We begin with a debate on SNP motion S1M-2248, in the name of Nicola Sturgeon, on the implications of the care development group report, and two amendments. I call Nicola Sturgeon to speak to and move the motion.
I begin by sending the best wishes of the SNP group to Mary Scanlon, following her accident earlier this week.
It is right and appropriate that we are having this debate this morning, because it was at the insistence of the Scottish Parliament in January that the care development group's remit was extended to include the implementation of free personal care. It is therefore right that we should now reflect on the conclusions that that group has reached.
I pay tribute to the work of the care development group. The group has produced a comprehensive report that endorses the principle of free personal care and makes a number of recommendations that are designed to expand the capacity of care services and enable more people to spend more of their later years in the comfort and familiarity of their own homes. I also welcome the Scottish Executive's acceptance of the recommendations and, in particular, the commitment to make personal care free from April next year.
Of course, that commitment was a long time coming. It is two and a half years since the Sutherland commission recommended free personal care. It is true to say that some members of the Executive took longer to convince than others, but the commitment has been made and we take some pride in the fact that it was an SNP motion that prompted the change of heart back in January.
The work of the Parliament is not complete, however. We have a duty to ensure that the package of measures to be implemented is watertight, properly funded and delivers the intentions of Parliament.
Perhaps later. I ask the member to be patient.
The care development group recommended, rightly, that a significant proportion of the extra investment made available by the Executive should be directed at expanding and improving care services to meet current unmet demand and the increase in demand that will result both from demographic changes and the policy of free personal care. I welcome that, but have concerns about the robustness of the care development group's projections. When we consider the extent of existing unmet need—the reduction in care home beds, the decline in home care services, the backlog for aids and adaptations and, as a consequence of that, the problem of delayed discharge—it is hard not to fear that all the money that has been set aside could be swallowed up in meeting existing need and that little might be left for the expansion that we need.
The internal pressure on the money that has been earmarked for service expansion means that it is important that there should be no external pressure on that money. I hope, therefore, that the minister will give me two assurances this morning. The report recommends ring fencing of the new money. Ring fencing of local authority budgets is not something that the SNP would normally argue for, as we believe that it undermines local democracy. However, experience tells us that, without ring fencing, local authorities will relieve pressures elsewhere by dipping into money that is supposed to be spent on services for the elderly. The minister made no mention of ring fencing in her statement yesterday. Will she assure us that the Executive intends to ring-fence the money?
Yesterday, the First Minister and the Minister for Health and Community Care said that, if Westminster refuses to continue to pay attendance allowance, the £20 million shortfall in the sum that is needed to fund free personal care will come from the Executive's resources. Will the minister give a categorical assurance that, if that proves necessary, the money will not come from the money that is set aside for the expansion in services? Free personal care is a victory for the Parliament and the people of Scotland. We must ensure that it is properly funded and that what is implemented genuinely represents free personal care for all.
I want to deal with two points of detail.
Yesterday, Shona Robison asked a question of Susan Deacon that was not answered—given that it was asked of Susan Deacon, that is no great surprise. Perhaps the minister can answer the question today. The care development group report sets the cost of free personal care at £145 per person per week. We know that the Executive has set aside £90 of that sum and that there is an on-going debate with Westminster about the remaining £55. However, not all the people who receive attendance allowance are on the top rate of £55; some get the lower rate of £37. Even if—and it remains a big if—Westminster agrees to allow people to retain attendance allowance, that will not amount to £55 for everyone and the Executive will have to find an additional £18 for those who are on the lower rate. Has the minister calculated how many people are in that category, what the total additional bill will be and where that extra money will come from?
People who have assets of between £11,500 and £18,500 pay for some of their care. Those people do not qualify for attendance allowance. Under the Executive's proposals, they will get £90 a week. From where will they get the additional £55 to take them up to £145 a week?
Those points may seem small, but details such as those may make the difference between free personal care for all and only subsidised personal care for some.
I want to deal with the principle of the payment of attendance allowance. Yesterday, Susan Deacon confirmed that, unless Westminster agrees to continue paying attendance allowance to those in care homes who currently receive it, the Executive will have to find an additional £21.7 million to fund free personal care. The Executive has said that, if the worst comes to the worst, it will find that money from its own resources. I do not quibble with the Executive giving that commitment—it allows the Executive to remove any doubt that the policy will be delivered from next April. However, the Executive should be determined not to end up in that position, because an issue of principle is at stake.
All of us in Scotland pay our tax and national insurance to the United Kingdom Exchequer, as do those south of the border. Some of that money comes back to the Scottish Parliament to be spent on the priorities of the Scottish Parliament; the rest of the money stays with Westminster so that Westminster can provide for us services that are reserved to that Parliament. That is not an arrangement that I—or the rest of the SNP—am particularly fond of, but it is the arrangement that we work with at the moment. It would be wrong if Westminster chose to abuse that arrangement simply because it took issue with the direction of Scottish Parliament policy. The money that
The fact that the Scottish Parliament has decided to enhance the provision that Westminster makes is entirely a matter for this Parliament and for no one else. We know that Westminster does not agree with our policy of free personal care—George Foulkes was here yesterday to remind us of that fact—and Westminster is entitled to have its opinion and to set its own policy. No one in this Parliament would disagree with that. However, Westminster is absolutely not entitled to withdraw benefits from Scottish pensioners simply because it does not like the policy of the Scottish Parliament. The Scottish Executive should be demanding a guarantee that that money will stay in Scotland and benefit Scottish pensioners.
Yesterday, I listened carefully to what Susan Deacon had to say. I heard her assure us that she was in constructive dialogue with Westminster—with George Foulkes looking down on her from the VIP gallery, I am sure that she was not able to put it any more strongly than that. I am prepared to believe that the Scottish Executive is fighting our corner on this issue.
The motion, for once, is not about having a go at the Scottish Executive. It is not about trying to set the Parliament against the Executive. It is about giving the Parliament the opportunity to speak with one voice—as it has done so often before on free personal care—and to strengthen the Executive's hand.
The Parliament has been dogged in its determination that free personal care for our elderly people becomes a reality. Even the Liberal Democrats stuck to that principle, which is a rarity indeed. We are nearly at the point of delivering that commitment to Scotland. Let us ensure that, at this late stage, no one—not even Westminster—can stand in our way.
That the Parliament notes the publication of the report of the Care Development Group and welcomes the opportunity for a full parliamentary debate on the detail of the recommendations contained in the report; further welcomes the Scottish Executive's pledge to make personal care free for all elderly people from April 2002 whilst noting that aspects of the detail of this commitment require further clarification; notes in particular that the £125 million set aside by the Scottish Executive will not be sufficient to fund the recommendations of the Care Development Group unless Her Majesty's Government agrees to allow those currently eligible for Attendance Allowance to retain this benefit, notwithstanding their entitlement to free personal care; believes that, as a matter
I too begin by sending our best wishes to Mary Scanlon. As far as I remember, today's debate is the first on health or community care in which she will not have participated. We hope that she returns soon to contribute to our debates.
The care development group report is a complex response to an even more complex subject. The Executive always intended that the Parliament should debate the report properly once the Health and Community Care Committee and other members had had a chance to digest the details.
It is a pity that the motion focuses on one aspect only—attendance allowance in care homes—especially when we are in the middle of constructive discussions with the Department for Work and Pensions on that topic. Put simply, passing the motion would hinder rather than help those discussions and risk turning an argument about resource transfer into a constitutional stand-off between Edinburgh and London. Let no one be in any doubt that we are pressing the case strongly for resource transfer. The case is set out most forcibly on page 60 of the report, and I will make three brief comments over and above that.
The fundamental point is that the DWP pays about £20 million to self-funders in Scottish care homes and that that money must not be lost to Scotland. The precise mechanism by which that is achieved is secondary, although resource transfer is probably the simplest arrangement and already happens regularly.
Secondly, the current rules do not take account of devolution, as savings to the DWP budget now result in costs to another Administration rather than to another department within the same Administration.
Thirdly, the rules about attendance allowance stopping in care homes when other publicly funded help is given were created to avoid any element of double funding. However, we in the care development group were careful: we deliberately and meticulously avoided any such double element, as outlined on page 60. Therefore, the £145 of free personal care is made up of £90 from the Scottish Executive and £55 attendance allowance, and the £210 for someone in a nursing home is made up of £155 from the Scottish Executive and £55 attendance allowance.
Will the minister take the opportunity to answer the question that I asked during my speech? What is the position of partial self-funders who do not qualify for attendance allowance in care homes? They will get £90 from the Scottish Executive. Who will pay them the additional £55?
Clearly, if people do not currently receive an attendance allowance, it is not an issue. I thought that Nicola Sturgeon was going to raise the point that Shona Robison raised yesterday. The vast majority of people in care homes receive the full attendance allowance. The reality is that no one—not the DWP, or the Scottish Executive, or anyone else—has the precise figures, but it is broadly accepted that most people receive the full amount.
So, £145 and £210 are the amounts that will be delivered. There will be no ifs, no buts and no maybes, as the First Minister made clear earlier this week.
That is just one half of the picture. Beyond that is free personal care in the community and the recommendation that £50 million of the new money should be allocated to the expansion and improvement of services in the community so that care is available and needs are met. That is the most distinctive of all the care development group's recommendations. I believe that it will be welcomed by everyone in Scotland, even those who have reservations about the policy as a whole.
In response to Nicola Sturgeon's point about the inadequacy of resources for services in the community, as she put it, I say that we must also remember to set the £100 million that Angus MacKay announced in June beside the £100 million that Susan Deacon announced last October, which was also for improvements in personal care and home care services more generally. That £200 million is an unprecedented investment in older people and a massive commitment to improving their lives. Through those extensive resources, we can ensure that building up services and extending the boundaries of free care go hand in hand.
To anyone in the wider community who still has doubts about the second part of that policy, I make three brief points. First, as indicated at the start of the report, free personal care is right in principle because it removes the discrimination against older people who have chronic or degenerative illnesses and need personal care.
Secondly, and contrary to what some journalists have said, our public opinion research indicated support for that approach. When questions were asked about the individual elements of personal care, as described on page 88 of the report, there
Thirdly, free personal care will make it easier to provide integrated health and personal care services. It is extremely helpful to the joint working agenda, which is strongly endorsed by the care development group report and driven forward by the publication this week of the Community Care and Health (Scotland) Bill. That bill facilitates the pooled budgets to which the Conservatives refer in their amendment to the amendment. It also provides powers for the Scottish Executive to ensure that the new joint working arrangements take effect in every part of Scotland.
The care development group made many other recommendations, to which I will refer as far as I can in my last minute. One of the most important was that a group should be established to consider in detail the mechanics of implementing our proposals. That group will be set up soon. Another recommendation was that the £125 million of new money should be ring-fenced until local authorities agree with the Executive robust and clear outcome agreements that will allow us to ensure that the investment is being channelled appropriately. That responds to Nicola Sturgeon's point on ring fencing. A third recommendation was that all the money for older people's services should be the subject of clear outcome agreements.
Those points address the substance of Ben Wallace's amendment, although not—I fear—the shocking arithmetical skills that he displayed yesterday. I wait with interest to find out whether he will make the same simple errors today.
Now is an exciting time for the development of older people's services. There is new money, new joint working and an absolute determination to ensure delivery everywhere in Scotland. I thank members for the endorsement that they have given the report over the past few days.
I move amendment S1M-2248.1, to leave out from first "notes" to end and insert:
"welcomes the report of the Care Development Group and the Scottish Executive's commitment to implement its recommendations and further welcomes the statement made by the Minister for Health and Community Care on 26 September 2001."
I thank members for their kind words for Mary Scanlon. I am sure that members join me in wishing her a swift recovery and hoping that we will welcome her back to the Parliament as soon as possible.
The Scottish Conservatives welcome the opportunity today to debate the implications of the
What a difference a year makes. In the chamber, almost exactly a year ago, the Labour party set out its reasons for not supporting the notion of free personal care. The then Deputy Minister for Community Care, Iain Gray, said:
"The remainder of the 34,000 Scots who are in residential or nursing care would see no change from that recommendation of the report".—[Official Report, 28 September 2000; Vol 8, c 743.]
Perhaps closer to home, Susan Deacon said on 5 October 2000 that implementation of free personal care "would not be right".
Those were the reasons that were set out in principle. New Labour did not support the notion of helping frugal pensioners. It saw free personal care as a means of helping only the wealthy. Most of the Labour MSPs had not the slightest idea that, to unlock and untangle the current system, the adoption of free personal care was vital. They would not even listen to Richard Simpson, who, as we all know, tried desperately behind the scenes to explain to some of his colleagues what the Sutherland report was about.
The record should be set straight. The Labour party was not against the principles of the Sutherland report. It was against the priority of putting the money into free personal care. Implementing the Sutherland report is costing us £125 million. That does not, in itself, benefit care of the elderly. The question is what Government must do, which is prioritise. The question is not the principles of the Sutherland report.
That helps to unlock the system. I only have to refer the member to the comments of his colleagues.
Let us turn to the Liberal Democrats. In Bournemouth, as we speak, they are claiming that they achieved Labour's conversion—that they had the influence. However, a year ago, they all—with the exception of Margaret Smith and John Farquhar Munro, who had done their homework—voted with Labour not to adopt free personal care. Who could forget Nora Radcliffe's reason for voting against the proposals? Curiously, for a member of a federal party, she said that we would have to wait for Westminster. I wonder what her reasons are now for backing free personal care.
Today is a success for the opposition. That means giving credit where credit is due—to the Scottish National Party, Margaret Smith, Richard Simpson and the Tories, who all helped to force the Executive, kicking and screaming, to introduce proposals for the implementation of free personal care.
How does the member react to his colleagues in the Tory party in Westminster calling his position on free personal care—the same position as ours—irresponsible? They also said that they believed that the money would be better spent elsewhere in the national health service. They do not consider it a devolved matter.
We are not a federal party, but we are a devolved party now.
Our amendment asks the Executive to put icing on the cake. The Scottish Conservatives would like the recommendation for the pooling of budgets and a joint delivery platform to be made more formal and not to be implemented on an ad hoc basis.
I notice with interest the rubbishing by the Deputy Minister for Health and Community Care of the study that illustrated how serious the leakage of community care money was becoming. No one denied that there was a problem. Before the minister sets about attacking the figures, perhaps he will tell us whether his department has done calculations and, if it has, whether it will publish them. After all, Sir Stewart Sutherland felt that the leakage was in the region of 16 per cent of the total budget—that is £150 million of the present community care budget in Scotland.
The Convention of Scottish Local Authorities, in its press release yesterday, admitted spending on children's services 42.8 per cent above the grant-aided expenditure. That 42.8 per cent came from somewhere—it seems to have come from care for the elderly.
Let us be clear. We are saying not that local authorities are being deceitful with the money, but that the budgetary pressures in some sectors must be addressed head on by the Executive and COSLA. Those pressures must not be used to justify cross-subsidising. The fact remains that relations between care providers and COSLA have almost broken down and thousands of Scots
The Scottish Conservatives believe that the solution is to lift those funds out of local authorities and to pool them with health board resource transfer and central Government funding into one clear budget stream that can be audited. I remember asking COSLA, when I was a member of the Health and Community Care Committee, to produce an audit trail for one such example. Two and a half years on, I have yet to receive it.
We are in favour of proposals such as those in the fine Labour and Conservative-held Perth and Kinross Council, which has been trying out shut systems with marked success.
Today is good news for all those who need long-term care. We should not be distracted by the SNP, which wants to create a constitutional crisis out of a regulation. The SNP will never understand that Labour and the Tories, as unionists, can engage in adult, pragmatic discussions at Westminster or at Holyrood with the aim of solving a problem.
I move amendment S1M-2248.1.1, to insert at end:
"but urges the Scottish Executive to implement the recommendation of the Royal Commission chaired by Sir Stewart Sutherland for the "pooling" of budgets and put in place systems to ensure that funds allocated for community care are actually spent on such services."
I echo the comments of others in wishing Mary Scanlon a speedy recovery. The community care debate this morning will be strange without her.
How we treat our older people is a benchmark of the kind of society that we form and Scotland's older people can say that devolution is working for them and making a real difference in their lives. Although the Executive's acceptance of the terms of the report means that free personal care will be a reality in Scotland, it has been a long and bumpy road with more twists and turns than an Ian Rankin novel. However, many of the people who got us to the end of that road are in the chamber.
First, the members of the Health and Community Care Committee should be congratulated. When we were elected as MSPs, the Sutherland report was gathering dust on a shelf somewhere. Members decided proactively to re-examine not only a community care system that they believed was failing the people whom it was meant to serve, but the Sutherland report itself and to ask whether we should pursue that report's recommendations.
After nine months of taking evidence, the Health and Community Care Committee decided unanimously to back the introduction of free personal care in Scotland. That decision was significant because it was the first time that there was a cross-party view that free personal care was the correct route. The Sutherland report was put back on the political agenda in Scotland and it has remained there since. I believe that the Health and Community Care Committee has much to be thanked for in that regard.
The Blair Government did not see the matter that way and—at that point—neither did the Executive. Although the joint future group continued with its good work, it failed to accept the principle of free personal care. However, last October the Executive put record funding into community care. It accepted the principle of free nursing care in January and, ultimately, the principle of free personal care. The Executive tried to find mechanisms to deliver joint working and pooled budgets and to do all that it could to keep people in their homes. The Executive should be congratulated on its record investment of more than £200 million in community care services.
The delivery of free personal care has been the policy of Liberal Democrats throughout the UK. It is clear that, without the support and actions of the Liberal Democrats in the Scottish Parliament in January, the measure would not have been introduced. Crucially, it is a triumph for the Parliament. It is a triumph for the Opposition parties and members of the Labour party who lobbied hard for the policy. It is a triumph for a First Minister who is committed to public services and social justice, for the Deputy Minister for Health and Community Care, Malcolm Chisholm, and for the members of the care development group, who have turned the Parliament's worthy aspirations into practically viable and sustainable proposals in the group's report.
At the heart of the debate is not only the issue of diagnostic fairness, but the question of how we deliver the best possible community care services. Through the Regulation of Care (Scotland) Act 2001, the Executive has built on the issues that I mentioned. The care development group has tackled problems such as the improvement of services, delayed discharge, inequality of service and charging and the need for better joint working among Scotland's councils.
We need constructive dialogue not only between the Scottish and UK Governments, but between Holyrood and local government. Scotland's councils will be central to the delivery of this agenda, so we welcome the Executive's decision to allocate £125 million a year from next April for the introduction of free personal and nursing care. The care development group, the Health and
I hope that the new unified boards with their council input will help to improve joint working and action on pooled budgets. However, we must remove the barriers to effective joint working and I am glad that the Community Care and Health (Scotland) Bill that was introduced yesterday will do just that.
Much has been made of potential shortfalls. However, I will be clear on this point: the Executive is committed to delivering the policy and that will happen with or without Westminster's support. We are not asking for new money, nor has the money been spent elsewhere on other provisions. The money is simply a resource transfer of £20 million that is already paid to Scottish pensioners for personal care.
The Executive is building on that earlier provision and it would be perverse, narrow-minded and mean of the Westminster Government to deny our elderly people their present entitlement simply because it does not agree with the decision of this democratically elected and accountable Parliament. If Westminster fails to listen to this legitimate request by our ministers, it will set up a different benefits system. I hope that common sense and partnership will prevail; however, if they do not, our pledge to deliver on the Executive's promise to the Parliament remains.
We welcome the investment of £50 million in community-based services and the definition of personal care that includes psychological counselling for dementia sufferers and which goes further than the Sutherland definition. We welcome the moves towards a single shared assessment process by April and the setting up of the implementation group that will take that forward. We also welcome the moves toward standardising charges for remaining council services, such as provision of home helps. Those measures will undoubtedly put extra pressure on our care service professionals in the social work and health services. We must support them with training and with the legal tools that are required to make joint working easier than it is. We hope that the Executive, taking into account the present situation in Scotland's care homes, will continue to work with all sectors to provide better services and to monitor the sector's work force planning needs.
The Scottish Liberal Democrats are delighted to welcome the care development group's report and the publication of the Community Care and Health
Congratulations are due not to any individual members or to a committee, but to the Parliament for having come this far. I would like to bring some clarity to the matter for elderly people. I think that I am correct in saying that the measures will apply only to those over 65. Obviously, some older people will suffer and pay for personal care and will not be caught up in the package.
It is not fair to refer to "free personal care", because some people will continue to have to pay a portion of the costs of their care. I would like to know why there is some deviation from Professor Sutherland's recommendations. Page xix of his report states:
"The costs of care for those individuals who need it should be split between living costs, housing costs and personal care. Personal care should be available after an assessment, according to need and paid for from general taxation: the rest should be subject to a co-payment according to means."
In chapter 6, paragraph 6.38, the commission's recommendation is
"first to take personal care costs out of the system altogether".
The commission viewed the fixed costs as living and housing costs, which were to be a set figure. The rest would be paid "according to means". There are great variations in personal care.
I was pleased to hear the minister say that £50 million is being put aside for care in the community. Such care is what most elderly people want; they do not want to be prised out of their homes. I note that the Minister for Health and Community Care said in her statement yesterday:
"We applaud the efforts that are being made by local authorities, the NHS and the voluntary and independent sectors".—[Official Report, 26 September 2001; c 2795.]
I want to focus on the voluntary sector. I want to know whether any of the £50 million will be directed towards it. If I remember correctly from a debate in February, we have about 585 day care centres, which provide 19,000 places. Many of those centres, whose existence means that people do not need to go into hospital, are on the brink of collapse because they cannot raise funds. They do not have enough money for the transport that is needed to pick up elderly people. I would like the minister to say how he will make the necessary assessment in Scotland.
I visited the Midlothian stroke club, which caters for elderly people who have had strokes and who are suffering great psychological problems after their strokes. Through its voluntary efforts, that club helps bring those people back into their communities. Such organisations are struggling, simply because they cannot afford transport and there are not enough volunteers. They perhaps need people to be partly paid to come and help. Their work is an essential part of the cycle of supporting people in the community and I would like to hear the minister's comments on that.
Reference was made to aids and adaptations. In a debate earlier this year we heard, following a point that was originally made by Mary Scanlon,
"that 10,000 elderly people had been assessed for aid and adaptations and 10,000 were awaiting assessment."—[Official Report, 14 February 2001; Vol 10, c 1239.]
I would like to know what the position is now. If an elderly person is in his or her house and has no ramp or rail to get in, why are they still waiting for one? Such adaptations are essential for halting decline in people's physical and mental health. In the end, provision of such adaptations would reduce the bill to the state—we must always talk about pennies. In the same debate, I referred to the fact that the number of home helps fell by 9,000 between 1997 and 1999. That is the reality, despite the fact that home helps are essential to enabling elderly people to stay in their homes. How will the minister address that?
I congratulate the Parliament on coming so far, but much more detail and many more practicalities must be considered. When those are delivered simply on the ground—such as through the provision of home helps, district nurses and ramps to houses—we will have delivered for Scotland's elderly.
Margaret Smith was right to say that it was the Health and Community Care Committee—an all-party group—that made the strong recommendation to adopt the Sutherland principles. As I tried to indicate in my intervention on Ben Wallace, Government must decide on priorities. Christine Grahame made that point extremely well, but all her points will present more difficulty because we have made—rightly, and Christine knows that I support absolutely the Sutherland principles—a principled decision to spend £125 million on introducing free care. That money does not exist to support groups such as those that Christine Grahame mentioned. Such funding is not included in the £125 million, so we must find the necessary funding from other parts of the budget. I agree that we must fund and develop that support. I want to develop that theme in a minute.
The Executive said that it is negotiating on the possible transfer of resources to which the SNP motion refers and we will see what the outcome is. I do not intend to address that point, however; I wish instead to concentrate on the Conservatives' amendment to the Executive amendment and the matter of ring fencing.
My one comment on the SNP motion is that the interrelationship between benefits and the Scottish budget must be examined. That relationship is complex in several areas, including employment and unemployment and moving people back into work with therapeutic benefits. Many matters in that area require and will involve continuing discussions, but we need to cater for those within the current settlement and we should not try to change it.
The Executive's proposal is to ring-fence the new money. I am not in favour of ring-fencing and I believe that, in the long term, the Government is not in favour of ring-fencing. I presume that it is an interim measure. We must move towards pooled budgets and a comprehensive settlement. In doing so, however, the first step requires transparency about the situation, and I think that we have started to move towards that.
The Conservatives, in their publicity over the past few days, have confused grant-aided expenditure and resource transfer and expenditure. Expenditure is published against GAE, not the combined resource transfer and GAE. That is how we arrive at a 44 per cent shortfall. I am glad that the Conservatives did not repeat their mistake in this morning's debate.
I will happily provide Dr Simpson with the figures that were given to us and with the background research. The definitions for the net expenditure came from the information and statistics division of the NHS in Scotland and included the resource transfers. The figures were set off against each other and I will be happy to talk Dr Simpson through them.
I will be happy to discuss the matter with Ben Wallace later.
I want to make a separate point on what Christine Grahame said to the effect that we need to move on. We have accepted the principles and have guaranteed the money for free personal care. We need now to consider everything that is happening and to try to reach a comprehensive settlement on this sector of care. The sector has been highly fragmented since it was, in effect, privatised under the Conservatives, through closure of long-stay beds and moving services into the private, voluntary and independent sectors.
The first step is to ensure complete transparency with the figures, and I look forward to a debate on that. We also need to deal with
Funding for all those who have indicated that they are ready for discharge should come automatically under the pooled budget. As a first step, all long-stay beds that are to remain closed should be moved under a pooled budget, which means that expenditure for individuals whose place of residence is settled is the responsibility of local authorities.
If that is not clear—it might not be—let me give an example. Within the Forth Valley Health Board area in my constituency there are two nationalist-led councils—Clackmannanshire Council and Falkirk Council. Clackmannanshire Council has overspent its budget in the past year but, in doing so, it has reduced the number of delayed discharges to zero. There is none beyond the contract period and the few that exist do not run up to the end of the contract period.
Falkirk Council, by contrast, decided unilaterally—without discussion with its partners—that it would not take patients out of hospital to relieve its budget constraints. The results are that Falkirk and District royal infirmary is on red alert, that Stirling royal infirmary must take patients that would have been taken by Falkirk, and that Clackmannanshire Council and my constituents are suffering. That is not a party-political issue—[Laughter.] It is not. Clackmannanshire Council, which is SNP led, has done an excellent job, but Falkirk Council has not. At issue is the approach that local authorities take. This is about partnership. There must be pooled budgets and we must give responsibility to one unitary group.
I hope that the Executive will take up the issues that I have raised and deal with them.
I thought that I was way down the list of speakers.
I welcome the report and praise the work of the care development group and of Malcolm Chisholm in particular. I am delighted that Margaret Smith highlighted an issue on which I would have focused anyway—the place of the Health and Community Care Committee in the process. The committee, on which all parties were represented, worked as a pressure group from inside the
The care development group's report is good and has taken a can-do approach to the problem. The report is positive in all respects where it could have been negative. It is decisive where it could have equivocated and it is generous where it could have been penny-pinching. It has accepted proposals that it could have rejected.
The new long-term care proposals will be particularly beneficial in my constituency and in the constituency of my colleague Euan Robson. The Borders has the highest proportion of elderly residents in mainland Scotland. In 1998, 13.1 per cent of the population was between the age of retirement and 74 and 8.8 per cent of the population was more than 75 years old. Those percentages are now probably even higher; we will see when the census data are published. The corresponding percentages for Scotland as a whole are 11.3 per cent and 6.7 per cent, which underlines the fact that the Borders population is heavily weighted towards the elderly. Thirty-seven per cent of households include pensioners, compared with 32.9 per cent in Scotland as a whole, while 28.8 per cent of households are made up solely of pensioners, compared with 24.1 per cent in Scotland as a whole. Any measure that offers benefits to elderly people in their homes and in residential care will be especially welcome in the Borders.
I recognise that arguments can be made both for universality of provision and for targeting of resources, and that those arguments will come up time and again. In this case, we have gone in one direction. The fact that on this important issue we have done the right thing must make ministers feel good. We have been on the side of the angels and have taken a positive approach. By doing so, we have eliminated some of the elements that Sir Stewart Sutherland identified as inequitable and wrong in the current system. Through these provisions, we will help to remove from old people and their families a potent source of anxiety, disappointment and distress. They will no longer feel the same sense of injustice, loss or humiliation. They will not face the financial worries that have sometimes wrecked people's lives even before they went into residential care.
As other members said, this is a good day for the members of the Parliament, it is a good day for the committee system and it is a good day for the Liberal Democrats, because some of our policy is being implemented. It is a good day for the partnership Executive, because together we are delivering something that Scotland wants. It is a
It is a good day for the Parliament in another way. In opinion polls, folk often say that the Scottish Parliament has not changed anything and that it does not make a difference to their lives. Here is the clincher, however: we can talk about central heating and the abolition of tuition fees, but the policy of providing free personal care for the elderly will lead people to say that, working together, the Scottish Parliament made a difference to their lives. Never again will they say that the Scottish Parliament does not matter.
I apologise for being late for the debate—sometimes a car is not the best mode of transport.
I welcome the report and the fact that it has taken on board what Sir Stewart Sutherland said. However, there are anomalies that must be addressed and questions that need to be asked. It has been said that the whole Parliament—especially the Health and Community Care Committee—is to be congratulated, but we should recall that it was necessary to pull some members along kicking and screaming. I am glad that they have seen the light.
Malcolm Chisholm, who was previously convener of the cross-party group in the Scottish Parliament on older people, age and aging, will know just how vociferous that group can be. As the present convener of the group, I would like to report what has been said to me about the implementation of the proposals. To begin with, members of the group were delighted. However, when they saw the recommendation from Westminster that, although this is supposed to be a grown-up Parliament, Scottish people will not be allowed to have an attendance allowance, the phone calls started to come in. I will not repeat half the words that were said to me down the phone—this is not the appropriate place to do that. However, members will gather that the people with whom I spoke were not at all happy with the situation. We should not go to Westminster cap in hand. We should make it clear that its response is a slap in the face of this Parliament. We are being been told that this is not a grown-up Parliament and that people do not deserve an attendance allowance from a fund into which they have paid for many years.
I will quote from someone whom Labour members will all know—Jim Devine, who is Scottish organiser for the health union Unison. He said:
"Our generation owe a debt to these people.
They were the ones who campaigned for the welfare
Exactly. We should not be too complacent. We should not pat ourselves on the back when Westminster is still saying that it holds all the power and that it will tell us what to do. That is a disgrace.
I have another question for Malcolm Chisholm on the care development group's report. Page vi of the executive summary states:
"We have assumed that Attendance Allowance will continue to be paid as a contribution towards personal care costs for people in care homes."
Was the care development group given assurances that that would be the case? I am sure that all its recommendations were made in the best faith, as I know that all the members of the group are hard-working people. However, the Parliament should know whether the group was given assurances on that point.
Christine Grahame touched on the fact that attendance allowances and the costs of care for the elderly are different in different areas. The care development group suggests £145 per week for personal care. It says that that is the national average, but in seven local authorities in Scotland the average residential home charge is higher than the national average. That needs to be considered. Forty per cent of those in Scotland who fund their residential home care privately live in areas where the average weekly charge is higher than the national average. For those people, personal care would not necessarily be entirely free. We also need to consider older people who are in nursing homes.
Although we welcome the report and are prepared to give the Executive half a pat on the back, we must say to Westminster that this is a Scottish Parliament, that we will deliver free personal care for elderly people and that it cannot tell us what to do. The people who voted for a Scottish Parliament deserve better. We should tell Westminster to stop being so petty with our people and our money. We also need clarity on some of the issues that have been raised today.
The Liberal Democrats warmly welcome the Executive's U-turn on free personal care. It was a close-run thing. On 25 January, five minutes before decision time, as the Executive faced losing a vote in the chamber, the Minister for Parliament, Tom McCabe, said:
"We have taken cognisance of the views expressed yesterday and today, especially the sincerely held views of our colleagues"—[Official Report, 25 January 2001; Vol 10, c 695.]
The SNP has been generally supportive of free personal care, but it has always tried to whip up doubt about whether free personal care would be implemented. Nicola Sturgeon's motion is another sign of the SNP's attempts to muddy the water.
Nicola Sturgeon is quite right: that is the job of Opposition. However, it is also the job of a responsible Opposition not to worry elderly people in Scotland, yet that is exactly what the SNP has been up to.
The SNP was poised for the care development group not to deliver free personal care for all. As usual, the SNP has to be negative. The Liberal Democrats cannot and will not support the SNP's motion. [Interruption.] SNP members should listen while I examine their logic. Why should we allow the UK Government to veto the policy of the Scottish Government? That is exactly what the SNP motion asks us to agree to do.
The motion says:
"unless Her Majesty's Government agrees to allow those currently eligible for Attendance Allowance to retain this benefit, notwithstanding their entitlement to free personal care"— the Parliament
"believes that, as a matter of principle, any such shortfall should not be met from within existing Scottish Executive resources".
What an untenable position. [MEMBERS: "Shame."] I am glad that Tory members shouted, "Shame", as I now turn to their position.
I shall give way in a minute.
In my view, the Tories' position has always seemed opportunistic. The Conservatives oppose the introduction of free personal care in England, but we are told that they support its introduction in Scotland.
I quote from a Westminster debate on the Sutherland report, during which the Conservative spokesperson said:
"'We believe that the money would be better spent elsewhere in the national health service.'"—[Official Report, House of Commons, 5 February 2001; Vol 362, c 737.]
The Tories derided the provision of free personal care as an irresponsible policy. I wonder whether
At least the Labour party is consistent. It opposed free personal care for the elderly, both north and south of the border, preferring targeted benefits. That is a perfectly honourable position, although the Liberal Democrats disagreed with it.
There is no doubt that, had the Liberal Democrats given way to Labour in January, we would not be debating today the implementation of free personal care for the elderly in Scotland. The partnership Government is successful—it delivers Scottish solutions to Scottish problems.
In conclusion, the Liberal Democrats welcome the debate and congratulate Malcolm Chisholm and the care development group on presenting sensible proposals on the implementation of the policy on free personal care. We congratulate the Executive on eventually coming round to the Liberal Democrats' view that the provision of free personal care is the right policy for Scotland. We believe that it is the right policy for the entire United Kingdom.
This should all be so simple. The Executive has endorsed the provision of free personal and nursing care for the elderly. What else could we possibly have to discuss? I presume that, as we have signed up to the recommendations made by Sir Stewart Sutherland and the care development group, we are all agreed.
It appears to me that, now that we have signed up to the implementation of free nursing and personal care, it would be sensible to provide that care in the most efficient way possible. It is obvious that that has yet to become clear to the Executive because neither yesterday's statement from Susan Deacon nor last week's Executive response mentioned the single budget for which Sir Stewart Sutherland, the Health and Community Care Committee and my party have been arguing.
I believe that all personal care should be provided free at the point of delivery under a unified budget. Without a unified budget, not only will there be widespread waste within the system
Joint measures will do nothing to tackle the conflicts between purchaser and provider, which cause many of the problems that we are trying to overcome. In fact, they simply reinforce the inherent weaknesses in the system. Thus, by implementing them we will be unable to make significant improvements.
On the problem of the attendance allowance, we do not know whether Westminster or Holyrood will cover the payments. The minister told us yesterday that talks with Westminster were continuing and no doubt those talks will resolve the issue. In an attempt to move the debate on to constitutional grounds, the SNP would have us believe that Henry McLeish and Alistair Darling are engaged in some kind of turf war, but the real issue is why the attendance allowance question was not sorted out earlier. To be honest, does that matter anyway? The Executive is endorsing a mechanism for care delivery that is so unsuitable that a large part of the benefit may never reach the intended recipients; it will disappear in the local authority black hole. How can so much of the money that is allocated to community care go missing along the way? Yet the Executive still refuses to formalise the single budget.
Although we support the Executive's amendment and its endeavours to deliver free personal and nursing care, I remain unconvinced that its approach provides the right mechanism through which to deliver that care. What is the point of making promises that inevitably will be undermined by a defective delivery system? We must ensure that the money the Executive is so busy telling us about is spent properly and reaches those people for whom it was intended.
This is just the start of the debate. The Conservatives have always made it clear that free care for all was the solution for the short to medium term only. The Executive's approach will still leave individuals having to pay the bulk of their accommodation costs. The next step must be to
Yesterday, Susan Deacon spoke about her sadness that some people had reduced the debate to "simple slogans", yet she is also a culprit. Providing free nursing and personal care will mean nothing if that care is not delivered effectively.
I support the amendment in the name of Ben Wallace.
Several interesting points have been made during the debate. In the time available to me, I shall try to respond to them, party by party.
I thank the Liberal Democrats for their positive response to the care development group's report. Margaret Smith made a point about diagnostic fairness—her point is repeated on page 69 of the report. She welcomed the publication of the Community Care and Health (Scotland) Bill this week—some members seemed to be unaware of its publication—and the fact that the bill will remove barriers to joint working. She reminded us that some of the bill's provisions will standardise charges for non-personal care services. We should remember that that is part of the picture.
Mike Rumbles made an interesting point about the SNP motion's support for a UK veto on our policy. I had not thought of that, but when members consider it, they will agree that he made an interesting and valid point.
Mike Rumbles also said that the Labour party preferred targeted benefits. I will make a general response to that point: the Labour party supports a combination of universal and targeted benefits. Since its first day, the welfare state has been based on that combination. It is clear that other Executive policies on health, social inclusion and many other areas are targeted.
I genuinely believe that that is a false dichotomy. Our policy has changed the boundaries of universal benefits in Scotland, but the fact remains that one cannot have only
I turn now to the Conservatives. It is unfortunate that Keith Harding and Ben Wallace were unaware of the developments on joint and pooled budgets that are laid out in the bill that was introduced to Parliament this week. As I indicated in my opening speech, Ben Wallace's figures were wildly out. We are aware that not all the grant-aided expenditure for a particular service is spent on that service and, on page 29 of the report, we refer in particular to the spending gap on older people's services. Our recommendations take that on board. They talk about the need for outcome agreements.
On resource transfer, our recommendation is that
"the full amount of NHS long stay resources freed up by bed closures should also be part of the aligned or pooled budget."
The details on older people's services are in our report, as I indicated. Local authorities generally spend 98 per cent of GAE, which is slightly different from the 44 per cent that Ben Wallace mentioned yesterday.
I will now turn to the SNP. Christine Grahame asked several questions. I assure her that the £50 million will be available for aids and adaptations. I agree with what she said about the decline in home care hours. The report refers to that point, but also welcomes the fact that, because of increased Executive funding, home care hours increased by 9.8 per cent in 2000. We strongly support the continued development of that trend.
I am sorry, but I must move on because I have only five minutes.
Christine Grahame was incorrect when she said that Stewart Sutherland favoured a fixed amount for housing and living costs. It is true that he considered that as an option, but he favoured a fixed rate for personal care. In that and in almost every other regard, we have followed Sir Stewart Sutherland's methodology. We have also adopted an average charge, which Sandra White asked about, which again, is what Sir Stewart Sutherland recommended. We used the same method for future projections as Sir Stewart, but we also built in an allowance for the response to the new policy, which he did not build in. That is why we allow a great deal of money for the expansion of services in the community.
Finally, let me respond to the one speaker in my
That is a detail in the context of today's debate. I welcome the positive responses that have been given and the constructive comments that have been made. I hope that we can all go forward together into the exciting new world that begins for older people next April.
I thank all, or certainly most, of the members who contributed to the debate. At the end of the day, the debate took place only because the SNP afforded Parliament the opportunity. In fact, yesterday's ministerial statement was also due to my party's determination to secure a statement sooner rather than later. Although Susan Deacon's statement yesterday was welcome, today's debate has been an opportunity to try to get answers to some serious outstanding questions. Perhaps it is unfortunate that some members have not taken that opportunity and that some questions remain unanswered.
When Mike Rumbles made his comments, he did not look over to the benches of his Executive partners. If looks could kill, Mike would look rather unwell. "How to Win Friends and Influence People" was perhaps lost on Mike Rumbles. The point about the whole resources issue is that it would be quite wrong if this Parliament had to find the shortfall from existing resources and raid other budgets simply because—I quote Mike Rumbles's colleague Margaret Smith—Westminster was being "perverse, narrow-minded and mean". Why on earth should that be?
That is nonsense. The principle at stake is that when this Parliament
Resourcing has featured heavily in the debate. It is crucial that the community care sector expands to meet the inevitable increase in demand. The sector cannot even meet current demand, before the care development group's recommendations are implemented next April. We have heard examples of the reduction in the number of local authority homes, in care home beds and in community care services on the ground. We need to move swiftly to build capacity. I am pleased that the minister has clarified that £50 million has been set aside to do that and I welcome that.
Any shortfall in the funding package will be a serious problem. The resources that are required from Westminster will be an essential component of making the package work. It is all very well for Henry McLeish to say that if Westminster does not agree to the transfer, the £21.7 million will be found, but we have a right to know about the contingency plans. Would the money come from the £50 million that has been set aside to build capacity? If it would, that is a serious concern. For the policy to work, every penny of that £50 million will be required to build capacity. It is right that the Parliament has the opportunity to ask such questions.
I agree that if we lose £20 million of that £50 million, it will have an impact on community care services. The £30 million that would be left would be the same as the total amount for community care that the SNP offered in its manifesto at the elections to the Scottish Parliament. Will Shona Robison comment on that?
At the end of the day, Margaret Smith must recognise that we want to go forward together on the issue. That comment was not worthy of her. The point is that a threat is undermining the very principle on which the package is based, which is that we must build up capacity. Otherwise, the whole package could be undermined. Among the many people I have spoken to outside the chamber, there has been agreement on that point, which is why it is frustrating that members, for whatever reason, feel that that they cannot support a very reasonable SNP motion. Perhaps people should reflect on why that is.
The way in which we do business and the way in which negotiations are conducted are also issues. I would rather the Parliament gave its view on Westminster's actions than that it went on with what are in essence back-door negotiations. I do not know what stage things are at, or whether
Let me turn to points that were raised during the debate. The Tory amendment, although—as others have pointed out—perhaps based on some spurious figures, makes an important point. The GAE spend by local authorities has been of concern for some time. Budgets for the care of the elderly are often the first to be plundered, so I am pleased that we are to have a far more rigorous assessment of how such budgets are spent. The way in which that has been done has been fundamentally wrong for quite some time.
In an intervention, Richard Simpson spoke about how the Executive's package would improve care for the elderly. What he said suggested that his conversion has been something less than that on the road to Damascus. I am not convinced that he has fully converted to the principles underlying free personal care.
I do not have much time, but if Richard Simpson wants an answer to the question of how free personal care will fundamentally improve the care of elderly people, it is this: it will remove the fear that thousands of elderly people have had about what will happen to them in their golden years. That principle is very important.
Christine Grahame raised important points about what is happening on the ground to community care services. Those points have to be addressed.
I should also deal with another point that Richard Simpson raised. I want to correct his point about Falkirk Council. It was the previous Labour administration that embarked on the policy that was referred to—although to be fair, that administration was in a difficult position because of the discharges from the Royal Scottish national hospital, which the SNP administration has inherited. Richard Simpson was perhaps a little economical with the truth.
Free personal care is an issue that unites the Parliament. I do not think that anyone was singly responsible for making it happen; I would like to think that it was a collective effort from all sides of the chamber.
We want to see joined-up government. In future, when we want to make radical changes that affect the lives of our people, would it not be much easier if we had control over social security benefits?
I support the motion in the name of Nicola Sturgeon.