Community Care and Health (Scotland) Bill: Stage 1

– in the Scottish Parliament at 2:30 pm on 28th November 2001.

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Photo of Lord David Steel Lord David Steel Presiding Officer, Scottish Parliament 2:30 pm, 28th November 2001

Our next item of business is a debate on motion S1M-2247, in the name of Susan Deacon, on the general principles of the Community Care and Health (Scotland) Bill, and one amendment to the motion.

I have a large list of members who want to speak, not all of whom are here. As a result, it would be very helpful if those who genuinely want to speak could indicate as much on my screen to allow me to draw up a batting order.

Photo of Malcolm Chisholm Malcolm Chisholm Labour 2:31 pm, 28th November 2001

There have been many significant developments in community care in this Parliament's lifetime, and the Community Care and Health (Scotland) Bill marks a further milestone in the Executive's commitment to better community care services in every part of Scotland. Just over a year ago, Susan Deacon set out to the Parliament the agenda of joint management, joint resourcing, joint working, better home care, more flexible services, free nursing for our older people and help for all Scotland's carers. As members know, free personal care was added to that agenda in January.

The Community Care and Health (Scotland) Bill is the legislative framework for delivering that agenda. I am delighted to say that the bill has also received widespread support and that the Health and Community Care Committee's stage 1 report contains many comments and recommendations with which we also agree. I will consider in detail the many improvements that the bill will bring and the many people whom it will help, as well as referring to the widespread support that the bill has received.

I begin by spelling out the four general principles at the heart of the Community Care and Health (Scotland) Bill, which are choice, partnership, equity and fairness. Our commitment to choice is clear in the bill's provisions on direct payments, top-up payments for care home places and the creation of a deferred payments scheme. That commitment is part of a broader commitment to services that put service users first and that meet the real needs and wishes of the people who use them.

The bill's second general principle is partnership. Real change can be achieved through true partnership, which will involve national health service boards and local authorities working together to provide services that meet all of a service user's needs. To be fully effective, the partnership approach must be broad enough to include voluntary and private sector care providers, those who use care services and carers, who have for so long been the forgotten, unsung partners in care provision.

Equity and fairness are the final two principles on which the bill is built. Because of those principles, the bill gives ministers powers to introduce free nursing care. No longer will someone in a nursing home have to pay for the same nursing care that would be received free in hospital or at home. For the same reasons, the bill also gives ministers powers to introduce free personal care to bring to an end the current situation in which an elderly person with cancer receives free personal care, whereas someone with Alzheimer's has to pay for the same care. By combining the principles of equity and fairness with those of choice and partnership, we are laying the foundations for care services in 21st century Scotland.

In developing the policies and proposals in the bill, we have tried to give all those with relevant experience and expertise the opportunity to help us in this important work. In some cases, that has happened through the establishment of working groups such as the joint future group and the carers legislation working group. More recently, we have had the care development group and the integrated human resources working group, of which I shall say more in a moment. All those groups have made an important contribution to the development of the Executive's priorities.

In all of this, I have been encouraged by the widespread support that the bill has received. Time after time, those who responded to consultation around the bill said how much they welcome the bill and the changes that it will bring. In session after session, those who gave evidence to the Health and Community Care Committee praised the bill's general principles. The committee, in its stage 1 report, welcomed the main changes that the bill is intended to make and recommended that Parliament approve the general principles of the bill. I thank the Health and Community Care Committee and the other three committees that considered the bill at stage 1. In particular, I thank the lead committee for a very constructive stage 1 report, which was the result of many painstaking hours of evidence taking, research and discussion. I will comment on several of the report's recommendations in a moment.

Let us consider the important changes and tangible benefits that the bill will bring. It will mean that the Executive will be able to tackle existing inequities surrounding care for older people by introducing free nursing care and free personal care. We will ensure that nursing care is finally free for all who need it, regardless of the context—free at home, free in hospital and, for the first time, free in nursing homes. In the same way, we will ensure that personal care is free for all Scotland's oldest people: the dementia sufferer and the stroke victim; those at home as well as those in care homes. The committee made it clear in at least three places in its report that it supports the inclusion in the bill of a definition of personal care. We have, of course, considered the committee's views carefully, and I am happy to announce that the Executive will lodge an amendment at stage 2 to include a definition of personal care in the bill, based on the definition that was arrived at by the care development group.

We will need to consider carefully how we can combine such a definition in the bill with the need for flexibility in its implementation. As I made clear to the committee in my evidence, I believe that that will be crucial to the bill's successful and sustainable implementation. I am therefore pleased to note that paragraph 32 of the committee's report

"recognises the need for a degree of flexibility".

The report also recommends that regulations that are made under the bill's powers should be subject to the affirmative procedure, and I am happy to accept that recommendation as well. I hope that this commitment to amending the bill will address the points that have been raised by the committee in its report and that we can all agree that the bill will mean a fairer future for Scotland's older people.

In line with its general principles, the bill will also extend choice. It will do that in many ways, above all by extending the availability of direct payments. Instead of service users being provided with services that are chosen by local authorities, direct payments give the service users the power to buy in their own services. The bill will ensure that direct payments are available throughout Scotland, while at the same time extending the scope of direct payments to all care client groups. In practice, that could mean that, whereas the care needs of someone with a learning disability are currently met by half a dozen different local authority staff, in the future that person would be able to employ one or two personal assistants to meet those same needs.

Changes such as that may be challenging, and perhaps difficult, for local authorities, but they will empower the service user, who will be able to commission the services that they need, when they want them and from the people whom they choose. The service user must come first. The extension of direct payments will help to deliver that change by increasing choice in home care.

The bill's provisions will increase choice not only in home care, but in residential care. Our commitment to improved choice in residential care is clear in the bill's provisions for top-up payments, in our removal of barriers to care home placements throughout the UK and in our introduction of deferred payment schemes, which will mean that people will no longer be forced to sell their homes to pay for residential care. Members will recall that a much smaller number of people would be in that position anyway, because of the introduction of free personal and nursing care. Those provisions will make a real difference for those in care homes and will combine with the improvements that arise from the Regulation of Care (Scotland) Act 2001 to bring better choice and quality into many people's lives. More than that, the provisions will ensure that anyone who is entering residential care for the first time will be able to experience real choice, with an assurance of quality services and the reassurance that they will not have to dispose of their home to meet the costs.

It is not only those who are in need of care who will benefit from the bill, however. As I said earlier, the Executive recognises the vital role that Scotland's carers play as partners in the provision of care. Our carers strategy acknowledges their immense contribution and our firm commitment to support carers better than ever before. This is no empty rhetoric; the resources that were attached to the carers strategy and the further new funding to expand short-break services throughout Scotland effectively mean that resources to support carers will have quadrupled in just four years.

One outcome of the carers strategy was the establishment of the carers legislation working group, which examined how we could support carers better through legislation. The group made a number of recommendations for change and those are an important part of our carers agenda. The majority of the recommendations do not require changes to primary legislation and we will be taking forward those changes in a variety of ways in discussion with carers organisations and other bodies that will be affected by them. The bill takes forward those recommendations for which new legislation is needed to improve support to careers. In particular, the bill gives carers the right to an assessment of their needs as a carer, independent of the cared-for person. I am pleased to announce that the Executive will lodge an amendment at stage 2 to ensure that the new right will be available to young as well as adult carers.

The new flexibility will improve carers' access to the support that they need to sustain them in their crucial role. It reflects their status as full partners in providing care, a principle that the Executive whole-heartedly endorses. I am aware that the Health and Community Care Committee suggested that that principle, and one other, be placed in the bill. We are considering what is reasonably possible, but we are concerned that the legislation should have precise legal meanings that will work in practice. If such meanings cannot be clearly set out in the bill, the interpretation might be left to the courts and might not reflect what Parliament intended. If it is not possible to give precise legal meanings, it is better to leave a provision out of the bill and avoid the problem. We need to distinguish between good intentions and good law and be sure that we deliver the latter.

The Health and Community Care Committee also suggested that there was a case for building on the extension of carers' rights by requiring local authorities and the NHS to identify carers and offer them information. I have also considered those points carefully. There would be practical and legal difficulties in imposing such a duty on the relevant people in the NHS in a way that would work. In any case, I do not believe that we need to go down that road as we can work with the NHS to build carer-awareness into the main stream of the health service through the development of a range of initiatives that are already under way. However, I recognise the committee's concern to ensure that carers are aware of their right to an assessment and I am examining carefully the scope that there may be for building further on the new right for assessment for carers with a view to lodging an amendment at stage 2.

The Executive will emphasise the importance of the partnership with carers in other ways. Good things are already being done to help carers in lots of different places, and the challenge for the Executive and other agencies is to spread that best practice. We plan to give clear new guidance to local authorities, the NHS and others to ensure that carers receive full recognition and support in their caring role and to ensure that best practice is turned into the norm.

No one should be mistaken about our commitment to improving support for carers not only through legislation, but across the range of the Executive's agenda. That same spirit of partnership is equally important for local agencies working together to provide services. The joint future group provided a new lead on joint working between NHS Scotland and local authorities, and applied the good practice of pilot schemes and projects across Scotland to the heart of community care.

Our commitment is to enable and drive a joint approach between agencies rather than to opt for wholesale reorganisation by creating a new body for community care services—such as care trusts, which are being implemented in some parts of England—which might be perceived as a takeover of one agency by another. The bill delivers on that commitment by removing the final remaining legal obstacles to better joint working within the parameters of existing agency structures. I believe that agencies are signed up to the joint approach and that that is more likely to deliver results in the short to medium term.

Much has already been done within the scope of existing legislation, such as the joint resourcing and joint management of learning disability services in Glasgow and of mental health services in Dumfries and Galloway. In Perth and Kinross, the agencies have formed a high-level partnership and have recently extended those principles by appointing joint locality management. However, the full flexibility of delegation and pooled budgets was not possible. Sections 10 to 14 of the bill will achieve that. They will allow NHS Scotland and local authorities to deliver services in a more integrated way. They will also allow more flexible resourcing to support our goal of care that is designed around the needs of individuals.

Sections 10 and 11 will free up barriers to the transfer of funds between NHS Scotland and local authorities. That will empower the new NHS boards and local authorities to plan for healthier communities, to improve well-being and to resource plans with the emphasis on the outcome for citizens, not the constraints on agencies. Those powers, as well as those in section 12 to delegate powers and pool resources, will allow the new approaches to community care service provision and the fuller integration of services that are needed to meet the expectations of service users, carers and patients.

The bill will allow local agencies to determine their local balance of care and to ensure that the resources that are available to them are used and channelled to best effect. It will also allow them real flexibility of response, pooled resources and the delegation of functions to the agency that is agreed to be best placed to lead on any particular function. In that way, agencies can concentrate on outputs for users, carers and patients rather than be restricted by fruitless discussions about who can do what and how it will be resourced.

I agree with the Health and Community Care Committee's observation that community care needs a well-motivated workforce. That is why we have established the integrated human resources working group under the chairmanship of Peter Bates. Membership of the group is drawn from a broad range of players. It includes, for example, a local authority chief executive, a primary care trust chief executive, personnel managers from NHS

Scotland and local authorities, and representatives from no less than five professional bodies and trade unions. The group, rightly, seeks to expand its membership to take account of the parallel interests of, in particular, the voluntary sector.

Already, the integrated human resources working group is consulting staff on the issues. Some issues, such as secondment protocols, training needs and personnel procedures to support new ways of delivering care, are short term. Other issues, such as pay and pensions, are clearly more complex and will require longer-term consideration. By the end of December, the group will have consulted more than 1,000 staff throughout the country on their concerns about, and aspirations for, joint working. A report will be produced for ministers by April 2002.

In the interim, section 13 is intended to reassure staff that their transfer between agencies will not affect them adversely. In section 14, Scottish ministers take powers to enforce joint working arrangements where necessary. That is not, and will never be, ministers' preferred option, but it may be necessary in the interests of users, carers and patients.

Of course, joint working is more than the sum of the statutory agencies. Voluntary organisations and private providers have a key role to play. We expect agencies to consult all the key players in care provision about joint working arrangements and to involve them in those arrangements. Agencies already have a statutory duty to consult the voluntary sector on community care planning arrangements; mechanisms to do that are in place throughout Scotland, and agencies should build on those. Our emphasis on the statutory agencies is deliberate. We want to improve joint working between the agencies as a matter of priority. From that, we anticipate better, more consistent engagement with the voluntary and private sectors.

The bill's contribution to better care services is matched by its measures to improve health services for all. Part 3 will extend the medical list system to all general practitioners, not just those who run practices. That will improve the coverage of our existing quality and discipline procedures. Patients can be confident that, whichever GP they see, that GP will be subject to high disciplinary procedures and standards. That may sound like a dry technical measure—if members have looked at the bill, they will see that it reads like one as well—but it is an important improvement to the quality of our health care service.

While I am on the subject of GP lists, I want to address the concerns that the stage 1 report raised about that issue. The Health and Community Care Committee recommended that the Executive should hold discussions with the Royal College of General Practitioners and the British Medical Association to clarify points in their submissions. I am happy to confirm that my officials have written to both bodies to resolve those matters.

I look forward to hearing the views and suggestions of my fellow MSPs during the debate. I also look forward to the detailed discussions with the Health and Community Care Committee that will follow at stage 2.

I remind members of the general principles that we have been discussing: principles of choice, partnership, equity and fairness, which have received broad support from many different quarters. I commend those principles to the Parliament and I commend the Community Care and Health (Scotland) Bill, which has been based upon them. I am confident that the bill will lay the foundations not only for better care services, but for better lives for many in our society: better lives for Scotland's older people, who will be able to live free from the fear of poverty and debt; better lives for service users, who will be able to choose how services are provided for them; and better lives for Scotland's carers, who will see that their contribution to Scotland's care provision is being recognised and valued.

I move,

That the Parliament agrees to the general principles of the Community Care and Health (Scotland) Bill.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party 2:51 pm, 28th November 2001

I welcome the new minister to his post and wish him well in the job. I congratulate the two new deputy health ministers, although it is perhaps appropriate to remind them of the old saying that quality is more important than quantity—as Shona Robison and I regularly demonstrate.

I also place on record my personal and sincere good wishes to Susan Deacon. Susan and I have crossed swords on many occasions over the past year and I have—with good reason—been a regular critic of her record in office. Having said that, I think that we would all agree that being the minister with responsibility for health in Scotland is one of the most difficult jobs in the country, if not the most difficult. I for one have never doubted the energy, commitment and, I believe, principle that Susan Deacon brought to the job. I wish her well in her future parliamentary work.

I am delighted to support the general principles of the Community Care and Health (Scotland) Bill, subject of course to the reservations expressed in the SNP's amendment, which I will turn to shortly. It is appropriate, while I am being nice, to place on record my thanks to all the witnesses who gave evidence to the Health and Community Care Committee. Something that will emerge from today's debate—it has already emerged from the committee's report—is the consistency in the themes that emerged from the evidence that the committee took. I hope that we will have the opportunity to explore many of those themes today.

I would also like to thank the committee clerks. It never fails to amaze me how a group of people can manage to distil the sometimes wandering deliberations of the Health and Community Care Committee and produce a report that is comprehensive and eminently readable. They are due some credit for that.

The main provisions of the bill are extremely welcome. As Malcolm Chisholm has said, the bill will regulate charging for care home services and, I hope, bring an end to the postcode lottery that has characterised community care for far too long, with local authorities charging wildly differing amounts for the same services.

The bill promotes choice for users of care services. Extending access to direct payments for community care will empower individuals who need care but who do not necessarily wish to relinquish control over their lives; it will enable them to access services that are more tailored to their needs. However, the Health and Community Care Committee is right to point out that that provision will make a real difference in practice only if local authorities are placed under a duty to advise people of their right to access direct payments. Local authorities must also provide people with support in exercising that right.

The provisions on third-party payments—allowing people to make extra payments from their own resources to secure a place in a more expensive home—are also welcome, as long as they are used only in circumstances where individuals have genuine choice. It would not be acceptable if people were expected to top up local authority payments in circumstances where the only care home place on offer is in a home that charges more than the local authority is willing to pay. The use of third-party payments must be closely monitored to ensure that they are not abused to plug gaps in local authority funding.

The bill also enables local authorities to make loans to people to pay for their care. Such loans will be secured against the value of people's houses. The arrangements have the potential to remove the need for anyone to sell their home—even to pay for the accommodation costs of care packages, which will continue to be chargeable after the introduction of free personal care.

The Convention of Scottish Local Authorities expressed legitimate concerns about the practical ability of local authorities to act as lending institutions. The committee took the view that preferably a national scheme, administered by a single body, should be established for the administration of that.

The bill contains some welcome news for carers. It gives them the right to request an assessment of their ability to care, regardless of whether the cared-for person is being assessed. The committee heard powerful evidence from Carers Scotland about the need to place local authorities under a duty to inform carers of that right. The experience of authorities is that if authorities are not placed under a positive duty to do that, giving carers that right will not be enough to improve the lot of carers meaningfully. I hope that the Scottish Executive will heed that advice.

The bill includes provisions that are designed to ensure effective joint working by local authorities and the national health service in the delivery of community care services. Those provisions are welcome, although there remains a degree of scepticism among the committee members and some of the many witnesses who gave evidence about the ability of senior NHS managers and local authorities to overcome their cultural and institutional differences to work together in the interests of service users. Frankly, the factionalism that often exists between those who run local authorities and those who run the NHS would make the Labour group look united.

Last year, in its report on the delivery of community care, the Health and Community Care Committee recommended that

"A single body should be given responsibility for ... planning and commissioning of community care services."

Notwithstanding the minister's remarks about the need to ensure flexibility and the dangers of imposing a uniform structure, I firmly believe that that recommendation should now be given serious consideration. I hope that the minister will not rule it out as a longer-term option.

Before I discuss the most important aspect of the bill—its paving the way for the introduction of free personal care—I will make a general point. The committee heard evidence from a number of witnesses to the effect that the bill should clearly state the principles that underlie it. It is becoming more common for bills to include statements of principle, but the Executive's approach to that is inconsistent.

Two weeks ago, we debated the proposed mental health bill. In that debate, Susan Deacon accepted the need to include in that bill a clear statement of the principles underlying it. For some reason, it appears that that approach is being resisted in this case. The minister says that that is because legislation must be precise. Of course, he is right about that, but if it is possible to produce a precise, workable statement of principles for the mental health bill, it is surely possible to do the same for the Community Care and Health (Scotland) Bill or for any other bill for which that is deemed appropriate. A clear statement of principle would undoubtedly be an aid to the interpretation of the eventual act and would help to ensure that the will of the Parliament was upheld. I hope that the minister will—as he has indicated he might—lodge an amendment at stage 2 to incorporate the principles of equity, fairness, joint working and partnership.

The debate should mark the beginning of the end of a hard-fought and well-won battle on the part of the Parliament to force the Executive to implement the key recommendation of the Sutherland commission, which is to make personal care free for all those who need it. I hope that this is indeed the beginning of the end of that battle.

The bill paves the way for free personal care by giving ministers the powers that they need to introduce that but, as Malcolm Chisholm has conceded, the bill does not enshrine in law the principle of free personal care, nor does it give any sense of what is to be included in the definition of personal care. The bill leaves it to ministers to define personal care by regulation. I warmly welcome Malcolm Chisholm's assurance that he will lodge an amendment at stage 2 to enshrine the definition in law. It is worth spelling out why that is so important.

Even if we accept the commitment of the current ministers to free personal care, what if a future Government, possibly a Tory one—I ask members to suspend their disbelief for a moment—which would probably be a malevolent one, something that does not require any suspension of disbelief, decided to scrap free personal care? Would we be happy to accept that a minister in such a Government—perhaps a new-generation Mickey Forsyth—should be allowed to do so by regulation, without having to pass primary legislation? I think not. But enough of fantasy. The Tories are not the real threat to free personal care.

Photo of Mary Scanlon Mary Scanlon Conservative

Does the member recognise that all 19 Conservatives voted in favour of free personal care? Will she endorse that fact?

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

I accept that, but it was the 19 years that preceded those 19 votes that led to me to make that judgment about the Conservative party.

The real threat to free personal care exists within the Labour party, both at Westminster and in Scotland. I was astonished to read in the Sunday papers comments from two Labour MSPs to the effect that the commitment to free care should be reconsidered and the definition watered down somehow.

Brian Fitzpatrick, who is not in the chamber, confessed to being "deeply concerned" about the policy. At least he has an excuse, as he was not an MSP when the Parliament unanimously agreed that the Executive should draw up proposals on free care. However, I am not quite sure what Kate MacLean's excuse is—incidentally, she is not in the chamber either. Was she not listening to the debates that took place in the chamber? On Sunday, she said that free personal care subsidises

"better-off people who can afford to pay for their own care anyway."

Really? Does not she realise that anyone who has assets of between £11,500 and £18,500 has to pay towards their personal care at present? Did she consider the position of people whose only asset is their family home or who have managed to struggle to save throughout their lives in order to be wealthy?

The most depressing thing about Kate MacLean's comment about wealthy pensioners is that it misses the whole point of free personal care, which is the very nature of that care. The fact that any one of us, irrespective of our wealth, could require personal care in our later years makes payment for that care out of general taxation the only equitable way in which to resource personal care needs.

Kate MacLean's comments were timely because they reminded us of the need for a clear definition to be enshrined in law. As I said earlier, I am glad that Malcolm Chisholm has given that commitment today. However, a question mark still hangs over the policy on free personal care, in the shape of £20 million. Before Jack McConnell was sworn in as First Minister, he announced a review of that policy because of doubts about the long-term funding of the package. There is a more immediate funding problem that the Parliament cannot simply ignore. The funding package for the introduction of free personal care in April is still £20 million short, because Westminster is insisting on the withdrawal of attendance allowance from Scottish pensioners as a way of punishing this Parliament for pursuing a policy that it disagrees with.

When the SNP raised that issue during our debate on 27 September, we were told not to worry. We were told that the matter was in hand and that the Executive was confident of winning the argument. When I raised the issue with Malcolm Chisholm at the Health and Community Care Committee meeting on 7 November, I was again told not to worry. On that occasion, I was told that Henry McLeish was leading the negotiations with Westminster and that it would all be fine. The following day, Henry McLeish resigned. It has been two months since the SNP first raised the issue in the Parliament, but it appears that we are no further forward. We are still £20 million short of the amount that is needed to implement free personal care next April.

Worse still, we do not know who is leading the negotiations now. At least when Henry McLeish was leading the negotiations, we knew that he was personally committed to the policy of free care. He had staked what was then his reputation on the matter. Frankly, we do not know what Jack McConnell's position is. All we know is that he has announced a review of free personal care. I dare say that he has had other things on his mind in the past few weeks.

That is why it is important that the Parliament takes two steps today, and I am delighted that Malcolm Chisholm has already agreed to take one of them. The first step that we must take is to send a clear message to Westminster that we want the matter sorted out quickly, so that our pensioners can at last have some certainty about the funding of long-term care. It is unacceptable for Westminster deliberately to undermine the will of the Parliament by withdrawing the very benefits that we want to enhance. We should not think twice about saying so loudly and clearly to Westminster.

The second step, which I am delighted that we will be able to unite around this afternoon, is that we should enshrine in law a definition of personal care, so that any minister—present or future—who wants to water down that definition must do so by primary legislation and not by the back door of regulation.

The care development group has already given us the definition that we should use in the bill. That definition would not deprive ministers of flexibility. If they want to enhance the definition, they should be able to do so by affirmative resolution; if they want to water it down, they should have to go through the Parliament's full legislative process. That would be appropriate. The SNP amendment would give us the opportunity to further both those aims.

In the spirit of unity that has brought us to the verge of implementing free personal care, I urge members of all parties to support the amendment.

I move amendment S1M-2247.1 to insert at end:

"but in doing so expresses its concern at the lack of a definition of personal care in the Bill similar to that suggested by the Care Development Group and at the fact that negotiations with Her Majesty's Government over the payment of Attendance Allowances have not yet been successfully concluded."

Photo of Mary Scanlon Mary Scanlon Conservative 3:05 pm, 28th November 2001

I congratulate the new minister. That he has gone from being a member of the Health and Community Care Committee and back-bench rebel to Minister for Health and Community Care is surely an endorsement of the democracy in the Parliament.

I also welcome Mary Mulligan and Hugh Henry. I hope that Hugh's attendance at health debates will be more frequent than his attendance at the Health and Community Care Committee. I also congratulate Richard Simpson, for whom I have a tremendous respect. That he has been given a remit on drugs and prisons is first class. As Nicola has already said, we extend our best wishes to Susan Deacon. I hope that Susan will join us on the Health and Community Care Committee because she would be a great asset—it would be fun.

I welcome the tone of the minister's speech. He accepted many of the points that the Health and Community Care Committee made. In the spirit of unity that Nicola Sturgeon mentioned we will support the motion in the name of Susan Deacon, not the SNP amendment. The points in the amendment have already been clearly made by the cross-party Health and Community Care Committee. The minister has already accepted one of those points and I know that the other is on-going. It is not necessary for the SNP to hijack the strongly stated recommendations of the cross-party committee.

We agree with what the new First Minister said last week that it is better to do less better. I am pleased to hear that he is reviewing health services. We can certainly confirm that considerable anger lies at the root of the change that is needed.

In June 1999, along with the other 10 members of the Health and Community Care Committee, I listed the main health priorities, so it is with much pleasure that I now stand to support the Community Care and Health (Scotland) Bill at stage 1. Given the fact that care in the community was highlighted as the major issue for committee members two and a half years ago, it is crucial that we get the bill right now. We need to address all the problems that have been highlighted in the oral and written evidence that the committee received and in the visits that it undertook, as well as in all the individual cases that are brought to us as MSPs.

We fully accept the principle that we need to end the discrimination whereby payment must be made for care for the frail and elderly yet NHS treatment is free for other conditions. It is only right that people pay the costs of accommodation including food and laundry because those costs would be incurred at home.

Our support for free personal care was based on the recommendations of the Sutherland report and the calculations that were made by the then Minister for Finance and Local Government, the care development group and the Department for Work and Pensions. None of those indicated the underestimation that we heard about at the end of last week. Our party did not sign a blank cheque when we backed the policy. Like other parties in the Parliament, we identified the accounting procedures and the calculations that were made at the time by well-respected bodies.

The definition of personal care has been endlessly discussed. I welcome the minister's announcement that the definition will be included in the bill. However, although the definition of personal care as endorsed by the care development group is now clear, the terms "social care" and "nursing care" are not quite so clear.

In fact, when he was Deputy Minister for Health and Community Care, the minister replied to my query by stating to the committee:

"there is a continuum between personal care and nursing care. There is an argument for collapsing the two into each other, because in going for free nursing care we are following a sort of international definition of nursing."—[Official Report, Health and Community Care Committee, 7 November 2001; c 2177.]

Photo of Malcolm Chisholm Malcolm Chisholm Labour

I want to point out that that was not correctly transcribed because, if members think about it, what I said was that free personal care could be regarded as part of the international definition of nursing. It would not make sense to say that free nursing care could be part of the international definition of nursing.

Photo of Mary Scanlon Mary Scanlon Conservative

My quote came from the Official Report .

Page 67 of the Sutherland report states that personal care

"falls within the internationally recognised definition of nursing, but may be delivered by many people who are not nurses, in particular by care assistants employed by social services departments or agencies."

Therefore, if personal care is nursing care and Westminster has decided to pay for nursing care with no argument over attendance allowances, we have to ask whether older people in Scotland are getting a raw deal or a different deal from older people in England. I ask the minister to address and clarify that point when he is summing up.

My next point highlights the most recent figure of 2,954 people who remain in hospital beds despite being assessed as requiring care in the community, at home, in a residential home or in supported accommodation. In February 1999, three months before the start of Parliament, the bed-blocking or delayed discharge figure was 1,724. Despite various initiatives and commitments, as well as a few million pounds here and there, the latest figure of almost 3,000 people highlights that major issue.

This week, I was at a meeting at NHS Highland with my colleagues Rhoda Grant and John Farquhar Munro. We were told that children were writing to the hospital to ask why their grandparents were being kept in hospital when they were being told that they should be cared for at home.

We welcome the emphasis on outcomes rather than budgets. However, point 66 of the policy memorandum refers to cases of failure in joint working and states:

"where the expected service outcomes are not being delivered ... Ministers will be able to use this power to require that local authorities and NHS bodies adopt certain key principles, such as a single management structure, with a single budget".

Why should we wait for failure when we already have well-documented failure. The case for a single budget is well made—it was recommended in the Health and Community Care Committee report. That issue must be addressed now.

More worrying statistics were published recently in "Scottish Community Care Statistics 2000" and in the Accounts Commission's review of home care services for older people, which was published last Friday. Between 1997 and 2000, the number of people seen by health visitors fell by 49,800. Between 1998 and 2000, the number of people who received home care fell by more than 9,000. Between 1999 and 2000, the number of people seen by a district nurse fell by 13,300. The number of people attending day centres and the number of people in residential homes were also down.

In a written response to those figures, the minister stated:

"recent changes in practice include increased activity in clinic-based settings".

In fact, the Accounts Commission's report states that

"with national policy focusing on care at home rather than institutional settings", the facts and the figures prove that the opposite is true. The national review revealed a different picture to Government policy.

We know the problems and we have the time, so we should address them and get the matter right.

Photo of Malcolm Chisholm Malcolm Chisholm Labour

I am sure that the member will accept that clinics are hardly an institutional setting. Does she accept that not only the number of visits but their length and intensity is relevant?

Does she accept that the emphasis has changed—for example, with the Starting Well project, which I visited recently—to intensive home visiting? Does she also accept that expenditure on home care increased by 10 per cent in the first year of the Parliament and is set to increase by much larger amounts in the next couple of years?

Photo of Mary Scanlon Mary Scanlon Conservative

I welcome the minister's point about increases in funding, but as I think all members of the Health and Community Care Committee have said, we are looking for increases in outcomes. The figures are horrific, by anyone's account. They fly in the face of Government policy, which emphasises care at home. That point cannot be missed.

In the Highlands, where 170 people are left in hospital when they should be in the community, we note that the Highland Council's proportion of net community care expenditure on home care for all ages is the lowest in Scotland at 8 per cent. We should also consider that. In comparison, Falkirk Council's proportion is 31 per cent. We need to consider the allocation of those budgets and why some councils allocate so much less than others.

The Highland Council tells us constantly that delayed discharge is all the health board's fault. On Monday, we were told that the fault lay with the council. That is not joint working, and patients are suffering. That could be overcome by accepting the Health and Community Care Committee's recommendation that a single body should be the budget holder, to achieve accountability and transparency and ensure a single point of entry for services.

The Conservatives would like that budget to be managed by the NHS, as the NHS carries the cost of councils' inability to accept that they must provide appropriate care and support to many people. The result is rising waiting lists in hospital and inappropriate care.

We fully endorse and welcome the recommendation of direct payments, which will empower and enable carers and families to purchase the care that they need, when they need it, and to choose the provider of that care. It is unfortunate that the number of people taking up direct payments in Scotland is just over 207. Of those people, 93 per cent are from the 18 to 64 age group. Half Scotland's local authorities do not participate in the scheme. I understand that eligibility depends on a person's being designated disabled, but nonetheless, a positive approach to direct payments must be taken, to maximise the success that the minister spoke about.

It is unacceptable for councils to monopolise referrals to their own homes at a weekly charge of £361 when, in the private, voluntary and independent sectors, the average cost is about £278. Direct payments would allow people to exercise choice in care and the quality of that care.

The Scottish Conservatives endorse, welcome and acknowledge the principles in the bill.

Photo of Margaret Smith Margaret Smith Liberal Democrat 3:18 pm, 28th November 2001

I welcome Malcolm Chisholm to his new job as Minister for Health and Community Care. As Nicola Sturgeon said, that is one of the most difficult jobs in Government in Scotland, but if anybody can do it well with charm and some ability, I am sure that that person is Malcolm. We trained him well on the Health and Community Care Committee, and he has continued to do great things since he ceased being a member of that committee.

I welcome the two new deputy health ministers—their positions reflect the importance of the health brief. The Labour party needs three people to do the job—or four if Margaret Jamieson, who is a member of the Health and Community Care Committee, is included—and the SNP needs two, while the poor old Tories and Liberal Democrats need only one each. I am not sure what that tells us about quantity and quality.

The experience of the three health ministers will be good not only for the health portfolio, but for the Parliament. Malcolm Chisholm has experience as a deputy convener and Mary Mulligan and Hugh Henry have experience as conveners of parliamentary committees. They will make use of that in performing their ministerial duties. I look forward to working with them in the future.

I must also pay tribute to, and bid farewell to, Susan Deacon. It would be fair to say that we did not always see eye to eye; we definitely did not see eye to eye on free personal care for the elderly. At no time, however, did we have anything other than respect for one another and the positions that we held. I was always very taken with the energy that Susan Deacon brought to her brief and with her hard work and commitment. Susan Deacon cared deeply about health care in Scotland and I wish her well for the future. For the past two and a half years, she has had her hands full, but she will have her hands full with something else in the year to come. I wish her well in that respect. If she finds herself on the Health and Community Care Committee, I recommend that to her—it is never dull. That would be fun, but I have no comment to make on what the former minister would make of it.

It is a privilege for me to stand in the chamber today as the Scottish Liberal Democrat spokesperson on health and as the convener of the Parliament's Health and Community Care Committee to acknowledge our wholehearted support for the general principles of the Community Care and Health (Scotland) Bill.

The bill will provide for the introduction of free personal nursing care for older people; the regulation of charging for home-care services, which have in the past been a postcode lottery; a legislative framework to permit greater joint working between the NHS and local authorities and others who provide care; and extensions of carers' rights. The bill will tackle iniquities and bring diagnostic equality and equity to care of the elderly. The way in which we treat our older people is a crucial test of our society. The bill represents an opportunity for the Parliament and the Executive to send a clear signal that we are determined to treat our older people with respect and dignity. I am happy to support that.

The bill is the culmination of a hard-fought battle and of a great deal of work that has been undertaken over many years. I pay tribute again to Sir Stewart Sutherland's work and to the work of his commission. I thank the members of the Health and Community Care Committee for their work over several years. I also thank the joint future group and the members of the care development group, under the chairmanship of the new Minister for Health and Community Care, for the work that they have put into the development of the policy.

The bill will deliver free personal and nursing care for Scotland's elderly and I welcome that whole-heartedly. Free personal care has undoubtedly been one of the Scottish Parliament's most contentious issues. However, in accepting the Sutherland commission's findings, we have contributed to one of the new Parliament's finest hours. Free personal care has the unequivocal backing of my party, the considered backing of the Health and Community Care Committee and the backing of the majority of MSPs of all parties. I believe that the paraphrase "the settled will of the people of Scotland" applies to the bill, which should not, must not and will not be thwarted or deflected.

Let us not forget some of the reasons why the bill is necessary. The system of payment for care was a confusing, unfair muddle: care in hospital was free, but intimate personal care delivered in an older person's home was means-tested and charged. The amount that an older person paid depended not on their needs but—because of charging policies in Scotland's councils—on where they lived.

That system has treated badly in particular the 60,000 Scots who suffer from dementia, because it penalises them for the consequences of their illness in a way that is different from those who suffer from cancer, heart disease or strokes. Opponents of the policy say—and will continue to say—that the provisions of the bill affect only a few thousand Scots who could afford to pay anyway, but I disagree totally with that. The provisions of the bill are about fairness for all our pensioners. The issue affects everyone. It will benefit us all to take away the fear of paying for care in old age and of losing the home that one has worked for all his or her life. The provisions of the bill will benefit tens of thousands of Scots who currently pay for nursing care and personal care and who currently receive care in their own homes.

If people look to the bill to reflect some of that sense of principle and some of the rhetoric that we have heard pronounced so eloquently in the course of the past two years' debate on the issue, I am sad to say that they will be disappointed. The bill is dry and technical and much of it refers back to and amends the Social Work (Scotland) Act 1968. Perhaps that is the way that it must be.

The Health and Community Care Committee supports the view that was expressed by many witnesses—including community care providers in Scotland and Carers Scotland—that the bill's general principles on the provision of free nursing and personal care, the delivery of joint working and the position of carers as partners in the provision of care services should be made explicit in the bill. We hope, partly because of what we have heard today from the minister, that the Executive will think again about that. I appreciate the need for clarity and precision in the legislation, but I do not think that the task is beyond our new minister.

I am delighted with the minister's assurances that the definition of personal care will be included in the bill. The committee welcomes the care development group's definition of personal care, which covers personal hygiene, continence management, food and diet, problems with mobility, counselling, simple treatments and personal assistance. The committee heard evidence for and against the inclusion of a definition of personal care in the bill, but on balance decided that such a definition should be explicitly included. However, we know that there might be a need for flexibility to improve the definition and we therefore recommend that ministers should be able to amend the definition by subordinate legislation, as long as that amendment improves and adds to the definition. Controversy surrounding the cost of the policies rages on, with different economists crystal-ball gazing into the future. Last June, Angus MacKay announced £200 million to resource free personal care and other aspects of the bill in 2002 and 2003. That built on £100 million for community care services that was announced by Susan Deacon in October 2000 and January 2001.

The Health and Community Care Committee took evidence from Professor David Bell, professor of economics at Stirling University, who is a member of the care development group with responsibility for costing free personal care. He outlined the costing exercise, which took into account demographic change and the aging population, health expectancy—which is expected to improve—and changes in the unit cost of care at the level of a 2 per cent increase each year. Although Professor Bell undertook a rigorous examination of costs, the minister has stated that the figures are at best prediction. There remains a lack of certainty over costs. It is clear that there will be increases in years to come and the committee has called upon the Executive to monitor continually progress in that area.

The Scottish Liberal Democrats and the Health and Community Care Committee back the Executive in its attempt to secure continuing payment of attendance allowance by the Department for Work and Pensions. The committee noted that in England, nursing care was being extended to include—without any withdrawal of benefits—elements of what would in Scotland be primary care. We consider that any withdrawal of the £20 million in Scotland would therefore be discriminatory.

The committee welcomes the Executive's plans to ring-fence the resources that are distributed to local authorities for implementation of free personal care and the other provisions of the bill. The Sutherland commission, the committee's report and the care development group all noted the funding gap between the amount of grant-aided expenditure that is distributed to local authorities and the amount that is spent on services for care of the elderly. Executive figures that the committee received—which show only part of the picture—show that only one third of Scotland's councils spend to or above GAE on older persons services, while overall our councils spend £98 million above GAE on all social work services. It is essential at this stage that we ring-fence the money that needs to be put in place to deliver those policies and that we move as swiftly as possible towards outcome agreements following negotiations with local authorities.

The bill includes elements of choice in care services, including deferred payments, which will allow individuals to enter into agreements with councils to defer selling their homes to pay for care. Although we welcome that, the committee had sympathy for a view that was expressed by COSLA, the Association of Directors of Social Work and others to the effect that that would mean councils engaging in new activities, which would be paid for by increased borrowing. We think that there is at least a need to consider that nationally and to have it administrated nationally rather than at council level. However, if the Executive does not accept that, it could consider the possibility of phasing some of those extra duties on to local authorities over the course of the coming year.

The committee welcomes the bill's provisions to extend direct payments and the ability to tailor services to individual needs. We recommend that a duty be placed on local authorities to advise individuals that they have a right of access to direct payments. We hope that that work will be developed in order to cut the bureaucracy of the present system and to encourage more people to make use of that service.

The committee welcomes the Executive's plans to give carers an independent right of assessment, but there must be a positive duty to ensure that carers are informed of that right. We welcome the news that there will be an amendment to that effect. We called on the Executive to consider the possibility of imposing a duty on councils and the NHS—which deal with 620,000 unpaid carers in Scotland—to identify carers and to ensure that they are informed of all their rights.

For many, the Community Care and Health (Scotland) Bill is simply the free personal care bill. However, the bill also sets up a framework for joint working that will allow greater partnership and flexibility between key community care partners in the NHS and Scotland's local authorities by lifting legal impediments to closer working. It is true that the committee has been concerned about the lack of progress on joint working to date, and we welcome the possibility of ministers being able to exert pressure on local authorities and other partners to work together. We also welcome their ability to enforce the bill's powers if that is necessary. We feel that it is important that all partners in care, including the voluntary sector, service users and carers, have a say in the development of joint working models.

There is a real challenge to all the component bodies to work together. We understand that the role of those who deliver services is critical and we have some concerns on that front. We know that successful joint working relies on a motivated and integrated work force. That is why we support the removal of barriers through nationally agreed salary levels and conditions for all those who work in care.

I welcome the minister's comments. We hope that the bill will mark a sea-change improvement in the delivery of community care services. We hope also that it will provide a framework that delivers not only free personal care but greater resources, better integration, shared assessments, effective partnership and our ultimate goal, which is a better quality service for the people who rely on community care services in Scotland.

Photo of George Reid George Reid Scottish National Party

We move now to open debate. Sir David announced that time would be tight, but some speakers have dropped out since then, so I shall allow up to five minutes for the first half dozen or so speakers. I call Margaret Jamieson.

Photo of Margaret Jamieson Margaret Jamieson Labour 3:31 pm, 28th November 2001

I record my congratulations to Malcolm Chisholm, Mary Mulligan and Hugh Henry on their appointments, and I look forward to working with them in the coming months. I also extend my good wishes to Susan Deacon. I am sure that she will play an important role for the Labour party on the back benches.

Before I begin, I declare an interest as a member of Unison, which has many members in the health and community care sector.

I add my thanks to Health and Community Care Committee members, to the committee clerks who worked hard to deal with the many submissions on the principles of this important bill, and to those who gave oral evidence to the committee. I must say that I am very disappointed that Scottish Care declined the opportunity to give evidence. That body is a key element in the partnership that will be required to deliver the care that is foreseen in the bill and its views would have been instructive. However, it would be quite wrong for any organisation that has had the opportunity to influence the bill at its earliest stage to criticise the outcomes from the margins. Partnership working requires all partners to play a full part in developing the process. Where better to do that than at the very start?

Partnership in building legislation is unique to the Scottish Parliament and, as such, is a particularly Scottish way of producing better legislation. It is on that partnership aspect of the bill that I want to concentrate. Sections 10 to 14 will enshrine in law, at the very heart of the act, the responsibility of the national health service and local authorities to work together effectively to deliver care services. That issue has been the cause of much heart-searching in the past as well as the cause of many disputes. The committee was disturbed that not enough had been done to ensure that flexible care arrangements were being developed. I draw the ministers' attention specifically to paragraphs 78, 79, 91, 92 and 95 of the committee's stage 1 report.

It is important that joint working can be developed flexibly and locally, but that must not be used as an excuse for delay and disagreement. Joint working also demands that resource transfer be open and clearly identifiable. There are few aspects of local government that have been more guilty of secrecy and, dare I say it, deception in some areas than resource transfer from the national health service to local government. That has been particularly obvious to those of us who have for many months sought to marry the GAE projections for social work funding with outturn spending to ensure that the needs of the most vulnerable people in society are being met from the funding that is made available for that specific group. It is therefore essential that all aspects of resource transfer and the methods of achieving it—such as pooled budgets—are clearly identifiable not just for accountants, but for ordinary Scots whose taxes pay for care.

That approach was called for in a previous Health and Community Care Committee report on the delivery of community care in Scotland, which stated:

"The Executive should take immediate steps to establish a simple and transparent guide to the funding of community care services, accessible to all stakeholders."

That approach would make it much easier to move towards another recommendation, which is made in paragraph 145 of the same report. That paragraph states:

"A single body should be given the role of budget holding, planning and commissioning of community care services."

The Health and Community Care Committee has returned to that view in reviewing the principles behind the bill. There is no reason to modify our stance on that approach. I urge the minister to consider the implications and benefits of such an approach as he takes the bill forward.

We must involve all stakeholders including the NHS, local authorities, the private sector, the voluntary sector, carers, clients and—equally important—the staff who deliver care. Providers must not compete with each other to provide the cheapest care. In the past, that has led to weakening of the quality of services in some areas, which is the very reason that the Regulation of Care (Scotland) Act 2001 was passed.

I have no hesitation in recommending that the Executive support a national pay and conditions scheme for all those who are involved in joint working. That scheme should involve all stakeholders in order to produce an effective national package. It should also be flexible enough to respond to local needs and circumstances. Members have agreed in many debates in the chamber that staff are our most valuable asset. Staff are not looking for words—they are looking for action. I urge the minister to reconsider his earlier statement.

We have an obligation to ensure that real or perceived obstacles are removed so that we can provide the best service for communities. We are concerned that that might not be happening in the integrated human resource working group. The watchword must be partnership—partnership to produce care services that the people of Scotland deserve and that involves all players meaningfully.

I commend the principles of the bill to Parliament and look forward to the minister addressing partnership issues at stage 2.

Photo of Tricia Marwick Tricia Marwick Scottish National Party 3:38 pm, 28th November 2001

I congratulate Malcolm Chisholm on his appointment. We have known each other for a long time in different roles and I am sure that he will bring to the job his commitment to and passion for health and social inclusion issues.

In the policy memorandum, it is made clear that most of the bill's provisions will have an impact on local government because of local government's central role in delivering social services. I am surprised and disappointed that I am the only member of the Local Government Committee who will speak in today's debate. The Local Government Committee took evidence and fed in to the Health and Community Care Committee's report. Local authorities expressed a number of concerns in that evidence. The minister acknowledged that there are challenges for local authorities in the bill in respect of joint working and resources in particular. I will perhaps address that later.

My colleague Nicola Sturgeon addressed the need for a definition of personal care within the bill. The Local Government Committee also felt strongly that there should be such a definition and the social work directors of Perth and Kinross Council and South Ayrshire Council indicated in their evidence to the committee that there should be a base-line definition of personal care on the face of the bill. I welcome the minister's commitment to introduce an amendment at stage 2, because it would be quite unacceptable if such an important piece of legislation gave to present and future ministers the power to determine by regulation what personal care is. We cannot allow personal care to be a political football that is juggled between health and finance ministers, who will decide by regulation from year to year what constitutes personal care and what does not. Decisions should be made based on what the patient needs, rather than on what can be trimmed to accommodate the budget of the day. I welcome the assurances that the minister has given.

An issue—which is not directly related to the bill and therefore cannot be removed by amendment—that came up in the Local Government Committee is the problem of dual financial assessments. Those assessments will be required as a result of the different levels of capital assessment for income support and for home care. It is absolute nonsense that we should even consider putting elderly and vulnerable people and their families through two different assessments. Not only will that lead to increased stress and confusion, it will—to be frank—be a bureaucratic mess.

Although I acknowledge that benefits and income support are a reserved matter, I would like the Executive to consider with colleagues in Westminster the possibility of a single assessment procedure. I would welcome an assurance from the minister that he will take forward that suggestion as a matter of great urgency.

Local authorities will be pivotal in delivering the social work services and as many members have said, joint working will present many challenges to the culture, management, structures and accountability of local authorities and health boards. The Local Government Committee heard evidence of good practice out there, but we need to ensure that that good practice is the minimum that is required in joint working.

My view is that much more work needs to be done before we can be confident that joint working arrangements are flexible and secure enough to ensure that the person who needs the service gets the service. We need to stop the turf wars that take place between health boards and local authorities.

Local authorities are also concerned about the resource implications of aspects of the bill. It is vital that the necessary resources are provided to ensure that the bill has the opportunity to make the difference that we know it can make.

The bill will be better when it is amended, but it must not be allowed to fail simply because there is not sufficient money to support it. I give a warm welcome to the bill and the amendments that the Minister for Health and Community Care said that he would lodge. However, it is vital to local authorities and health boards that the resources that are needed to fund the bill are put in place and that they work for the benefit of the people who need the bill.

Photo of Janis Hughes Janis Hughes Labour 3:44 pm, 28th November 2001

I echo the comments that have been made elsewhere in the chamber and offer my congratulations to Malcolm Chisholm and to the two new Deputy Ministers for Health and Community Care. I thank Susan Deacon for her past contribution to the health portfolio. I declare as an interest that I am a member of Unison.

The Community Care and Health (Scotland) Bill represents a significant step forward in the care of the most vulnerable people in our communities. I believe that the Executive should be praised for that. That is not to say that the bill is perfect. I was disappointed that it was published and introduced to the committee before the care development group's proposals were published. We heard from some of the people from whom we took evidence of their concerns about the timing. Sometimes we have to be careful about just how quickly we push legislation through. It would have made more sense to wait for the care development group's report before introducing the bill to Parliament.

Along with fellow committee members, I feel that the bill suffers from not having a statement of its general principles. That comment has been made by others this afternoon. While we do not doubt the current Minister for Health and Community Care's good intentions, it would be helpful to have a clear statement of what this bill seeks to achieve. I accept the minister's argument in his opening speech about legal meanings, but I urge him to consider whether further clarity may be possible. It would also be helpful, as we have already heard, to have a clear definition of what constitutes personal care. I am delighted to hear from the minister that the Executive will lodge amendments to provide that at stage 2, in line with the recommendations of the care development group.

I will focus on the provisions in the bill for carers. Members who have read the Health and Community Care Committee's stage 1 report will have noted the comments of Isobel Allan of Carers Scotland, who gave evidence to the Health and Community Care Committee. She lives in my constituency and is an active member of Cambuslang Community Carers. I have been particularly interested in legislation to support carers, which I have mentioned on numerous occasions in various debates in this chamber. I am pleased that the bill will extend the right to an independent assessment for carers. That is important and has been long awaited by carers groups. I hope that an examination of the provision of respite care will be an integral part of assessments.

Isobel Allan told the committee:

"Forgive me for personalising the issue—I cannot speak for the 600,000 other carers—but, as a carer, I need what you need. I need the right to have a normal life. I am not looking for anything special or anything extra. I just want the chance to sleep, to eat, to go out, to finish a meal and to have some kind of ordinariness in my life. The only way that I can get that is by getting a break. That is crucial; it is paramount."—[Official Report, Health and Community Care Committee, 24 October 2001; c 2072.]

Ensuring that those breaks are provided for people like Isobel Allan is vitally important. I hope that that will be a crucial part of the assessments.

The Health and Community Care Committee recommended that the bill should be amended to impose a duty on local authorities to take steps to identify carers and ensure that they are informed of their right to an assessment. The evidence that we took persuaded us that it is important that that duty is enshrined in legislation, not just in the guidance. I hope that the Executive will respond favourably to that request in due course.

I echo my colleague Margaret Jamieson's comments on pay and conditions for staff who are involved in joint working. Good pay and conditions are vitally important not only for the motivation of staff, but for their recruitment and retention, which is sometimes a major problem in the caring professions.

The Community Care and Health (Scotland) Bill is a good piece of legislation. It is another step towards helping those who need it most. I hope that the Executive will take note of the committee's report, which has been offered in the best possible spirit, and produce proposals to make the bill even more effective.

Photo of Bill Aitken Bill Aitken Conservative 3:48 pm, 28th November 2001

When this matter was first debated, there was a consensus that the bill was an important piece of legislation. It is a sad fact that none of us is getting any younger. The fact is that the people of Scotland, including Nicola Sturgeon, are all getting older and, more seriously, all getting older at the same time. Given that demographic difficulty, there are difficult times ahead unless we resolve matters and consider carefully the approach that we are going to take to care of this nature.

We have to recognise that there have been failures in the present system. Joined-up thinking is one of new Labour's buzz phrases, but unfortunately it is manifestly obvious that joined-up thinking has not been apparent between the health authorities and local authority social work departments over many years. Accordingly, that issue must be examined. I see from the Health and Community Care Committee's report that some consideration has been given to it already. That can only be of benefit.

Some of the figures are pretty depressing. The numbers of people affected by bedblocking push things far beyond a tragedy, and the issue clearly impinges upon individuals with sometimes devastating effects. For example, 2,954 people in Scotland are unable to leave hospital because the appropriate arrangements are not in place. There are 335 such cases in the greater Glasgow area; indeed, I find it surprising that in the Lothian area, where the minister and deputy minister—to whom I offer my congratulations—have their constituencies, the figure is as high as 463. As for Hugh Henry—whom I can see watching avidly from the back of the chamber and whom I also want to congratulate—the figure is 452 in the health board area that contains his constituency. Indeed, the number of bedblocking cases in the Renfrewshire Council area is 232, which possibly reflects the era when Hugh Henry was in charge. Those issues have to be examined closely and progressed.

We were encouraged by the minister's comments on the definition of personal care. As the matter is of supreme importance, we do not want the definition to require interpretation by the courts. The wording must be sufficiently tight to ensure that no difficulties arise.

The question of choice and direct payments is vital. Frankly, it is little short of a disgrace that uptake by local authorities is so low, and I strongly suggest that they should be made to participate in the direct payments scheme. That can only benefit all concerned.

As Mary Scanlon said, when our party decided to support the Sutherland recommendations we did not suggest that a blank cheque should be issued. We stated the tremendous savings that could be made by scrapping health boards and solving the current bedblocking scandal. That is the nub of the problem.

Janis Hughes's words were particularly apt. Sadly, we have failed to recognise the immense contribution that carers have made to Scottish society. Many of them lead a very difficult life because of their commitment to the individual for whom they care. It is particularly striking that carers organisations should have underlined in correspondence the fact that their members have often been poorly served by statutory agencies. Those people are frequently not informed of their rights, are left isolated and find authority difficult to deal with. We have to address that situation, and the bill contains a provision to do so. If we do not do so, paragraph 66 of the policy memorandum—which ominously mentions "failures"—would have to be brought into play.

Photo of Dorothy-Grace Elder Dorothy-Grace Elder Independent 3:53 pm, 28th November 2001

I do not know why Bill Aitken is so worried about blank cheques. He knows perfectly well that one has been issued to pay for the new Parliament. Anything that this legislation will cost us will be cheap at the price. Dare I whisper that the latest bill for roads and mere landscaping is more than £14 million. I do not know how one could possibly rack up such a bill for trees and dauds of grass.

However, that is beside the point. I welcome the two new Deputy Ministers for Health and Community Care. Given the fact that the brief is so huge, having two deputy ministers is a sensible move. Furthermore, I welcome Malcolm Chisholm back into the spotlight. I have always known him to be a man of principles, and I hope that he does not lose any along the way. One can occasionally mislay these things if one is in a high ministerial position. I also pay my due to Susan Deacon, who took on a terrible burden as the first Minister for Health and Community Care in the first Scottish Parliament.

The Parliament sometimes has the public popularity rating of scabies or head lice, but today we have something to be rather proud of. The bill could not have been scrutinised and approved in anything like this time span if we had stuck with Westminster. It would have taken two or more years to secure even a debate for Scots on this subject, yet a bill has been drafted and is on our desks in just over two and a half years.

I think back to the beginning of the Health and Community Care Committee—I am an original committee member—and remember my colleague, Kay Ullrich, a former social worker, going on and on about free personal care and the Sutherland report. We achieved total consensus on the issue. We had valiant backing from our convener, Margaret Smith, and we showed the advantage of members' having come from real jobs before they entered politics. In our midst, we had Margaret Jamieson, a former Unison official; Shona Robison, a former care organiser; Dr Richard Simpson; and Mary Scanlon, who has vast life experience and who did indeed—I can testify to it—back the provision of free personal care. All that experience helped to bring us together in the battle on behalf of people who have been neglected for so long.

Our generation's record on helping pensioners is really shameful. We have not got much time left to change that because the generation that won the war, created a national health service and gave us almost every benefit that we now enjoy is leaving us. We have let those people down shamefully. In their old age, they are not being rewarded but punished simply for being old and frail. I offer a word of warning. The bill must be a test for the new Cabinet. There must be no delay, no foot-dragging and no interference from Westminster. The bill is ours and we are rather proud of it. Westminster could not have done the job that the Scottish Parliament has done.

I support Janis Hughes and others who have mentioned the need to include our commitment to carers in the bill. Malcolm Chisholm spoke of what he called the

"need to distinguish between good intentions and good law" when putting that commitment in the bill, as Carers Scotland has pleaded on behalf of Scotland's 620,000 carers. Carers deserve that dignity and assurance. Good lawyers should be able to find the words to back good intentions with good law. Otherwise, what are we paying them for?

I hope that free personal care will one day extend to others besides the elderly—to all who are in need. The plight of younger disabled people is too often ignored. It is summed up by a case that I am dealing with right now, in Baillieston, in the east end of Glasgow. A 41-year-old woman who is suffering from multiple sclerosis has been put into an old folk's home there because there was nowhere else to put her temporarily. There had been huge bureaucratic delays in the building of an extension to her home. Help to keep people in their homes is one of the budget facilities that we must consider, because people want to remain at home with their families whenever possible. That 41-year-old woman, who tonight will have to spend another night in an old folk's home, is the sort of person whom we must help in the future. However, today we have at least made a start in helping older people.

Photo of Nora Radcliffe Nora Radcliffe Liberal Democrat 4:00 pm, 28th November 2001

I congratulate the new health team, wish them well in their work and pay tribute to Susan Deacon for her contribution as our first Minister for Health and Community Care.

Like everyone else, I welcome this bill, which will enable provision of free personal care. I was pleased to hear the minister's earlier assurance that a definition of personal care will be included in the bill, as I am frequently asked by constituents what personal care is. The inclusion of a definition is fairly fundamental.

As well as benefiting individuals, the funding of personal as well as nursing care should make it easier to integrate health and personal care services. It should eliminate, or at least greatly reduce, the hidden drain on resources, both financial and human, that results from having to decide what falls within or outwith definitions and, therefore, budgets.

I welcome particularly the elements of the bill that will make a difference for carers. The general principles of the bill should promote the role of carers as partners in care provision. The positioning of carers as key partners in the provision of care should replace the all-too-prevalent perception that carers are clients and are a drain on resources, which results in their being sidelined and ignored. The contribution that carers make must be acknowledged. The hundreds of thousands of carers in Scotland are relieving the statutory authorities of service provision that is valued at anything up to £3.4 billion. Sadly, that contribution is sometimes not recognised. Even more sadly, it is often totally unsupported.

That is why the extension of the right of carers to have their needs assessed independently of the cared-for person is important. To benefit from that, however, carers have to know what their rights are and how to access them, and the resources have to be there to meet the identified need. The statutory authorities must recognise the special circumstances of many carers that might lead to isolation and make it difficult for them to take care of their needs and participate in consultation, for example. If one's caring commitments are such that one has no opportunity to take a break from them, how can one seek out information on respite care or go to meetings to discuss better service provision? We have to invoke the Heineken principle and ensure that we reach parts that we have not reached before.

I make a special plea on behalf of young carers. Too many children are shouldering adult burdens and are being robbed of their childhood. We are failing them badly and my experience shows that, even when we know who they are and where they are, the support that is available to them is thinly stretched.

I strongly support the recommendation that the health service and local authorities should have a duty to identify carers. If they do not identify carers, how can they either work properly with them in partnership or see that they have the support that they need to carry on caring? To illustrate the necessity for that, I will tell members of a case that recently made me extremely angry. An 80-year-old man who had been caring single-handedly for a dependent wife discovered by pure chance—by way of a passing remark by an acquaintance—that voluntary respite care was provided in the town that he was living in. His household had been visited regularly by medical staff and someone, somewhere, should have seen what was happening and put that man in touch with the resources that eventually made an enormous difference to his quality of life.

I welcome the bill in total and the provisions for carers in particular. I also welcome the elements of the bill that will facilitate people working together.

Photo of Irene Oldfather Irene Oldfather Labour 4:04 pm, 28th November 2001

I offer my congratulations to the new minister and his two deputies. I also extend my good wishes to Susan Deacon. As Margaret Smith said, two of the three ministers have come from the Health and Community Care Committee. All bring with them invaluable parliamentary experience that will be helpful in the months ahead.

I am pleased to be able to speak in today's debate. Community care has been at the heart of the work of the Parliament since it was set up and I know the hours of effort that the Health and Community Care Committee has devoted to this subject, first with its community care inquiry and, more recently, in taking evidence in connection with this bill. Today seems a little bit like a reunion as Kay Ullrich and I, both former members of the Health and Community Care Committee, are back in the debate. It is nice to be here. The Parliament owes the committee members and convener its thanks.

When the Scottish Parliament was set up, many of us said that the test of its success would be whether it changed lives for the better. There cannot be a clearer demonstration of that than the potential that the bill offers for our older people. Other speakers have made pertinent points about the opportunities that the bill presents. There is widespread agreement that an assessment of the needs of carers is a welcome development. As well as ensuring that local authorities have a duty to inform carers of their rights, we must ensure that there is adequate follow-through on assessments. Carers must not be left feeling that assessments have been bogus exercises. I take heart from the minister's comments and look forward to seeing his proposals at stage 2.

The minister mentioned equity and fairness. Those involved in caring for the elderly will whole-heartedly endorse those principles. As the minister said, they must translate into tangible benefits. I join others in welcoming the minister's commitment to introducing a definition of personal care. I ask him, when he defines personal care, to take careful account of the nutritional needs of the elderly. To keep old people healthy, we must ensure that they eat properly in hospital, in residential accommodation and at home. Unfortunately, research has shown that many older people in care and in the community are undernourished. For those with Alzheimer's disease or dementia, the provision of a cooked meal is just as important as ensuring that they take their medication. For others who are physically frail, assistance with eating is needed. That is part of good health and must be recognised.

Few would disagree with what I am saying. However, there is a voluntary group in my area that prevents those on the margins of maintaining independence in the community from going into care. Despite that, the group is unable to obtain funding because it does not provide a statutory service. It falls between the health board and social services department. Recognising the importance of nutritional needs as part of personal care would better allow old people to benefit from voluntary provision. That brings me to joint working, which all of us welcome. It is important that voluntary organisations are integrated fully into the process of caring.

A challenging agenda lies ahead, particularly for smaller local authorities in which management and staffing structures are lean. Although my local authority fully supports the principles of the bill, it would welcome assurances that it will be guided and supported in implementing the major but welcome policy shift.

The debate has been useful. I hope that the message goes out from the Parliament that we value our old people and that we are committed to ensuring dignity in old age. I support the motion.

Photo of Alex Fergusson Alex Fergusson Conservative 4:08 pm, 28th November 2001

I take part in the debate with great personal pleasure. That is partly because, as I am now on the wrong side of 50, I am keen to ensure that as much as possible is free for the elderly. It is also partly because it gives me an opportunity to warmly welcome the minister and his deputies to their new posts. They will not need me to remind them of the importance of their task. I am sure that all members wish them well for the future.

I take part in the debate with pleasure particularly because, however hard Nicola Sturgeon may find it to accept, I have always been uncomfortable with the notion that, if someone works hard all their life, saves what they can, perhaps manages to buy their own home and to put something aside to leave to their family, all their efforts may be negated should they be unfortunate enough to be in need of long-term care in their old age. That becomes all the more perverse when we realise that someone who has been profligate all their life, never saved a penny or even thought about retirement has their long-term care costs met in full by the state. That seems to me to be utterly wrong. In effect, hard work is being penalised and profligacy is being rewarded. That completely undermines the ethic of personal responsibility on which any free society rests and, in reality, provides people with a huge disincentive to make sensible provision for their future.

I was delighted when we as a party accepted the principle proposed by the Sutherland commission that personal care—let us be clear that we are talking about the cost of personal care only, not the hotel costs of board and lodging—should be provided free at the point of delivery by the NHS. That is right and proper and the Scottish Conservative party will play its full part in bringing it about.

I will spend a short time on annexe B of the Health and Community Care Committee's report. My point concerns an item of supplementary written evidence from Age Concern Scotland that concentrates on the vexed question of notional capital—a suggestive and condemnatory phrase—which determines whether someone has disposed of capital specifically to avoid any charges for their care. The case studies that are listed by Age Concern Scotland—no doubt most members have been made aware of similar cases in our regions and constituencies—show that the concept of notional capital has led to appalling cases of apparent injustice that take a considerable time to solve and undoubtedly cause a great deal of added stress to someone who is already ill. In our view, that is an untenable situation that I hope can be corrected during the passage of the bill.

The south of Scotland region, which I represent, and the region of Dumfries and Galloway, in which I am lucky enough to live, have a very high age profile. There is a disproportionate number of the elderly in those regions. I suspect that that situation applies to rural Scotland in general. Many people choose, after all, to retire to the country for the peace and tranquillity that the countryside offers. The bill is of great importance to rural Scotland.

Rumours have circulated from time to time that the provision of free care for the elderly will somehow bring hordes of pensioners from south of the border to live in the sort of free-care havens that might be offered in rural Scotland. We utterly reject that theory. If teachers have not been tempted north by the McCrone settlement—and evidence shows categorically that they have not—there is no reason to suggest that pensioners would be similarly tempted to live in a part of the United Kingdom with which they are unfamiliar and in which they would, therefore, feel somewhat uncomfortable.

We greatly welcome the provision of free personal and nursing care, but we have always made it clear that that should be looked upon as a solution for the short to medium term only. Much more work needs to be done to find the best long-term solution, which should encourage people to make more provision for themselves in a way that would benefit the thrifty without rewarding the profligate. Such a solution might well include encouraging people to make provision during their working lives not only for their pensions but for care costs. For that to succeed, assets that people build up during their working lives must be protected.

People need incentives; they respond to them. Without incentives, people will not bother to make provision for care. Forcing people to sell their assets to pay for care is no incentive, so the current situation must be addressed.

I look forward to following the passage of this bill through Parliament, and I warmly welcome its publication.

Photo of Colin Campbell Colin Campbell Scottish National Party 4:13 pm, 28th November 2001

I want to reiterate the point made anent the £20 million attendance allowances that are being held back by the UK Exchequer, to which the people of Scotland who are in care are entitled. First, it is a small sum when compared with the global totals that the Chancellor tinkered with yesterday; it should not be the subject of internecine strife between the Scottish and UK Governments. Secondly, at the risk of provoking the UK parties—although a little provocation this afternoon may get things going a bit—I have to say that, if Scotland had fiscal autonomy, preferably as an independent nation, this particular dispute would not be necessary.

The underlying issue that the debate addresses is clear: there is a lack of uniform provision in the present arrangements, with people in hospitals having free care and people in nursing homes having to pay.

Photo of Ben Wallace Ben Wallace Conservative

If Scotland was independent, will Mr Campbell tell us where he would find the £20 million? Whom would he tax to get the £20 million to provide free personal care and the extra money that Scotland receives through the Barnett formula?

Photo of Colin Campbell Colin Campbell Scottish National Party

We have already paid the money in tax to the United Kingdom Exchequer; it is sitting there as part of the totals that we have already paid in. Good try, Mr Wallace.

There is little doubt that care is an enormous problem that will only become greater. Life expectancy has increased as a result of improved living conditions, safer working conditions, increased leisure provision and technological advances in health care. Concomitant to that is an increase in the survival rate and an increased financial burden on the employed population.

I was going to remark on the absence of a definition of personal care. I am delighted to have been able to delete that part from my speaking notes and I am pleased that Malcolm Chisholm will address the point in the proposed primary legislation, where—as Nicola Sturgeon said—the definition must be enshrined.

I was impressed by the proposal to put carer awareness into the main stream. The value of that is obvious. So many professionals are so overwhelmed with their work that, if a certain service that they provide is not understood to be a sine qua non—or essential—of their job, there is a danger that it may be omitted, even by the best intentioned among them.

We all share the Government's ambition to get legislation in this area right. I say that objectively, not—as Alex Fergusson—was indicating, because I am chronologically closer to the possibility of requiring care than some other members, although I understand that the need for care is not necessarily age-related.

I make a presentational plea. My experience from talking to constituents with benefit difficulties is that such problems inevitably expose the labyrinth of regulations surrounding all Government allowances, which people have to wade through with great difficulty. I ask the minister, after his section-by-section overview, to remember the advice given by a former agent of mine—KISS, or "Keep it simple, stupid." It was not pejorative; it was just a bit of advice to me. I ask that even the complexities of the worthwhile regulations that flow from the eventual legislation be easy to read, clear, concise and comprehensive, for the benefit of carers and people who require care. People in those situations do not need to have to wade through the small print of legislation. I make that plea to the minister as a former teacher to a former teacher.

Photo of George Reid George Reid Scottish National Party

If members want their time to be extended, permission will gladly be given on this occasion.

Photo of Karen Whitefield Karen Whitefield Labour 4:17 pm, 28th November 2001

I add my congratulations to Malcolm Chisholm and his two new deputies. I wish them well in their new role. I pay tribute to the work of Susan Deacon, our former Minister for Health and Community Care.

I am particularly pleased to be able to speak in the debate because I am not a member of the Health and Community Care Committee. For that reason, and as the convener of the cross-party group on carers, I intend to limit my remarks to carers issues. Much of what I intended to say has been expressed well by committee members, who are well aware of the issues.

Before commenting on the sections of the bill that relate to carers issues, I pay tribute to Health and Community Care Committee members for their stage 1 report. I welcome the report, and hope that the Executive will give it full consideration.

There is no need to highlight the vital role played by carers. Discussions about the vital support that they provide have been well rehearsed. We have all heard the relevant figures and we are all convinced of the value of carers in Scotland and of the need to ensure that they receive proper recognition, support and assistance.

Representatives of Carers Scotland gave the Health and Community Care Committee moving evidence regarding the need for strong assessment and support structures for carers. I was pleased to note how they felt:

"The principles of the bill offer the opportunity to revolutionise the experience of carers in Scotland and to change fundamentally their status and position, from being perceived as needy and a drain on resources to being seen as partners in the provision of care."—[Official Report, Health and Community Care Committee, 24 October 2001; c 2062.]

The carers strategy began the process of providing proper recognition to Scottish carers and clarified the commitment of the Parliament and the Executive to carers. The bill continues to strengthen that commitment.

I am pleased that the bill will ensure that carers have an independent right to assessment. However, the right to an assessment is useful only if the carer is aware of it. In that regard, I share some of the concerns of Carers Scotland, of other carers organisations and of members of the Health and Community Care Committee, and find myself agreeing with the recommendations in the committee report.

There is compelling evidence to suggest that there is a need to impose a duty on local authorities and the NHS to take steps to identify carers and to ensure that carers are informed of their right to an assessment. There is a need for clear and flexible guidelines, although such guidelines will not be enough on their own. If we insert a statutory duty in the bill, we will provide a much greater incentive to local authorities and the NHS and greater recourse for dissatisfied carers or carers organisations.

I am pleased that the bill recognises that carers are key partners in the delivery of care services. Many local authorities already work in partnership with carers. Indeed, my local authority, North Lanarkshire Council, has successfully involved carers in the design of services. I am also pleased that the minister indicated that the Scottish Executive is willing to lodge an amendment that will give young carers the right to assessment, which I believe is a vital step. Young carers face a particularly difficult task. The burden of caring can often have a negative impact on their education and on their ability to socialise with their peers. They deserve all the support that society can provide.

I will conclude with a few words on the importance of providing respite to carers. Carers Scotland was right to point out that carers should not be seen as clients or recipients of services, but as the providers of services. They need support and assistance in the provision of care, including the provision of adequate respite. We would not dream of asking professional carers in the NHS or in local authorities to provide care 24 hours a day, seven days a week, and we should not expect such a service from Scotland's carers. We need to provide proper respite, so that carers can spend time away from their caring duties, safe in the knowledge that the person for whom they care is not suffering as a result of their absence.

I reiterate my opening point. I am pleased with the bill's provisions on carers, but the Executive could still go a step further and deliver a Scottish bill that would be the envy of carers across the United Kingdom.

Photo of Keith Raffan Keith Raffan Liberal Democrat 4:22 pm, 28th November 2001

I welcome the minister to his new post. When I first became a spokesman on health, there seemed to be at least two health debates a week. I was thrown in at the deep end and asked the minister how I should deal with the situation. He metaphorically put his hand on my shoulder and said, "Keith, specialise—and quickly," meaning in those areas in the health field in which I felt I had some in-depth knowledge. I respect the way in which he has initiated and responded to debates as a deputy minister and I wish him well in his new post. I also congratulate his two deputies.

I am sorry that we have lost Susan Deacon from the Executive. I respected her commitment, her obvious concern and her desire for an improved health service. Not least, I respected the quality that she brought to debate in the chamber that might best be described as feistiness. I may not always have agreed with her, but I certainly have great respect for her.

I welcome the Community Care and Health (Scotland) Bill. As others have said during the debate, the bill goes beyond free personal care for the elderly, but I will restrict my comments to that issue.

I resigned as my party's health and community care spokesman earlier this year over free personal care for the elderly. That is past history—I do not want to rake over it. Despite the fact that I have been given extra time, I will not abuse that position by giving the chamber a lesson on that quite colourful period in the Parliament's history.


Go on.

Photo of Keith Raffan Keith Raffan Liberal Democrat

A lot has happened since then, not least in the past few days—so that period is almost pre-history.

We have come a long way since the Minister for Parliament made that famous statement to Parliament in January, just a few minutes before decision time, conceding on free personal care on behalf of the Executive. I pay tribute to the new Minister for Health and Community Care for the way in which he has made progress on the issue since then. Few of us would have believed that he could have produced—virtually on time—the care development group's substantial report. He met a tight deadline. He and the Executive have been as good as their word.

I do not find much with which I would disagree in the SNP amendment, although it has been overtaken by events and, in particular, by the minister's opening speech. I welcome the minister's willingness to produce an amendment that contains a definition of free personal care. That is important and I look forward to such an amendment being lodged at stage 2. I presume that the amendment will be along the lines of paragraph 4.14 of the care development group report. It is as clear a definition as any that I have seen. I would be grateful if the minister could confirm that when he winds up.

Photo of Keith Raffan Keith Raffan Liberal Democrat

I will finish my point, then—as I have so much time—I will be happy to give way to Ms Sturgeon.

I hope that the minister will lodge an amendment along the lines of paragraph 4.14.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

I may be jumping the gun somewhat, but I hope that Mr Raffan accepts that only half of the SNP's amendment has been overtaken by events this afternoon. The other half of the amendment remains perfectly valid and is important. Does he agree that we should send a clear message to our counterparts in Westminster that this Parliament will not tolerate its policy of undermining free personal care?

Photo of Keith Raffan Keith Raffan Liberal Democrat

I am grateful to Ms Sturgeon for providing a trailer for the better part of my speech, which is about to come. I thank her for that commercial break before I go on with part two. Ms Sturgeon has jumped the gun by anticipating the important point to which I am about to come.

The Parliament has been patient about the Executive's negotiations with the UK Government on attendance allowances. I am somewhat mystified that Nicola Sturgeon continually used the term "Westminster" in her speech, because the issue is very much between the Scottish Executive and the UK Government, especially the Treasury and the Chancellor of the Exchequer. I do not want to say or do anything—not that I could, for that would be grandiosity in the extreme—to upset delicate negotiations between the Executive and the UK Labour Government. Anything that might have caused upset has happened in the past 48 hours. However, I am concerned that the negotiations have dragged on for such a long time.

The Government and the chancellor seem to be dragging their feet over the payment of attendance allowances, the value of which is about £20 million. Mr Campbell said that £20 million is not a lot of money in global terms or as a proportion of the total budget either down south or up here, but £20 million is a significant amount that would need to be found from elsewhere if it were not provided by the Treasury, as I passionately believe that it should be. That means that cuts would need to be made elsewhere within the Scottish block, which I would find difficult—in fact, impossible—to accept.

Ms Sturgeon mentioned all-party unity, as did Ms Scanlon, although—not for the first time—I found it difficult to follow the logic of Ms Scanlon's speech. I do not want to make a partisan point, but we should speak with one voice so that there is no illusion down south—either in the UK Government or at Westminster—about how strongly we feel.

Photo of Keith Raffan Keith Raffan Liberal Democrat

I will finish this point.

Indeed, in view of the widespread speculation in the media in the past few days, the important question concerning resources for the long-term cost of free personal care for the elderly needs to be settled. I do not want to create problems—I do not think any of us does—but it is important that we speak with one voice and sing from the same hymn sheet, so that the word goes forth from the chamber and they understand down south that we are all speaking together, no matter what political party we belong to. The UK Government should be under no illusion about the strength of feeling on free personal care that exists across the parties.

When the minister winds up, I hope that he will say something about the important resources issue. There has been much speculation about the long-term cost of free personal care for the elderly and when the speculation comes from academics, it is always more worrying. One can dismiss tabloid speculation, but speculation that comes from those who are specialists in the field must cause real anxiety.

I hope the minister will also touch on a point that is not in the bill. I understand why it is not in the bill but it is a point that I have raised with him before and it is directly related to free personal care—free personal care for the disabled. The minister will know that a number of organisations—not least the Leonard Cheshire homes—have raised the issue. In one of those answers that we get at question time that are not as helpful as written answers, the then deputy minister said that the issue would be considered after the bill. I hope that he can assure me that that is still the case.

With those provisos, I wish the minister and the bill well.

Photo of Margaret Smith Margaret Smith Liberal Democrat 4:30 pm, 28th November 2001

We have had an interesting debate. The ministerial team should take from it that the bill has the support of the whole chamber. Some outstanding issues remain to be worked through at stage 2. As convener of the Health and Community Care Committee, I look forward to doing that.

I thank colleagues for their kind comments about the work that has been undertaken by the members and clerks of the Health and Community Care Committee over more than two and a half years. We have been committed to the issue and we welcome the bill. We also welcome many of the minister's comments. We welcome the fact that there will be a definition of personal care in the bill. That is important to make sure that provision is protected in future. We also welcome the minister's comments about young carers being eligible for assessments.

I am concerned that the minister has not accepted the point about the general principles being in the bill. That is important, and I take Nicola Sturgeon's earlier point that general principles have been stated in other bills—in the proposed mental health bill and in the Housing (Scotland) Bill, for example. The approach has value, in sending a general message that carers are partners in the provision of care, because, as Nora Radcliffe said, the care that they provide is worth somewhere in the region of £3.5 billion.

To put that in context, that is more than half the Scottish health budget or half of what statutory organisations provide for health care. The carers of Scotland contribute to our society, so the general principles of the bill should acknowledge carers as partners in care. The general principles should also acknowledge the principles of equity and fairness that are behind the bill and the need for joint working between statutory bodies, the voluntary sector and carers. That would be a valuable move.

It is important that we acknowledge the role of the voluntary sector and I am pleased that the human resources group, which is chaired by Peter Bates, will include representatives of the voluntary sector, as well as unions, professional bodies and chief executives. That is a welcome move.

I take Margaret Jamieson's point about the private care sector. We asked Scottish Care to give evidence to the committee, but it was unable to do so. That does not mean that we should stop listening to what Scottish Care has to say. The organisation is crucial to making progress with the bill because changes that might come about in care home fees will have an impact on the funding of the policy. It is important that we continue in the spirit of partnership and continue the dialogue with Scottish Care.

Many colleagues identified the need for better joint working. Some problems exist, such as bedblocking, which was identified by Mary Scanlon and Bill Aitken and which is a tragedy for those involved and their families. I hope that better joint working will result in a reduction in the number of people—currently 2,000—who are waiting in blocked beds and receive what amounts to inappropriate care in institutional settings. Bill Aitken mentioned my area, Lothian, where the care home sector has problems because of property costs in Edinburgh and the difficulties of accessing a work force in a buoyant local economy. There are no end of wider community care issues, with which the ministerial team and the Health and Community Care Committee will have to wrestle.

The Health and Community Care Committee has been sceptical about the move towards joint working. We do not think that it has happened fast enough. Unfortunately, the evidence that we have been given and the attitudes that we have encountered do not suggest that there is a groundswell of people who are willing to break down the barriers between professionals and between budgets, and other barriers, to make joint working a reality.

The committee accepts the Executive's preferred policy on joint working. In its stage 1 report, the committee says that it

"feels that it is appropriate at this time to allow a degree of flexibility. However if the Executive has to consistently apply the power of enforcement the Committee would recommend that consideration be given to the establishment of an overarching body as outlined" in our previous community care report. I am happy to be proved wrong, but if ministers must consistently apply the power of enforcement to ensure that joint working happens, perhaps an overarching single body, which we suggested a year ago, is required. I hope that I am wrong—I am occasionally.

Several members spoke about carers. The Health and Community Care Committee is happy that carers will receive their own assessments as a result of the bill. It is important that carers are given information about assessments, that they are told that they have a right to expect an assessment and that their needs in their caring role are identified.

Many carers have cared for their husband, wife, son, daughter, mother or whomever for many years. They think of themselves not as carers, but as family members. We must identify those people. Often, they come into contact not with social workers—because they do not identify themselves as carers—but with GPs, community nurses and, if they are young carers, school nurses. People who work in statutory bodies should be told that they have an obligation to identify carers. That might happen over time, but we want the Executive to reconsider the matter.

I am running out of time. Irene Oldfather made important points on diet and Alex Fergusson's comments on notional capital are covered by the Health and Community Care Committee's stage 1 report.

I welcome the bill and look forward to working with colleagues on stage 2.

Photo of Ben Wallace Ben Wallace Conservative 4:37 pm, 28th November 2001

The road to today's debate has been long. From the moment that the Sutherland report recommendations and their implications for personal care were mooted, many members pushed for their implementation. The Executive was quick to respond. It was quick to implement some measures and quick to reject others. It was quickest on personal care.

The bill is an achievement for the Parliament, but I question whether it is an achievement for the partnership—the Lib Dem-Labour Executive—which fought to fudge the matter or to reject the proposals of the Conservatives and the SNP. The bill needs considerable work if it is to provide free personal care for the elderly and untangle the present muddle.

The bill has few principles. We should reflect on the reason for that. May I be so bold as to suggest that it is because the bill was drafted before the care development group's report was published, which makes it something of a hotch-potch of amendments?

The bill allows for plenty of measures, but directs the implementation of few. We would prefer stronger directions to local authorities to produce national and standardised rates, for example. Surely the minister is aware of the clear recommendation of the Accounts Commission and the care development group that local authorities must clarify and prepare charges for home care and other services, in preparation for the implementation of the bill.

The opportunity to insist on those reforms does not seem to have been taken. The same goes for single and pooled budgets. The bill may allow some of those changes, but unless the minister makes the situation clearer in regulations, I fear that some of Sir Stewart Sutherland's recommendations will be pushed aside.

We must be clear about why we are here. Long-term care was in a mess for many reasons—there are too many to list them all, but turf wars, inefficient accounting methods, the siphoning of funds from their intended destinations, lack of joint working and arguments over types of care were the main thrust behind the need for the Royal Commission on Long Term Care.

We believe that, unless the system that is to deliver community care is transparent, flexible and standardised, the patient will not receive the correct care for their specific needs. Real leadership is required to implement the strategic reforms in the bill. When the minister looks at the regulations, he should consider that point carefully. The Scottish Conservatives seek real assurances from the minister on those matters.

We are not minded to back the SNP amendment, as it has hijacked many of the recommendations that were contained in the Health and Community Care Committee report. At stage 2, we will ensure that the Executive sticks to its word. That is the right and proper time for us to do that.

I associate myself with the comments that Bill Aitken and Karen Whitefield made about carers. I also agree strongly with what Margaret Jamieson said. The SNP talked of a pot of money that waits in Westminster with Scotland's name written all over it—we have heard that one before.

Photo of Ben Wallace Ben Wallace Conservative

No. I will get back to Nicola Sturgeon in a minute.

A question mark exists over the £20 million and the changes to the attendance allowance. I have a letter from the Department for Work and Pensions. I wrote to Alistair Darling asking him to consider changes to the attendance allowance and to state his position on the issue. The reply is recent. I hope that the minister is aware of its contents—the Executive may have been given a copy. The final paragraph is important. The last sentence says:

"The rules exist to prevent the duplication of payment designed for the same purpose and it is only right that they remain uniform throughout Great Britain."

If negotiations were not going on, that would be a matter of serious concern. The negotiations seem to be taking longer than any others that I have come across. Keith Raffan alluded to that. I ask the minister to provide us with details of the negotiations.

If we are not to receive the £20 million, I implore the minister to make plans to ensure that we get free personal care; I ask him to identify where he can find funds within existing budgets. Finance should not be allowed to be a barrier to free personal care.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

Will Ben Wallace, as a Tory member of the Scottish Parliament, ever stand up and fight for Scotland's interests? He says that the SNP refers to pots of money, but will he agree now that the £20 million that is already paid in attendance allowance to Scottish pensioners is money that rightly belongs to Scotland? Will he further agree that that money derives from taxes that have been paid by Scottish pensioners for that purpose? Will he say to Westminster—or the UK Government, as Keith Raffan prefers to call it—that it is unacceptable for that money not to be kept in Scotland?

Photo of George Reid George Reid Scottish National Party

Ben Wallace should please answer and close his speech.

Photo of Ben Wallace Ben Wallace Conservative

I say to Nicola Sturgeon that it was I who wrote the letter to a UK Government department. I have not seen her writing letters. It was I who got the answer on behalf of the Scottish Parliament. If anyone is sticking up for Scotland, it is I. Rather than chirping from the sidelines, the SNP should try to get the answers.

We support the Executive's motion. We welcome the bill. We will scrutinise it carefully at stage 2 to ensure that the minister and the Executive stick to their word. It will be a good day for the pensioners of Scotland when, at last, the frugal are not punished at the expense of those who perhaps did not bother. I urge the Parliament to support the Executive motion and to reject the SNP amendment.

Photo of Shona Robison Shona Robison Scottish National Party 4:43 pm, 28th November 2001

I will not go through all the congratulations that are due—members can take them as read. Suffice it to say that I am excited about the prospect of not knowing which Deputy Minister for Health and Community Care I will be up against in each debate. I look forward to debating with them.

The stage 1 debate has produced much agreement. The bill provides us with an opportunity to make a major impact on the way in which community care services are delivered. Key to the enhancement of the rights of users and carers are free personal care, direct payments, carers' assessments and joint working. The bill is based on the principle of equity and fairness.

As many members have highlighted, all bar one of the organisations that gave evidence to the Health and Community Care Committee said that they would like the general principles to be included in the bill. As was said, that has been done in other bills, most notably the Regulation of Care (Scotland) Bill and the Mental Health (Public Safety and Appeals) (Scotland) Bill. The minister cited difficulties in interpretation, but I am not convinced about such legal barriers, which have not been a problem with other bills. I ask him to look at the issue again at stage 2.

The general principles should promote the role of carers in the delivery of care. The bill presents us with an opportunity to enhance the role and rights of carers. Janis Hughes proved that that needed to happen when she described the evidence given by the carer Isobel Allan. There should be a duty on local authorities and the NHS to take steps to identify carers and to ensure that they are informed of their right to an assessment. I am not convinced about the legal difficulties of doing that, which the minister outlined. I would welcome his saying that he intends to consider building on the new right for assessment for carers, which I hope will meet carers' demands—we will hear from them whether it does. I welcome the extension of the right to assessment to young carers. That is an important provision.

On direct payments, I welcome the fact that the minister recognises that the needs of service users are paramount, despite the difficulties that, as he highlighted, that might bring to local authorities. Local authorities have to be confident that their services will be of such quality that users will choose to use them. That is about empowerment and choice. I hope that the bill will impose a duty on local authorities to inform users about direct payments.

On joint working, the bill removes the legal barriers between agencies, as many have said. However, the question remains whether that goes far enough, as was said in evidence to the Health and Community Care Committee. There are compelling arguments for a single budget. I was pleased to hear a number of people say that that will not necessarily be ruled out for the long term. Perhaps when the minister sums up he will confirm whether that is indeed the case. I support Margaret Jamieson's comments and her call for a national pay scheme for all those involved in joint working. That is also important.

Free personal care is, as many have said, the settled will of the Parliament. I welcome the minister's commitment to lodge an amendment to include a definition of personal care in the bill. That is an important concession. However, it was right for Nicola Sturgeon to comment on the recent utterances made by a couple of members who do not seem to have signed up to that settled will of the Parliament and still peddle the myth of rich pensioners. I am sure that Kate MacLean's comments will not go down well with the hundreds of pensioners in her constituency who have struggled all their lives to save, and perhaps to buy their council house, and who will be the beneficiaries of the bill. I am sure that they will have noted her comments about how rich and undeserving they are. I hope that the minister will take this opportunity to distance himself from Labour back benchers' comments on the issue.

As Margaret Smith said, the bill will benefit not only those who go into residential and nursing home care but the tens of thousands of people who receive personal care in their own homes. Nicola Sturgeon and I raised that issue many times in the early stages of the debate and are happy that it has been recognised as an important effect of the bill.

As Colin Campbell and others have highlighted, the arguments in favour of Westminster continuing to pay attendance allowance to those in Scotland who qualify for it are indisputable. The argument has been strengthened by the decision that attendance allowance will continue to be paid to residents of nursing homes in England and Wales who will receive free nursing care, the definition of which is likely to include elements of personal care. The Department for Work and Pensions is not being asked to increase its expenditure, as the money is already coming to Scotland. Ben Wallace should know that, but he seemed ignorant about the issue. I would be happy to bring him up to speed with that after the debate.

As Nicola Sturgeon said, the concern is that Henry McLeish was personally involved in the negotiations with Westminster over the matter, as Malcolm Chisholm confirmed in his evidence to the Health and Community Care Committee. We now need assurances that the new First Minister will be as involved and as committed to pursuing Westminster for Scotland's attendance allowance moneys.

Mary Scanlon should not cut off her nose to spite her face. If she agrees with the SNP amendment in principle, she should not get hung up on silly arguments about who lodged it. If it is right, it is right, and she and everyone else in the chamber should support it. As Keith Raffan said, the Parliament should speak with one voice. Tonight, members have an opportunity to do that. I urge them to do the right thing and support the amendment.

Photo of Malcolm Chisholm Malcolm Chisholm Labour 4:50 pm, 28th November 2001

To confuse Shona Robison even more, I am afraid that, although she is up against me in this debate, I assure her that that will not happen again. We look forward to hearing from Hugh Henry and Mary Mulligan, probably starting with one of them at 5 pm tomorrow, when we will have the first health-related members' business debate for more than a year in which I have not summed up.

This has been the second excellent health and community care debate in two weeks. This debate and the debate on mental health law have shown the Scottish Parliament at its best. I thank Nicola Sturgeon, Margaret Smith, Mary Scanlon, Janis Hughes and others for their good wishes to Susan Deacon. I reiterate those good wishes. I also thank Margaret Smith, Tricia Marwick and others for their kind remarks about me.

Many detailed points have been made in the debate and I would like to touch on two or three of them before moving on to the broader themes. Nicola Sturgeon and Alex Fergusson raised the issue of a precise time limit for notional capital. I assure members that the Executive is committed to ensuring that people in receipt of residential care are treated in a fair and equitable manner. There are already national regulations and guidance covering notional capital based on the circumstances of each individual case.

Nicola Sturgeon mentioned top-ups and protecting individuals' disregarded income. Those are sensitive issues and regulations will need to be carefully framed to balance the aims of allowing choice, protecting people from pressure to impoverish themselves and ensuring that people with existing top-up arrangements are not adversely affected.

Margaret Smith and Nicola Sturgeon also raised the issue of deferred payment agreements. We expect that deferred payments will not be difficult to administer locally, as local authorities will simply pay the person's care home fees in the normal way, recover an income contribution and keep a record of the extra money owed to be recovered from the person's estate. Because that process is so closely tied into local authorities' normal care funding and means-testing arrangements, it is difficult to see how such a scheme could be administered nationally. Funding has already been allocated to local authorities for that from next April.

I move on to the broader themes of the debate. Support for carers was perhaps the strongest theme of all. In particular, I note the contributions from Janis Hughes, Irene Oldfather, Karen Whitefield and Shona Robison. I have made clear the Executive's full support for the principle of carers as partners in providing care. That means carers of all ages. The bill makes important steps in extending carers' rights to have their needs assessed in their own right. As I said, I will look closely at how we may reinforce that by ensuring that local authorities make carers aware of that right. I believe that that approach will be the best way of offering better support to Scotland's carers.

Janis Hughes also mentioned her constituent, Isobel Allan, whom I was pleased to meet recently. I echo what Janis Hughes said about her. Janis Hughes also mentioned respite care provision, which will be an integral part of assessment. I remind members of the 22,000 extra weeks of respite care that are provided from last October's funding package.

That takes me on neatly to the subject of resources, to which Tricia Marwick referred. I remind members that £100 million was allocated for older people's services in October 2000 and that an extra £100 million was announced by Angus MacKay in June this year. That is an unprecedented investment in older people.

Many members welcomed the direct payment proposals. Nicola Sturgeon asked about support for them. We have given £400,000 to the UPDATE consortium to support people using direct payments. Moreover, local authorities will be required to inform people of their rights.

Margaret Jamieson mentioned resource transfer and grant-aided expenditure for older people's services, as did Margaret Smith. The importance of those matters is highlighted on pages 28 and 29 of the care development group's report.

Margaret Jamieson also reinforced the need for a partnership approach with staff in particular. We share her view. The integrated human resources working group embodies that approach and, by the end of the year, it will have consulted more than 1,000 people. The group includes five trade union representatives. Some members of staff have expressed interest in a single public sector pay scale. I look forward to receiving the group's report in the spring.

I have dealt with Mary Scanlon's remarks about home care and will not repeat myself. However, I want to reinforce my point about the intensity of home care and health visiting. The average number of home care hours per client is rising, as are total home care hours. The number of clients who receive more than 10 hours of home care a week rose by 1,500 during the first year of the Parliament. As I said, resources for home care are increasing in an unprecedented way.

Mary Scanlon highlighted the importance of delayed discharges. The care development group report drew attention to that issue and, in my first day in the job, I have flagged it up as part of the more general issue of delays in the journey of care. We are committed to dealing with the issue as one of our key health priorities.

Many references were made to the care development group's report. Keith Raffan asked about long-term costings. That is a complicated subject, but I repeat that we used one of the best economists in Scotland—David Bell—so we can be confident about the costings that have been given. The care development group's recommendations are being taken forward by an implementation steering group under the convenership of Alexis Jay.

I reassure Shona Robison about attendance allowance. The First Minister will pursue the issue with Westminster. We will concentrate on the merits of the argument rather than turning the issue into a constitutional stand-off, as some SNP members seek to do.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

Perhaps the minister will take this opportunity to update us on the progress of negotiations with Westminster. In particular, will he tell us what contact there has been with the UK Government on the matter since Henry McLeish's resignation? Will he concede that the issue is fundamental to the implementation of free personal care and that pensioners should be given some certainty?

Photo of Malcolm Chisholm Malcolm Chisholm Labour

The First Minister was sworn in yesterday. Nicola Sturgeon should give him a little more time before we update her on progress on the matter.

The SNP amendment refers to attendance allowance and the definition of personal care, but it is now redundant. It would be illogical to express concern over the lack of a definition of personal care in the bill, as I have assured members that we will put such a definition in the bill. I am glad that other parties have accepted that the amendment is no longer necessary.

I remind members of the general principles that underpin the Community Care and Health (Scotland) Bill: choice, partnership, equity and fairness. With those principles, the bill paves the way for free nursing and personal care, the extension of direct payment schemes, an independent right to assessment for carers, improved arrangements for joint working and many other improvements to the provision of care and health services. The principles are admirable and I commend them to the chamber. I ask members to join me in supporting the bill.