or maintain the required standards. If a service is given only a small number of referrals because of problems of
Some people fear that care services will be reduced to a standardised form to suit the commission rather than the care needs of individuals. I will be consistent and refer again to the Leonard Cheshire homes' provision of care. If that organisation had to pay five fees, that would quickly lead to a reduction in, and a more standard form of, care. For example, after 2004, registration and inspection of a 40-bed care home will cost £7,000. From 2002, registration and inspection of a day care centre will cost between £1,400 and £1,800. For a home care service, the amount will be between £1,200 and £1,800. That is not to mention respite care and supported accommodation.
Amendment 77 looks towards a more appropriate single fee that is based on the multiple services that are provided. The amendment would address the provision of more than two services.
I ask the minister to clarify a point about the collection of registration fees. It has been drawn to my attention that the registration board in the Ayrshire and Arran Health Board area has recently experienced difficulty with care home owners who have not paid last year's registration fees and have had this year's inspection conducted. Does the bill deal with such circumstances? I am concerned that individuals may delay payment of fees and thereby cause the commission difficulty.
The issue of fees exercised many members in the Health and Community Care Committee and several witnesses who gave oral or written evidence. Many people were concerned by aspects of the proposals that are not specified in the bill but are in its accompanying memorandums, regulations and guidance. The financial memorandum to the bill suggests that the system will be self-financing through fees by 2004, which caused a great deal of concern. I ask the minister to clarify further his comment this morning that the rate of self-financing will vary among care services.
I welcome the fact that, by lodging amendment 24, the Executive has shown that it has listened to that general concern about fees. It is appropriate that ministers must consult. Ministers must take an overview of the sector and keep a watching brief—a monitoring brief—on the impact of the bill and on other aspects of the long-term care sector.
Many members are concerned about the
I have some sympathy for the points that Mary Scanlon raised this morning and repeated in relation to amendment 77. However, we must remember that section 20(3) gives the commission discretion to remit fees. Malcolm Chisholm discussed with the Health and Community Care Committee some circumstances in which the commission might exercise that discretion. The minister said that he would issue guidance and that the commission would attempt to be consistent. He suggested that fees would be waived when multiple care services were operated and managed in an integrated way, when a service was due to close within a short time after fees were due or when a service could reasonably expect to attract only an unusually small number of clients because of its geographical location. Obviously, that would interest members who represent more rural areas.
The bill has some scope to meet the concerns that Mary Scanlon outlines with amendment 77. I support amendment 24 and ask for further clarification on the points that I raised.
I share some of Shona Robison's concerns. In trying to make clear the costs of the commission, we may introduce a bureaucratic system in which the public pound will circulate through several hands and be devalued. I continue to feel instinctively that we have not got the system correct. However, I hope that amendment 24 and the terms of the bill will allow the minister to reconsider the arrangement and decide that fees should all be paid centrally. We should get rid of the bureaucracy. In a post-Sutherland era, where personal care is to be free, the public pound will pay for almost the whole of the care sector—apart from personal living costs. The situation will change radically and the system will need to be re-examined.
I wish to raise a point about registration and deregistration of beds in interim periods. At a meeting of the Health and Community Care Committee, I indicated that, when care homes in the Tayside Health Board area have a reduced occupancy that is perceived as continuing over a period of time, they are not allowed to adjust their staffing levels to be appropriate to the number of beds that are occupied at the time. The care homes in that area have to continue to staff themselves as if they were fully occupied. In some
A process that registers and deregisters care homes with any frequency means that the occupancy figures, which we will return to when we look at section 24A, are invalid. Comparisons across the sector and the sort of level playing field that the minister has referred to as being essential and central to the bill will also not apply. I hope that the minister will consider those processes in his discussions with the commission so as to ensure that they are in the least bureaucratic form.
It is fair to say that registration fees are the most contentious aspect of a bill whose main provisions are otherwise to be welcomed. Every witness who appeared before the Health and Community Care Committee and was asked about fees expressed deep concerns about that aspect of the bill. Their concerns were twofold but, as both points have been covered in the debate, I will repeat them only briefly.
First, witnesses expressed deep concern about the drastic increase in the level of fees. We are to go from a system where only 17 per cent of the costs of the bureaucracy are levied from providers to one where the figure is 100 per cent. Witnesses expressed a real fear that, as those increased fees will come on top of financial pressures that the voluntary and independent sectors are already experiencing, the viability of many care homes and many beds in those homes will be threatened.
Those who gave evidence expressed my second point even more strongly. As Shona Robison and other members said, a system in which money circulates from one part of the system to another is absurd. Malcolm Chisholm has said repeatedly that funding to local authorities will be increased so that they can meet the increased fees that will be charged. The assumption is that providers will pass their fee increases on to local authorities. Money will just circulate around the system without a pound of the additional money going to improve the quantity or the quality of care. As a number of witnesses said, such a system will be absurd in the extreme. I share Richard Simpson's instinctive feeling that that system is not right. I hope that Malcolm Chisholm will show himself willing to listen to the overwhelming opinion that was expressed in the committee. I hope that he will support amendment 76.
I, too, am one of the members of the Health and Community Care Committee who were exercised about the Executive's proposals on registration
The Association of Directors of Social Work described the proposal as unrealistic and said that it was not a good use of the community care pound. Their employers—the Convention of Scottish Local Authorities—were equally sceptical about whether the new system could be made to work. If anything, the transitional arrangements that are to be put in place for 2002-03 and 2003-04 were much more popular. That is because the transitional arrangements are a mixture of grants and fees rather than being exclusively one or the other.
I was pleased to hear the minister say that, although the bill allows ministers to set maximum fees, it also allows them to pay grants. There is nothing in the bill about the ministers' final decision about the mix between grants and fees. Indeed, I was encouraged to hear the minister talk about a balance between fees and grants. He said that, although self-financing remains a general policy, it will not be allowed to undermine other aspects of the system. The sector must be sustainable so that it can survive into the future, when the new conditions to which Richard Simpson referred will apply.
Like the convener of the Health and Community Care Committee, Margaret Smith, I was interested to hear the minister say that the rate at which self-financing is achieved will vary across the sector. That sounds as though he is making room for a compromise. Although I am not usually one to argue for compromises, I welcome the fact that the minister has signalled a compromise. Indeed, I hope that the minister goes beyond signalling and talks to COSLA and other providers to create an agreed, consensual system. I am in favour of amendment 24.
I will not support amendment 76 because it contains a fundamental flaw. As the minister said, the financing of the system, whatever system is implemented in the long term, is a matter for elected politicians. Ministers must take those decisions, as they are accountable to the Scottish Parliament. I will not support an amendment that would allow a quango to overrule a decision that had been made, and a system that had been put in place, by the elected ministers of an elected Parliament.
The debate has been interesting and has included many useful contributions. I will start with the point that John
Shona Robison's amendment 76 would not strengthen amendment 24, as it is quite irrelevant to it. As I said, amendment 76 is pointless. The commission should not—indeed, it could not—get involved in such decisions, as running that operation would require financing. Amendment 76 is a total irrelevance and members should not support it.
I am glad that people have picked up the point that I made about a balance between fees and grant, as that has always been implicit in our proposals. We have already exempted early education and child care from the self-funding principle. As I indicated, amendment 24 makes it clear that we are determined to take account of the effect of fees on issues such as the care home market.
The reality is that the commission has somehow to be funded. We take the view that it is best for providers to have some stake in the system. People who suggest that the commission should be funded totally from the centre perhaps forget that many private operators, such as private health care services or individuals who self-fund, will pay fees. I am not sure whether members are suggesting that those fees should also be fully paid for by public funds.
Nicola Sturgeon and Richard Simpson made great play on the idea of money circulating in the system, but what is local government finance but money circulating in the system? If people want to argue that the Parliament and the Executive should fund everything directly, perhaps they will do so, but it is not sensible to argue in terms of money circulating in the system.
Clearly, money is given to local authorities through GAE. I accept Margaret Smith's point that there is an issue about whether the money that is allocated for community care is spent appropriately. I have no doubt that we will revisit that issue later this morning—and on many other occasions—because there are concerns about it. However, I have made it clear on several occasions that, when GAE is set in future, community care will be taken into account.
Mary Scanlon made several points, one of which concerned the situation in which a service can reasonably be expected to attract only a small number of clients. As Margaret Smith reminded us, that situation would be covered by the
Margaret Jamieson referred to Ayrshire and Arran Health Board and difficulties in collecting fees for registration. The bill makes it explicit that registration can be cancelled if the service is carried on
"other than in accordance with the relevant requirements".
That includes, of course, the payment of fees.
I have dealt with the point that Margaret Smith made about GAE for community care, but she also referred to what I said about the rate of self-financing varying from one service to another. Again, I will use the example of private health care. That system will be self-financing from the outset in 2003, whereas there is no proposal that residential care should be self-funding within such a time scale.
Richard Simpson referred to the registration and deregistration of beds. That was a timely reminder of how fragmented the current system is. I know that one area may adopt that procedure while others may not. We are bringing that fragmentation to an end through the system of registration, which will be the first-ever national system. I can assure Richard Simpson that the staffing levels that will be agreed by the commission will be flexible and that the arrangements will be able to take into account changes in occupancy.
The debate has been important. Clearly, there is no finality about what is said today. I merely repeat that the bill leaves the balance between fees and grant entirely open. That balance can be revisited on any occasion that members wish it to be.
Amendment 24 agreed to
[Amendment 76 moved —[Shona Robison].]
Division number 1
For: Adam, Brian, Aitken, Bill, Campbell, Colin, Canavan, Dennis, Davidson, Mr David, Douglas-Hamilton, Lord James, Elder, Dorothy-Grace, Ewing, Mrs Margaret, Fabiani, Linda, Fergusson, Alex, Gibson, Mr Kenneth, Goldie, Miss Annabel, Grahame, Christine, Hamilton, Mr Duncan, Harding, Mr Keith, Hyslop, Fiona, Johnstone, Alex, Lochhead, Richard, MacDonald, Ms Margo, Marwick, Tricia, McGugan, Irene, McIntosh, Mrs Lyndsay, McLeod, Fiona, Mundell, David, Paterson, Mr Gil, Quinan, Mr Lloyd, Reid, Mr George, Robison, Shona, Russell, Michael, Scanlon, Mary, Scott, John, Sturgeon, Nicola, Tosh, Mr Murray, Ullrich, Kay, Wallace, Ben, Wilson, Andrew, Young, John
Against: Alexander, Ms Wendy, Barrie, Scott, Brankin, Rhona, Brown, Robert, Butler, Mr Bill, Chisholm, Malcolm, Craigie, Cathie, Curran, Ms Margaret, Deacon, Susan, Eadie, Helen, Ferguson, Patricia, Finnie, Ross, Gillon, Karen, Godman, Trish, Gorrie, Donald, Gray, Iain, Harper, Robin, Henry, Hugh, Hughes, Janis, Jackson, Gordon, Jamieson, Cathy, Jamieson, Margaret, Jenkins, Ian, Kerr, Mr Andy, Livingstone, Marilyn, Lyon, George, Macdonald, Lewis, MacKay, Angus, MacLean, Kate, Macmillan, Maureen, Martin, Paul, McAllion, Mr John, McAveety, Mr Frank, McCabe, Mr Tom, McConnell, Mr Jack, McMahon, Mr Michael, McNeil, Mr Duncan, McNulty, Des, Morrison, Mr Alasdair, Muldoon, Bristow, Mulligan, Mrs Mary, Oldfather, Irene, Peacock, Peter, Peattie, Cathy, Robson, Euan, Rumbles, Mr Mike, Simpson, Dr Richard, Smith, Iain, Smith, Mrs Margaret, Stephen, Nicol, Thomson, Elaine, Watson, Mike, Whitefield, Karen, Wilson, Allan