Section 24A — Examination of contracts for care services

Regulation of Care (Scotland) Bill: Stage 3 – in the Scottish Parliament at 10:45 am on 31st May 2001.

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Photo of Malcolm Chisholm Malcolm Chisholm Labour 10:45 am, 31st May 2001

Section 24A was inserted at stage 2 by an amendment in the name of Richard Simpson. It imposes a duty on the commission to examine and comment on contracts between purchasers and providers of care services, when asked to do so by the provider in a range of circumstances. As I said at stage 2, there is a serious issue about commissioning, but section 24A is emphatically the wrong way to deal with it.

We all want a fair and equitable system for the commissioning of care services and we can all agree that the present system does not produce equity and fairness in all cases. Many private and voluntary sector providers have complained about inadequate funding from local authorities. Those providers see that, in some cases, local authorities' own services are well funded in relative terms. That issue is clearly of great interest to the care development group in its consideration of the whole map of long-term care.

However, we are not addressing the issue only in that way. My officials have been in discussion with the Convention of Scottish Local Authorities; Scottish Care, which is the private sector umbrella organisation; and Community Care Providers Scotland, which is the voluntary sector organisation. My officials have agreed to chair an initial meeting as soon as possible to bring together the commissioners and the providers of care. The aim will be to develop a shared understanding of the problems of the present commissioning arrangements and a way forward that is based on equity and realism. The process will not be a talking shop. Providers want reassurances very soon about what will happen to their funding, and COSLA is well aware of the urgency of the situation. The process aims to make progress, in the short term, on the immediate funding situation and seeks to reach agreement on longer-term solutions. I undertake to report the results of the process to Parliament in due course. The results will also feed into the work of the care development group.

The commission will have an important role in contributing to thinking on the funding of care in general, as it will report to ministers in the Parliament through its annual report. As members know, the intention is that the commission will fulfil the recommendation of the Royal Commission on Long Term Care that there should be a national care commission to take a strategic overview of the care system and its funding and to advise on trends. However, that is totally different from examining individual contracts, as proposed by section 24A.

The Scottish commission for the regulation of care is a non-departmental public body. As John McAllion reminded us in another context, the commission should not intervene in decisions that are made by democratically elected local authorities on the funding for individual providers. It is for elected local authorities to consider the overall interests of their local population and to decide how much of their resources should be spent on purchasing care, taking best value fully into account.

The commission's main purpose is to ensure quality of life and of care for service users. It would be diverted from that purpose if it were to consider funding when considering any individual care service. That would be bound to lead to compromises over care standards and would be a complete distraction in terms of time, effort and focus. If section 24A stands, every care provider could argue that their problem was not the will, but the means to meet the care standards. The commission would quickly become tied up in controversial financial judgments and case-by-case discussions with local authorities on finance. If the commission has to take into account a range of factors, including the financing of the service, it will not be able to press for improvements in quality and the thrust of the bill would be fundamentally undermined.

The commission is not intended to resolve every problem with the care system in Scotland, but only the commission can address quality in a way that ensures that the needs of users are at the centre. We must let it get on with that.

I move amendment 34.

Photo of Richard Simpson Richard Simpson Labour

Section 24A was inserted at stage 2 and the Executive now seeks to delete it. Members have heard the arguments for that deletion from the minister—I will come to those.

I want to put on record some facts and concerns about care in the community that led me to introduce section 24A. The bill seeks to deliver for Scotland's most vulnerable and needy citizens a quality of care that treats them with respect and dignity. The principles of the bill that the Parliament will approve today aspire to maximising the autonomy and independence of those who require care. Through the commission for the regulation of care, we will attempt to create care facilities that are fit for purpose and of the highest standards. Through the social services council, we will ensure that the staff are valued, trained and motivated. Those are worthy goals; indeed, all those aspirations are highly commendable. However, without any mention of the funding of care, the bill is doomed to remain simply an aspiration. Without a mechanism to deal with funding, the bill will have problems. Without a mechanism to ensure a level playing field for funding, inequities will remain, either for the quality of care or for the terms and conditions of those who work in care provision. It is vital that the funding issue is addressed, for it will not go away.

Let us examine briefly the history of care in the community. Ever since the process began of closing long-stay national health service provision, the voluntary, charitable and independent sectors have expanded to accommodate those in need. The past seven years have been characterised by a continuing squeeze on the funding of both public sector and non-public sector providers. However, blame for that cannot be laid entirely on the local authorities, as we should recognise the years of underinvestment in care and the difficulties that were incurred as a result of inadequate resource transfer from health boards.

The reality is that whenever local authorities have difficulty with funding care, they tackle first the problems of those who are at home and in greatest need. That approach is based on the entirely reasonable premise that those who are in hospital, awaiting discharge into community care, are at least being looked after by the NHS. Research in 1997 showed that the number of blocked beds, as they were called then, in Scottish hospitals was around 2,500. Today, despite additional funding from the Government, there are still nearly 3,000 elderly patients languishing in hospital, exposed to the growing risk of hospital-acquired infection, to which the elderly are particularly vulnerable. Meantime, resources in the voluntary and independent sectors are underutilised. Delayed discharges are not only dangerous and distressing for the individuals affected; in addition to the human cost, there is a significant financial cost to the taxpayer.

Let me give one or two examples to illustrate how desperate is the need to address contracting and funding issues. The Church of Scotland is one of our largest not-for-profit care providers. In 1993, its capital expenditure was £5 million. Last year, that expenditure was down to £1 million and was spent entirely on essential repairs. Why? Because the purchasers—relying on the dedication of that provider—had reduced funding. As a result, seven homes have been closed and the remaining 34 are under threat of closure. Staff wages are no longer linked to the Scottish Joint Council for Local Government Employees terms, although they have, in practice, remained close to those levels.

The Church of Scotland has spent no less than £20 million of its own money to meet revenue costs, yet that provider superannuates its staff and offers 80 training courses annually to Scottish vocational qualification levels 3 and 4. Except for the decaying fabric of its buildings, that employer will meet the care standards of today and most of those of tomorrow. How long can it continue to run any homes if proper levels of funding are not made available?

Crossroads (Scotland) runs 53 care attendance schemes, from Shetland to Stranraer, and the funding increases for the past three years have been zero. As a result, staff have had only one inflation-level pay increase in the past three years, although they are being asked to take on increasingly complex, quasi-nursing tasks. Their social work equivalents are paid more, have greater job security and, in many regions, will not perform the tasks that I have referred to

"because our staff are not insured to do them".

Crossroads (Scotland) has recently been advised to raise money from private clients to meet that deficit.

The William Simpson Home in my constituency, which looks after those with end-stage complications of alcohol abuse, has received awards for its staff training. The trustees report to me that they have reached the end of the road in their ability to fund activities, because of the squeeze on revenue.

I do not propose to go into great detail about private sector issues, which have made headlines in the past week. If we continue to collude with the Government and local authorities in the funding system, offering low levels of pay and poor staff conditions, and paying minimum wages and no superannuation, how can we realistically expect the quality of care to improve, which is what the bill aspires to? I understand that 100 homes have closed in Scotland. Further closures will reduce choice for those persons who require that sort of care. Many voluntary organisations are funding either capital or revenue costs, or both, out of charitable money. Two thirds of them are no longer able to employ their staff on joint council terms and conditions.

In a post-Sutherland era, the local authority will be the monopoly purchaser of care provision. In my discussions with providers, I have detected a reluctance to expose funding problems for fear of antagonising the purchaser. I therefore want to acknowledge the positive response that I have had from COSLA, and from David Wiseman and Alexis Jay in particular, about ensuring that the process becomes open, transparent and equitable between public and other providers. The aspirational care standards that are embodied in the bill must not be achieved through either the exploitation of workers in the sector or the charitable contributions of the public.

We need a system that will ensure that funding is fair to all sectors and which recognises and values the importance of a partnership between the Government, the local authorities, the voluntary, charitable and independent sectors, and the workers. We need a system that recognises that, post-Sutherland—with free personal care, with the elimination of the residual Department of Social Security benchmarks, and with the economics of the new single-care home system replacing separate residential and nursing homes—the Government will be the monopoly funder and the local authority the monopoly purchaser with public funds.

I accept that the commission may not be the best organisation to deal with funding issues, as Malcolm Chisholm has said. I share his unease, which was also expressed at stage 2 by John McAllion, about a quango being able to comment in that way on local authority financial matters. As a result, subject to the assurances that the minister has given, I will support the deletion of section 24A. However, I need the minister's reassurance that the series of meetings that he referred to will result in a long-term, sustainable solution that will ensure that our future care standards are not built on the backs of care workers, but recognise the value of those workers.

I can support the deletion of section 24A if, as he said he would, the minister undertakes to report back to the Parliament in the autumn. I hope that he will also consider dealing with the issue in the bill on long-term care of the elderly or the bill on best value. I give notice that, if sustainable solutions are not agreed by all partners, I will seek to ensure that one or other of those bills deals properly with the issue. I am content that the insertion of section 24A at stage 2 has opened up to debate the connection between care standards and funding, which is crucial to the implementation of the bill, and that the crucial importance of funding to the delivery of the aspirations that are enshrined in the bill has been acknowledged. I am happy to support amendment 34.

Photo of Margaret Smith Margaret Smith Liberal Democrat 11:00 am, 31st May 2001

The nub of the issue is how we can deliver effectively quality care standards backed by a qualified, professional and motivated staff. It would be ridiculous not to acknowledge the impact that national care standards, and the changes that they will bring about in care services, will have on the financing of care services. A cost will be attached to the laudable aspirations and general principles that we all endorsed at stage 1 and during our stage 2 discussions.

On a pragmatic point, I take issue with the rationale of including the matter in the bill. The Liberal Democrat position is that the commission is not the best organisation to do what is provided for in section 24A. I therefore concur with Richard Simpson's comments, and what I say from here on is based on the Liberal Democrat group's support for amendment 34.

We support amendment 34 for two reasons. First, the commission, set up as it is with a certain number of duties to perform—Donald Gorrie asked whether it will cover too many care services—will have a vast programme to tackle against a backdrop of varying national care standards being introduced in tranches. The commission's role is to register, inspect, monitor and regulate, and to have a strategic overview of the care sector. Its role is not to get involved in the particulars of specific care service contracts, and it would be deflected and diverted from its main focus if it were required to do so.

Secondly, the Liberal Democrats will accept the minister's comments about on-going dialogue with Scottish Care, the voluntary sector, COSLA and, I hope, with unions and staff. The minister is seeking progress in the short term on funding and solutions for the long term, which will be reported back to Parliament.

With the bill on long-term care, which will come before Parliament in the coming months, we will have an ideal opportunity to consider the wider issues in the long-term care sector, many of which have been outlined by Richard Simpson today. Those issues include resource transfers and the impact of health board funding going—or not going—to local authorities, and whether the GAE is being used as it ought to be. They also include the on-going squeeze that goes straight from central Government to local government, down to the voluntary sector care providers and, at the very bottom of the heap, to the poorly paid staff, many of whom are exploited.

Those issues must be subject to an appropriate period of consultation to ensure that they are examined in the round. The coming weeks and months, as we move towards the bill on long-term care, will be the right time for us to do that. I believe, as does the Liberal Democrat group in this Parliament, that our motivation should be the fact that the principles that Richard Simpson outlined in his speech and which his amendment added to the bill in section 24A are to be applauded and worked towards. That is what we ought to be doing.

I recognise the minister's comments that discussions have begun and that the care development group, moving towards the forthcoming long-term care bill, is the ideal place to consider the matter. I do not believe that the right way to take the matter forward is through the commission. We will be able to consider the issue, taking the required holistic view, in the coming weeks and months.

At the bottom of this is the fact that we have all agreed that we support the Regulation of Care (Scotland) Bill. We aspire to better care services and to having a work force in the sector that is professional, that has its professionalism acknowledged, and that is supported through training. Members of that work force should, ultimately, be supported by having a decent quality of life and decent pay to recompense them for the incredible work that they do in the care sector in Scotland.

The issue must be accepted and dealt with. Bringing together all parts of the sector in on-going discussions, with a view to introducing proposals in the long-term care bill, is a better way of doing that than dealing with the issue in this bill, which has a narrower focus. For those reasons, the Liberal Democrats will support the Executive's amendment 34.

Photo of Shona Robison Shona Robison Scottish National Party

I begin by paying tribute to Richard Simpson for getting his amendment into the bill at stage 2. In his speech, he laid out why it was necessary. He clearly knows his subject well and delivered a persuasive speech. It is therefore nothing short of tragic that in the face of pressure—probably considerable pressure—he has been forced not to see it through.

Although we all welcome meetings—meetings are always a good thing—it is fair to say that the meeting that the minister had last week with Scottish Care was a fruitless exercise. How are we to be assured that another meeting will produce anything more than that? How do we know that the Executive will not seek to pass the buck back to local authorities, as it did at the meeting last week? The timing of the announcement of a meeting is, to say the least, extremely suspect. It is an attempt to get out of a situation that the Executive has got into because of the lack of assurances that it has given on funding streams.

Community Care Providers Scotland has made its position clear. It is an association of voluntary sector organisations that provide care in Scottish communities. Those organisations are at the coalface, so they know best—even better than the minister. The key issue is the link between quality and cost. The voluntary sector welcomes the establishment of the commission and the setting of standards, but it realises that the new standards will be a challenge for the voluntary sector, in the context of many receiving zero inflation budgets and some having their budgets cut by their local authority. As we all know, voluntary organisations do not have the profit margins to absorb additional costs and, as Richard Simpson highlighted, staff pay and conditions are the first casualty.

Section 24A introduced the ability for the commission to examine and comment on any contract or other funding arrangement between a local authority and a voluntary body, when it has failed to meet standards purely as a result of inadequate resources. Voluntary organisations are concerned that, without section 24A, services will have to close because standards are not met due to budget constraints. That would be a tragedy and a practical difficulty, given the number of services that are provided by the voluntary sector in Scotland.

Checks and balances are required in the system. The commission's ability to comment on, not compel, the adequacy of funding arrangements would be a good check on the funding arrangements for voluntary organisations, which are often at the mercy of the local authority, which is, in turn, at the mercy of Government ministers. That check would create some welcome transparency in the funding process.

Photo of Mary Scanlon Mary Scanlon Conservative 11:15 am, 31st May 2001

I also commend Richard Simpson on his speech, and especially on his passion and commitment to care services. He moved the amendment to introduce section 24A at stage 2 with the majority support of the committee. Section 24A addresses major concerns about the provision of care throughout Scotland.

Richard Simpson's amendment, which introduced section 24A, was supported by the Scottish Association for Mental Health, Alzheimer Scotland—Action on Dementia, Capability Scotland, the Richmond Fellowship, Penumbra and many other care providers in Scotland. In the points that I will make, I refer to the document that Community Care Providers Scotland produced for the stage 3 debate.

Photo of Margaret Jamieson Margaret Jamieson Labour

Does Mary Scanlon accept that the position of Community Care Providers Scotland is that it accepts amendment 34, in the name of the minister, because it believes that the best way forward is to hold discussions on the matter and address it in other proposals for legislation?

Photo of Mary Scanlon Mary Scanlon Conservative

Community Care Providers Scotland has certainly not notified me or my colleagues that it has accepted the amendment. Perhaps I am a couple of days behind.

Richard Simpson has outlined a basic principle: it is important that the Parliament addresses it. Voluntary organisations are concerned because the link between standard setting and funding will be severed. They will have the impossible task of having to meet new, high standards set by the commission while dealing with zero inflation budgets, and sometimes funding cuts, imposed by local authorities.

Despite the minister's comments this morning about increased funding for local government, it has come to the attention of the Health and Community Care Committee time and again that the increases in funding are not always passed on to the care providers. In our budget deliberations, we could not get information on the provision of community care within local councils. Sir Stewart Sutherland said that local authorities do not always spend the money on care of the elderly. They may spend it on other aspects of social work, but the Parliament has no guarantee or mechanism to ensure that, if we give local government more money to care for the elderly, the mentally ill, the disabled and those with learning disabilities, the money will address the care needs. As Richard Simpson said, voluntary organisations do not have profit margins that they can use to absorb the extra costs that new standards will involve, and when they are left with a funding gap, staff pay and conditions are generally the first casualty.

The main point is that, according to section 24A, in cases where the provider fails to meet standards purely as a result of inadequate funding by local authorities, the commission will have the ability to examine and comment on the contract or funding arrangement. There is no doubt that quality and cost are inextricably linked. There is a need to make funding provisions and local authority contracts and referrals more open and transparent. Without section 24A, staff wages and staffing levels will be cut and many services will have to close down. Such an outcome would seriously undermine the bill's main purpose, which is to raise standards and promote excellence.

More than 100 care homes closed last year and, despite Executive funding to address the issue, there are still around 3,000 delayed discharges to deal with. That situation obviously has an impact on the acute and primary care sectors. People are not receiving the appropriate level of care in the community because they are being held at far greater expense in NHS hospitals. This morning's news that Grampian care home owners will refuse to take any referrals highlights the point that care often costs twice as much in a council home as in the private and voluntary sectors. The retention of section 24A will allow the scrutiny and transparency of council care home contracts. The council is indeed a monopoly purchaser and the level of openness and transparency to date has not been sufficient.

I accept the minister's comments about the care development group, which is considering the long-term care of the elderly. However, section 24A(1)(a)(ii) says that the commission can "examine and comment on" any contract when asked by any

"provider or any other interested party who has reasonable grounds for believing that there is an unequal distribution in the allocation of public funds to providers to meet similar care needs".

Will the minister assure us today that the care development group—and any future bills—will examine the contracts and ensure openness, transparency and fairness? Will the group also address the issue of care of the mentally ill and disabled?

Photo of John McAllion John McAllion Labour

At committee, I voted against the inclusion of section 24A in the bill and I will vote again this morning to delete the section. I should say that no one put me under any pressure to act in that way.

I voted that way partly because, as the minister and Richard Simpson have said, decisions about how the system should be funded should be left not to quangos but to elected politicians, who are accountable for such decisions. Indeed, I am surprised to see that, for the second time in the space of less than an hour, the SNP is supporting the idea of placing quangos above elected politicians. At a hustings meeting in Dundee on Monday night, the local SNP candidate said that he wanted all quangos to be abolished; now we find SNP MSPs arguing that quangos should be placed above elected councils and politicians. They seem to speak with a forked tongue on the issue.

I am also opposed to section 24A because it does not address the problem that it claims to identify. Although it gives a new right of appeal exclusively to providers, allowing them to exercise that new right will not solve the problem, because the commission can then only comment "in writing" on the contract to the purchaser and provider. It does not change the contracts. What happens if the local authority does not have any more money to give the provider? Are those who support the section suggesting that one local children's service should be closed down to release more money for the providers in the elderly care sector?

Photo of John McAllion John McAllion Labour

I will give way to a member who might soon be a recipient of child care services.

Photo of Ben Wallace Ben Wallace Conservative

Why does the member fear transparent contracts between the purchaser and provider? Is it because some Labour councils have an ideological barrier about patient need? We are talking about transparency.

Photo of John McAllion John McAllion Labour

I am all in favour of transparency, but section 24A has nothing to do with transparency. Instead, all that it does is give powers to the commission to "comment on" a contract. It does not solve anything or bring any extra money or resources to bear on the problem; it only gives the commission the chance to intervene on a contract between purchasers and providers when the purchasers themselves are elected local authorities that are transparent, accountable and answerable to the electors in their areas. That is the way it should be and I am surprised that any democratic party should be opposed to that.

Photo of Richard Simpson Richard Simpson Labour

I want to quote from the e-mail I received from David Wiseman after our meeting. He says:

"the local authorities would want to demonstrate an 'even-handed' approach in how we commission services between different types of public, voluntary and private providers, with transparency about intentions for 'managing the market'. Therefore any preferences for one ... type of provider would need to be explicit and defensible since it was recognised that in some instances local authorities may essentially be in competition with voluntary and private sector organisations to provide certain services."

That is the sort of transparency that we are talking about, and COSLA is committed to it.

Photo of John McAllion John McAllion Labour

Richard Simpson has made the point that I was just about to turn to. This part of the debate has identified a serious issue. However, although it is the right issue to raise, this is the wrong solution. I think that the Parliament will see the common sense in that position in a moment.

I entirely agree with Richard Simpson that we are talking about one of the most vulnerable and needy sections of our community. The provision of decent nursing care to an increasingly aging population in Scotland is a national responsibility; indeed, it should be a national duty. It should be as much a part of the NHS as any other service, although I realise that that argument is a bit utopian.

I also agree with Richard Simpson that no matter how wonderful any new system might seem on paper, it is absolutely worthless unless it is backed up by the funding and resources to translate ideas into the reality on the ground. That is what we need to do. Indeed, the allocation of such funding will save us money in the longer term. The problem with delayed discharges from the NHS is that hundreds, possibly thousands, of beds across the country are costing a fortune.

Elderly people who should be in nursing homes cannot be transferred out because there is not enough money in the nursing home system to accommodate them. The Parliament has to address that problem seriously.

That said, there are different perspectives on the issue. Members have spoken about the difference between how local authorities fund their own homes and how they might fund homes in the private or voluntary home sector. However, we should also draw attention to the reasons for such differences in funding. Local authorities recognise trade unions and negotiate with them on the wages, employment conditions, pension rights and holiday entitlement of their workers. If the independent sector wants equivalent funding from the local authorities, it will need to deliver equivalent employment terms and conditions for its workers.

I would be quite happy with a private nursing home that agrees to recognise trade unions and negotiates with them to give workers the same wages, the same conditions and the same holiday entitlements. Until private nursing homes do that, they cannot argue for equal funding. This is not just a matter of left versus right. The quality of people who work in nursing homes is critical to the standard of care that is delivered in those homes. If the work force is not motivated, well paid and well looked after, there will be no quality care for elderly people. That is fundamental.

Let us use the same argument that is used in the public services. We hear again and again that any new investment for public services has to lever in change in how those services are delivered. If we are going to give more money to the private and independent sector, we should use that money to lever in change, which means beginning to treat the people who work in that sector with the decency and dignity with which they are treated in the public sector.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

This debate has been revealing. I should say at the outset that I have more respect for Malcolm Chisholm's position than I have for Richard Simpson's. It is one thing to argue against section 24A in principle; it is an entirely different thing for someone to spend seven minutes putting forward a very powerful and persuasive case for something, just to turn round at the last minute and say that they will vote the opposite way. That says to me and to the people outside the chamber that fear of the Labour whip is more important than issues that concern people in Scotland.

The problem is that, without section 24A, the bill fails absolutely to take account of the link between quality and cost, and no amount of ministerial assurances will change that. It is absolutely right that voluntary organisations will be required to meet the standards laid down by the commission; however, there will be no obligation on local authority purchasers to ensure that the fees paid by them reflect those higher standards. Given that the current fees paid by local authority purchasers do not reflect the current level of service, what confidence can we have that that will change in the future?

I support local government absolutely. I will take no lectures from John McAllion on that front. However, local authorities do not always make the right decisions. I should have thought that the member's local experience would have taught him that. I suspect that John McAllion is right to say that the real problem is underfunding of local authorities, which means that they do not have the resources to ensure that fees reflect the level of service. Transparency in contracts will reveal that and tell everyone where the finger should be pointed.

Let us ensure that in this bill we make the crucial link between quality and the cost of quality. To do anything else is simply to engage in rhetoric, without being prepared to put our money where our mouth is. Let us keep the section that Richard Simpson made sure was included in this bill. Let us give providers of care the chance to ensure that what this bill is intended to do can be delivered.

Photo of Donald Gorrie Donald Gorrie Liberal Democrat 11:30 am, 31st May 2001

Funding is the key to this issue, and Richard Simpson is right to highlight it. He is also right to accept the deletion of section 24A if the issue that he raised can be dealt with in a different way. Nicola Sturgeon's attack on him was quite disgraceful.

There is no point in an excellent minister producing an excellent bill if there is no improvement on the ground. Our predecessors in the Scottish Parliament 600 years ago noticed that we often lost battles to the English because they were better at archery. They passed lovely bills saying that people must stop practising football and golf and concentrate on practising archery. However, because no practical efforts were made to enforce those laws, we continued to lose battles to the English, while football and golf continued to make progress. There is no point in having a lovely bill unless it can be translated into reality on the ground.

The way forward is to get the funding right, rather than to retain this section in the bill. First, we want an assurance from Malcolm Chisholm that there will be adequate funding, from whatever source, for nursing home accommodation, in order to stop bedblocking. We have made some progress. I was the first person at Westminster to ask questions about bedblocking, about three years ago. Then the Government had no figures for the problem. Now at least we know the figures, which are depressingly high. We must reduce them. The minister needs to tell us whether enough resources will be made available in future budgets to stop bedblocking.

Secondly, we need to know whether the funding will be sufficient to ensure that we do not run a public service on the slave labour of some of its employees. Some of the wage levels in this sector are absolutely disgraceful. I know that that is not our direct concern, but we are morally involved. If we fund a service, as happens at the moment, in such a way that it can be delivered only by having totally inadequate staff wages and conditions, we must do something about that.

Photo of Mary Scanlon Mary Scanlon Conservative

Does Donald Gorrie agree that it is very difficult for care providers such as the Church of Scotland—which Richard Simpson mentioned this morning—to maintain the same wage levels and staff conditions as council homes, given that they receive half the funding per care bed that council homes receive?

Photo of Donald Gorrie Donald Gorrie Liberal Democrat

That is precisely my point. The Executive and the Parliament must ensure that the enterprise is adequately funded. First, we must not run the service on the inadequate wages of its employees. Secondly, the funding for the organisations involved must be such that the voluntary sector does not have to invest its own money. The funding of homes should be such that they make neither a profit nor a loss on the money that we provide. I would like an assurance from the minister on that.

Thirdly, some homes are subsidised by private residents, who pay more than they should to make up for the inadequate funding of public residents. That is wrong. People who pay privately for their care should pay the full sum for their keep, but they should not be asked to subsidise others.

To sum up, I would like the minister to assure us that we will not underwrite inadequate wages; that the voluntary sector will not have to subsidise places with its own money; and that private residents will not have to subsidise other people. I know that the minister is not allowed to promise lots of good things during an election, but I ask him to indicate that these financial issues will be examined.

The problems cannot be put right overnight, as large sums are involved. However, we need an assurance from the Executive that it recognises the financial problems and will take them seriously. On that basis—without having been leant on, but having had a civilised discussion with Malcolm Chisholm, who is better than some other ministers at that—I am happy to support the amendment.

Photo of Ben Wallace Ben Wallace Conservative

I want to speak against amendment 34, which deletes section 24A, and to reply to some of the points made by Mr McAllion and Richard Simpson.

SNP members are right to say that meetings are all very well, but they are not included in the bill. I am sure that COSLA's dedication to open meetings will be a delight to people in Glasgow, Falkirk and Clackmannanshire, whose councils have left COSLA. COSLA does not work in the interests of those people. That is an important point to make in reply to Richard Simpson's claim that this process will be open and transparent.

The defender of the left from Dundee has told us how brilliant the public sector is. However, Audit Scotland says that private sector homes—I mean not just the profit-making ones, but also the many charitable sector homes—represent better value for money, provide a better service and have better working conditions than council-run homes. The public sector does not work miracles. It is terrified of the fact that, under section 24A, contracts would have to be fair, equitable and transparent.

Photo of Ben Wallace Ben Wallace Conservative

No, I will not. The people who will suffer if section 24A is deleted are the patients. They will suffer because of John McAllion's views on quangos and so on. What counts is people in care and their needs. Why is Mr McAllion not asking the Executive why it does not give more money to local authorities? Why is he not asking the Executive why it does not agree to fund personal care? I have heard John McAllion provide a good justification for funding personal care.

Photo of Ben Wallace Ben Wallace Conservative

I will not give way. John McAllion is happy to let the Executive fix a definition of personal care.

This is about transparency, fairness and equity. John McAllion and his colleagues are clearly not interested in that. They are not interested in the care of people blocked in beds. Community care is going down the pan, because Susan Deacon will not talk to private sector homes. We must do what we can for people in long-term care to get them out of a system that is going bankrupt.

Photo of Christine Grahame Christine Grahame Scottish National Party

I feel like an intruder in a debate among members of the Health and Community Care Committee, but in speaking against amendment 34 I want to comment on some of the things that the minister has said.

The minister spoke about equity and realism. How can there be equity when certain providers—those in the private sector—receive £50 less per person per week from the local authority for providing the same service as homes in the public sector? The minister referred to meetings with COSLA. However, recently I heard a representative of COSLA say on the radio that the request for an additional £50 per person per week for private sector homes was unrealistic. The agenda already has its limitations.

The minister said that not all contracts can come before him. Section 24A does not ask for that. It refers to providers who have

"reasonable grounds for believing that the funding offered by the purchaser does not allow that provider to achieve or maintain the care standards required by the Commission".

There is a reasonable grounds test that would sift out trivial applications. To John McAllion, I say that the commission's comments could be made public if a provider's application were upheld, which is very valuable. That test applies not just to private care providers, but to all providers.

I did not understand the remarks that the minister made about the role of the commission. Section 1(1)(b) of the bill states that the commission will

"have the general duty of furthering improvement in the quality of care services".

The provisions of section 24A could be slotted into that. The duty for which section 24A provides is not an inappropriate role for the commission.

The minister referred to quality, but he did not mention choice. The only residential home in Selkirk is in the private sector. Its budget is squeezed and it cannot meet its requirements. The local authority expects the home to ask the families of the residents to make up the difference, but the home will not do that. To John McAllion, I say that the home meets its requirements under the minimum income legislation, although it is struggling against the odds. If that residential home closes—as it might well do under the present circumstances and without the kind of protection that the bill might give it—the residents will be transported 20 or 30 miles away from their original residences and will lose contact with their community. For those reasons, and in the interests of openness, I cannot see the flaws in retaining section 24A. Therefore, I will not support amendment 34.

Photo of Malcolm Chisholm Malcolm Chisholm Labour

This has been an interesting debate, with several important contributions. Richard Simpson began by saying that the funding of care is not mentioned in the bill. It is not mentioned in the bill because that is not the correct place for it. That is not to say that we are failing to recognise and address the problems; we have implemented a series of measures to address some of the issues that have been raised. I have been aware of the problems since my appointment as a minister, and, like Richard Simpson, I was pleased to meet representatives of the Church of Scotland not long ago to hear about some of the difficulties that it faces. We are willing to confront those issues.

Nevertheless, members should be wary of overstating their case and misrepresenting the facts. For example, Nicola Sturgeon referred to the underfunding of local government—her description may have been more extreme than that, but that is what I wrote down. The reality is that every local authority will receive a real-terms increase in funding for each of the next three years and the increase in funding for community care this year is 10 per cent.

Photo of Shona Robison Shona Robison Scottish National Party

The minister's opening remarks were quite heartening, as he said that the Executive recognises the funding problem, but he proceeded to say that the funding that is given to local authorities through grant-aided expenditure is adequate. What solutions does he propose?

Photo of Malcolm Chisholm Malcolm Chisholm Labour

We will not come up with any solutions unless we realise that the funding situation is complex. If Shona Robison will allow me to continue, I shall address some of the complexities.

Margaret Smith and Mary Scanlon referred to one of those complexities, which is the way in which the distribution of funding and GAE work. Mary Scanlon quoted Sir Stewart Sutherland, who has also drawn attention to the issue, which the Parliament has become increasingly aware of. I am concerned if local authorities are not spending up to their GAE on services for the elderly. That matter needs to be discussed and addressed.

Another issue that has arisen in the debate is delayed discharges. I would be the first to recognise that there are problems with delayed discharges. Nonetheless, in the interests of balance, we should also recognise the fact that the Executive has done more than any previous Government in recent times to address that problem, through the resources that we have allocated to it over the past year and through the new joint working. Delayed discharge figures began to fall over the winter, and I am not aware of any previous year in which that happened. I am not saying that the problem is solved. I am saying that we should keep a sense of proportion and realise that such issues are being addressed. [Interruption.] Sorry, I thought that Mary Scanlon was waiting to pounce, but she has not done so yet.

The care development group, to which Mary Scanlon and I referred, is examining all those issues. However, the group has been asked to report within six months and it is not its role to consider individual contracts, although we are addressing the whole range of issues that have been mentioned this morning. I remind Ben Wallace, who wanted to bring personal care into the debate, that part of our remit is to introduce proposals for the implementation of free personal care.

I reassure Richard Simpson that the process that we are setting in motion will involve a series of meetings with the main players. As I said in my opening speech, we are aiming for long-term, sustainable solutions. I reassure him that I shall report to the Parliament on any progress.

Photo of Mary Scanlon Mary Scanlon Conservative 11:45 am, 31st May 2001

I have two points to make. First, given the fact that the Executive has allocated millions of pounds to resolve the problem of delayed discharges, is the minister not disappointed that today, after several months, around 3,000 people who should be funded by local authorities and cared for in the community are still in hospitals? Secondly, will the minister assure me that the care development group will consider not only care of the elderly? Am I right to assume that there will be openness, fairness and transparency in local government contracts not only for care of the elderly but for care of the mentally ill and the disabled?

Photo of Malcolm Chisholm Malcolm Chisholm Labour

The commission will not solve all the problems of community care and neither will the care development group. The group was set up to address specifically the care of older people, which is not to say that we do not care about other people who require care in the community. However, the group's broad remit is circumscribed. I could pass on a copy of that remit to Mary Scanlon if that would be helpful.

It was predictable but wrong of Shona Robison to pick up a suggestion that the series of meetings that I mentioned is timed to coincide with the general election. Community care groups can verify that they have been planning to meet the Executive for several weeks and that the meetings have absolutely nothing to do with the general election.

Shona Robison and Mary Scanlon both referred to a desire for transparency. I completely support the principle of transparency, as does COSLA, as Richard Simpson reminded us. Much activity has been set in motion over a period of time to address the issues that have arisen in the debate. In the vote that is about to take place, members should remember what Margaret Smith said—that supporting section 24A would deflect and divert the commission from its main function. Christine Grahame said that the provisions in section 24A are an appropriate role for the commission. However, as I said in my opening speech, the commission will have an important role in contributing to thinking about the funding of care in general, and will be able to make general observations to ministers and the Parliament. That will fulfil the recommendation of the Royal Commission on Long Term Care for the setting up of a national care commission. That is one thing, but commenting on individual contracts is another—in terms of the time that it would take and the general principle, which John McAllion highlighted. I thank John McAllion for pointing out the inappropriate role that is proposed in section 24A for non-departmental public bodies.

I end by agreeing with John McAllion that we have a duty to address these issues nationally. I accept that duty and commit myself and other ministers to working to ensure that we find long-term, sustainable solutions to the issues that have been debated in the past half hour.

Photo of Lord David Steel Lord David Steel Presiding Officer, Scottish Parliament

The question is, that amendment 34 be agreed to. Are we agreed?



Division number 2

For: 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, 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
Against: 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, Harper, Robin, Hyslop, Fiona, Johnstone, Alex, Lochhead, Richard, MacDonald, Ms Margo, Marwick, Tricia, McGrigor, Mr Jamie, McGugan, Irene, McIntosh, Mrs Lyndsay, McLeod, Fiona, Monteith, Mr Brian, 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

Photo of Lord David Steel Lord David Steel Presiding Officer, Scottish Parliament

The result of the division is: For 53, Against 40, Abstentions 0.

Amendment 34 agreed to.