Community Care and Health (Scotland) Bill

– in the Scottish Parliament at 3:45 pm on 6 February 2002.

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Photo of Murray Tosh Murray Tosh Conservative 3:45, 6 February 2002

The next item of business is a debate on motion S1M-2678, in the name of Malcolm Chisholm, which seeks agreement that the Community Care and Health (Scotland) Bill be passed.

Photo of Malcolm Chisholm Malcolm Chisholm Labour 3:58, 6 February 2002

I am pleased to be opening a stage 3 debate for the first time. We may celebrate the new parliamentary procedures that have been working so well throughout the bill's stages as well, more importantly, as celebrating the very substantial advances that are embodied in this piece of proposed legislation. Political comment usually focuses on disagreements, so it may be that the joint purpose and common ground that we have witnessed at the various stages of the bill will not get the recognition that they deserve.

I thank the Health and Community Care Committee for all its work on the bill over the past three months. I also thank the Local Government Committee, the Equal Opportunities Committee and the Subordinate Legislation Committee for their work, comment and reports. All have contributed to a parliamentary process that has been effective in improving and refining the bill. Many of the changes that were suggested by the Health and Community Care Committee at stage 1 were taken on board at stage 2. We have a better bill as a result.

That process has continued today. I assure Janis Hughes, who has worked so tirelessly for carers throughout the bill's progress and before, that we shall drive forward action on information for carers and the identification of carers. The work of the Princess Royal Trust for Carers has been mentioned, as has general practitioner practice accreditation in relation to the identification of carers and the carers focus of the Clinical Standards Board for Scotland. Mary Mulligan, Hugh Henry and I undertake to monitor all that work and to ensure that the concerns of the Parliament about the identification of carers and information for carers are translated into action.

Turning to the contents of the bill, it will be a significant achievement of our Parliament in helping to improve community care services throughout Scotland. It will enable us to deliver real benefits for thousands of people who need those services. It will enable us to deliver fairer charging; more support and recognition for carers; greater choice and independence for people who need care; higher-quality care services through greater joint working; and free personal and nursing care.

Through the bill, we will ensure that nursing care is 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 older people—the dementia sufferer and the stroke victim, those at home as well as those in care homes.

Today the Subordinate Legislation Committee reported on the powers to make orders and regulations in relation to that part of the bill. I am pleased that the committee welcomed the changes noted above and I am grateful for its careful consideration of the matter and for making its report available so quickly to enable Parliament to have the benefit of its members' views. However, I disagree with their comment that the power to qualify the requirement for free care can be used to

"undermine the purposes of the Bill."

A power to qualify is not a power to remove the requirement for free care.

The Health and Community Care Committee accepted in its stage 1 report the Executive's view that some flexibility is required. That is because we will need to be able to update the provisions in response to future changes in the way that care is delivered. We also need to allow for clarification where necessary to ensure that free care is applied consistently throughout Scotland. We have been clear and consistent about the need for those powers and how we intend to use them to provide free care. I remind the Parliament that we have amended the bill to ensure that such regulations are made by affirmative procedure so that they can become law only if the Parliament votes for them.

Debate on the bill has often focused on free nursing and personal care. Those provisions are a major step forward in improving fairness in care charging throughout Scotland, but they should not overshadow the other important changes that the bill will introduce. The bill will extend choice for people in need of care. The measures to extend direct payments will put real power into the hands of those needing care at home to choose the best care package to suit their needs. Instead of people being provided with services chosen by local authorities, direct payments give them the power to buy in their own services.

The bill will ensure that direct payments are available throughout Scotland and will make them available to all care client groups. In practice, that could mean that whereas a person's care needs are met currently by half a dozen different care staff, in the future that person could choose to employ one or two personal assistants to meet their needs in the way that suits them best.

The bill will also extend choice for people who need to go into care homes. Deferred payment of care home fees will mean that people will no longer have to sell their homes to fund their care during their lifetime. Leaving home to live in a care home will always be a stressful time, but deferred payments will mean that people are spared the additional worry of selling their homes. Of course the overall number of people involved will be greatly reduced by free personal and nursing care in any case.

Part 2 of the bill will allow new closer ways of joint working between NHS Scotland and local authorities, enabling them to develop more effective seamless services to suit local circumstances. It will give them real flexibility in how they manage and resource services jointly. We want local partners to come together to provide the best services for users, carers and patients. The bill lets them do just that.

Part 3 of the bill provides measures to improve health services. It will extend the medical list system so that it applies to all general practitioners, rather than just those who run practices. That is an important improvement in the coverage of our existing quality and discipline procedures. It will mean that patients can be confident that every GP will be subject to similar disciplinary procedures and standards.

Significant though it is, the bill cannot and should not be seen in isolation. Effective change does not come about just because of some words on a piece of paper. That is why we are already engaging with local partners and why the bill links to many other crucial initiatives.

First, there is the work of the carers legislation working group. I pay tribute to everybody who was involved with that group. Secondly, there is the work of the implementation steering group in preparing for the implementation of free personal and nursing care. Thirdly, there is the work of direct payments Scotland in laying the foundations for the expansion of direct payments. Fourthly, there is the work of the integrated human resources working group, under the chairmanship of Peter Bates, on the staffing issues that arise from our joint working agenda. Hugh Henry and I were pleased to meet Peter Bates on Friday.

I take this opportunity to thank the members of those working groups and to pay tribute to all who have been involved in the bill's development over many months. Some of those were mentioned earlier. I also thank Susan Deacon, who developed many of the policies that underpin the bill and who introduced it to Parliament. I thank Henry McLeish, who was particularly identified with the central policy of the bill, as well as all the officials who were associated with developing the policies of the bill and with its detailed drafting.

The bill is also better because of the various consultations that took place on its different provisions. The extent to which we carry out consultation is a new and very positive feature of this Parliament. I thank the hundreds of individuals and organisations that took the time to contribute their views and insights at public meetings, in focus groups and through written consultation.

Finally, I must mention some of those who have been instrumental in laying the foundations for the measures that the bill will put on to the statute book. I am grateful to my fellow members of the care development group, as well as to the carers legislation working group and to the joint future group before that.

The completion of the bill's progress through Parliament is far from the end of the process. We will continue to face challenges. We will continue to work with key agencies to ensure that progress is made in other ways on areas for action where legislation is not needed. I repeat what I said concerning the identification of carers. I have already mentioned some of the implementation work that is under way. We now need to turn our attention to regulations and guidance, to provide some of the detail that is needed beneath the provisions of the bill. We will continue to work in partnership with stakeholders on implementation and the development of regulations. I welcome the Parliament's input to the process.

The bill is a major step forward in improving care for the thousands of people in Scotland who need it and for their carers. I am pleased that there is such widespread support for the bill and am proud to see it nearing the end of its time in Parliament after months—indeed years—of planning. Although much remains to be done, the bill represents a major milestone in improving care.

I move,

That the Parliament agrees that the Community Care and Health (Scotland) Bill be passed.

Photo of Shona Robison Shona Robison Scottish National Party 4:09, 6 February 2002

On behalf of the SNP, I am pleased to support the Community Care and Health (Scotland) Bill at its third and final stage.

I want to place on record my thanks to all the witnesses who gave evidence to the Health and Community Care Committee. I also thank the committee clerks, who have worked very hard to ensure the smooth progress of the bill through the Parliament.

The bill will make some important and welcome changes to the way in which community care services are delivered. It promotes choice for users and carers in a number of ways. It extends access to direct payments for community care services. It will empower individuals who need care and enable them to access the services that they want and that are suited to their needs.

The bill enables local authorities to make loans to people so that they can pay for their care. Those arrangements have the potential to remove the need for anyone to sell their home, even if only to fund the accommodation costs of their care. I hope that the bill will also improve joint working on the delivery of community care services, particularly between local authorities and the national health service. However, many witnesses cast doubt on whether cultural and institutional differences can be overcome—the jury is out on that point.

The bill contains good news for carers. It will provide carers with the right to request an assessment of their needs, regardless of whether the cared-for person is being assessed. The Executive has accepted that local authorities should be under a duty to inform carers of their rights, which is welcome news. This afternoon, we agreed to amendments to place a similar duty on the NHS and I am pleased that, by requiring health boards to prepare carer information strategies, some progress has been made along that road. It remains to be seen whether those strategies are effective. If they are not, we will certainly be back to make further progress.

Most important, the bill marks the end of the Parliament's hard-fought battle, which it won, to force the Executive to implement the Sutherland commission's key recommendation of making personal care free for all who need it. The bill paves the way for free personal care by providing ministers with the powers to introduce it. I am pleased that, despite the protestations of the Minister for Health and Community Care, the Executive accepted the need to include in the bill a definition of personal care, which will make it far harder for future ministers to attempt to dismantle that principle.

The funding package for the introduction of free personal care is still £20 million short—it is unfortunate, to say the least, that that shortfall led to a delay in the implementation of the policy. I will end on a more positive note. Despite the existence of a dwindling band of detractors of the policy, I hope that, by passing the bill, the Parliament will ensure that the end of the battle for free personal care is beginning.

Photo of Mary Scanlon Mary Scanlon Conservative 4:12, 6 February 2002

On behalf of the Scottish Conservatives, I support the bill. I thank all those who contributed to and supported the passage of the bill, including the witnesses and our loyal and hard working clerks. I agree with the minister that work remains to be done. After spending two years and eight months as a member of the Health and Community Care Committee—I am one of the first members of the committee—I had not appreciated that that work would include the manuscript amendments that arrived at the last minute. However, we are at the beginning, not the end, of the process.

The bill is undoubtedly the most contentious to pass through the Parliament. Many considerations and principles underlie it, including financial considerations, which tended to get the most press. The bill should also be viewed from the perspective of equality of access to health care. If an elderly person is dying from cancer, a stroke or heart disease, all their health care costs are met, but old, frail people with Alzheimer's disease or Parkinson's disease are given limited support. The bill will ensure that elderly people will not be discriminated against on the grounds of their illness.

For me, visiting places such as the Western Isles was an incredible experience. Four members of the existing committee—Margaret Jamieson, Margaret Smith, Dorothy-Grace Elder and I—went on those visits. I suspect that the people that we met were shocked by the similarity of members' lines of questioning and that they felt some admiration and respect for us, as we were big enough to put health, and health of the elderly in particular, before politics.

The one or two points that I will make relate to our continuing work. Age Concern Scotland raised the issue of notional capital, although the committee probably did not spend as much time on that issue as it should have done. There is no doubt that that issue causes enormous distress, confusion and argument, as well as lengthy legal battles. Given the fact that the bill strives for equity, surely we need to set out guidance for families on that issue.

I make no specific proposal, but I draw members' attention to the fact that inheritance tax is not due on assets that are disposed of seven years prior to death. However, councils—at their discretion—can take into account a family home that was disposed of 20 years before care was accessed by claiming that the home was disposed of in order to deprive that person of capital. I am not saying that the period of 20 years is right or wrong, or that the period should be seven years. I am asking simply for clarity and, in particular, consistency in councils across Scotland.

I will quote from the Age Concern document:

"We do not wish to support the practice of giving away property with the sole intention of avoiding care fees, but we want to see an end to the draconian practice of including as notional capital the value of assets given away over a decade ago."

I am not saying that the period should be seven, 10 or 20 years. I am asking simply for clarity and consistency across health boards in Scotland.

Much of the free personal care will be delivered in the elderly person's own home. The recent Accounts Commission report talked about

"national policy focusing on care at home rather than institutional settings", but the facts and the figures prove that the opposite is true. I raised that point in the Health and Community Care Committee and I make no apologies for raising it again. There will be tremendous demand for care at home on 1 July.

I will use the figures from the Accounts Commission's report. Between 1997 and 2000, the number of people that health visitors saw fell by 49,800. Between 1998 and 2000, the number of people who receive home care fell by 9,000. Between 1999 and 2000, the number of people that district nurses saw fell by 13,300. The numbers of people who attend day centres and who live in residential homes were also down. I hope that the provision of care to assist people in their own homes will be in place on 1 July, given the decline in those figures in recent years.

Although I am disappointed that we will still not have a single body for budget holding and planning and commissioning community care services, as was recommended by the Health and Community Care Committee, I accept that aligned and pooled budgets are undoubtedly a move in the right direction.

I note that where joint working does not deliver the outcomes that are expected—in other words, in cases of failure, in which the expected outcomes are not delivered—ministers can intervene to adopt key principles, such as single management and single budget. I am still not clear how the effectiveness of joint working will be measured. There needs to be some clarity about that. Quite honestly, 3,000 blocked beds represent proof that joint working is not as effective as it should be. There should be clarity about the outcomes that are expected from joint working—the outcomes on which joint working will be judged—and at what point the Executive will intervene.

There is also a concern about unmet need, which has emerged often in the Health and Community Care Committee. I spoke with my colleagues John Farquhar Munro and Rhoda Grant at a meeting with Highland Council and Highland NHS Board this week. Very little seems to be known about the unmet need for care in the community. Although we are clear about waiting times, waiting lists and all the procedures that are undertaken in the NHS, we are not clear about the unmet assessed need in the community. It is not always acknowledged that the care plans that people are given should reflect the provision of care—not a wish list.

Photo of Murray Tosh Murray Tosh Conservative

I will break in to assure the members who are waiting their turn that I am confident that everybody will be called.

Photo of Mary Scanlon Mary Scanlon Conservative

I am on my final point. Perhaps you mean that I should take another 20 minutes, Presiding Officer.

I welcome the introduction of direct payments, which will bring freedom, choice and, I hope, competition in care services. The provision of direct payments will mean that the carer and the cared-for person will be in charge of their package of care. It will mean that they are not simply passive recipients of what someone else thinks is best. I welcome that exciting development, which will fundamentally change care services in Scotland.

As other members will have found, many people believe that, after 1 July, those in residential care homes will not have to pay anything. It is incumbent on us to be totally clear about what free personal care means. People think that it means that they will not need to pay for accommodation, food and laundry charges—what we term hotel costs. We must be clear that, although personal and nursing care will be free, people will still need to pay substantial sums for their hotel costs.

I am delighted to support the bill on behalf of the Scottish Conservatives.

Photo of Murray Tosh Murray Tosh Conservative

I should perhaps make it clear that, as we anticipate that we might require a motion without notice to bring forward decision time, I am reasonably relaxed about the timing of speeches during this part of the debate.

Photo of Margaret Smith Margaret Smith Liberal Democrat 4:21, 6 February 2002

I am delighted to take part in today's debate and support the Community Care and Health (Scotland) Bill, which will provide a real improvement in community care services as well as the delivery of free personal and nursing care.

I thank my colleagues on the Health and Community Care Committee for the work that they have done not only on the bill but on the whole community care issue, which we began considering at the beginning of the Parliament's life. I thank our clerks and all the witnesses who gave evidence during the bill's passage.

Age Concern has said that the bill is a milestone for devolution. I echo that view, but the bill is also a milestone for community care services in Scotland. In 1997, the Labour Government set up the Sutherland commission and the road since then has been a long one. It feels as if the route has been equally long and tortuous since the Health and Community Care Committee unanimously recommended that the Parliament should implement in full the Sutherland report, which recommended that free personal and nursing care be provided for Scotland's elderly.

That policy has been consistently supported by the Liberal Democrats both in Scotland and across the UK, so we have no hesitation in supporting the bill today. Today is a good day for the Executive. The bill is a good bill, but today is also a victory for the parliamentary committee process and—as the policy has attracted widespread support across the chamber—for the Parliament as a whole.

I want to acknowledge the work of certain key individuals: Sir Stewart Sutherland, whom I met yesterday and who was delighted that the bill will be passed; Malcolm Chisholm, who not only steered the bill through Parliament but chaired the care development group that produced a delivery framework; and Henry McLeish, whose former role as First Minister should not be underestimated in the delivery of the policy. He was staunch in his support for those of us who have argued consistently for the policy.

The bill is also a victory for all those outside the Parliament who have campaigned long and hard: Age Concern, Help the Aged, Carers Scotland, the Princess Royal Trust for Carers, pensioners groups, local authorities and social work and health professionals. I should also mention the ordinary men and women of our country who knew that the existing system was unfair and campaigned against it.

Backed up by £250 million over the coming two years, the bill will deliver free personal care and much more. It will deliver better joined-up working between local authorities, health boards and other partners in care. That will be done through a flexible approach that is backed by the possible enforcement of outcome agreements. The bill recognises the crucial role that Scotland's carers play as key partners in the provision of care. It gives individuals greater choice in the provision and delivery of services through direct payments. The bill also paves the way for an end to the postcode lottery of services and the great variations in charging that exist across Scotland. It introduces a deferred payments scheme, which means that Scots will not have to sell their homes to pay for the hotel costs of their care home bill.

Despite difficulties, the stage 2 and stage 3 processes have enhanced the bill. Significant amendments have been made by the minister. The Health and Community Care Committee was especially keen to see a definition of personal care in the bill. It is now there, and it builds not only on the definition of personal care in the Regulation of Care (Scotland) Act 2001 but on the list of care services in the care development group report. The committee was also keen that there should be enhanced recognition for Scotland's 620,000 carers and for their role as partners in care. We welcome the fact that carers—including, crucially, young carers—will have a right to an independent assessment of their needs.

The Executive introduced amendments that required local authorities to consider the views of the person in need and their carer, before deciding on the services to be provided. Amendments also placed a legal obligation on councils to inform carers of their right to an assessment. Today, Janis Hughes's amendment 19 has extended the obligation to inform carers to the NHS.

Some of Mary Scanlon's points give us cause for concern. An awful lot of work has still to be done. Work has to be done by the implementation working group—which is chaired by Alexis Jay, who, in the past few weeks, has thrown a small spanner in the works, but rightly so—and work has to be done by the human resources working group, which is chaired by Peter Bates.

Today, in passing this bill, this Parliament has done its duty by the people of Scotland. We have sent a clear message that this Executive, this Parliament and, indeed, this country intend to cherish our older people—through community care services, through the regulation of care homes and the setting of care standards, and through the provision of free central heating and of concessionary public transport. Those people have been there for us in the past; now it is our turn to be there for them. Today, the Scottish Parliament has not let them down.

Photo of Henry McLeish Henry McLeish Labour 4:27, 6 February 2002

I would like to say a few words at the conclusion of the debate on this bill. I would like to congratulate the Executive—Malcolm Chisholm and the new ministers—and Susan Deacon, the former Minister for Health and Community Care. I would also like to congratulate the Parliament, which has had the vision and courage to take the bill to this stage and which will now move on to its implementation.

The statement that this care bill makes is crucial. It widens, deepens and strengthens this Parliament's commitment, and this Executive's commitment, to those in our communities who need help and who may be vulnerable. It is important to put that commitment into perspective. A recent Executive report suggests that, by 2031, nearly 1,200,000 people in our country will be over 65. Not all those people will require the kind of care that we are talking about. However, this bill sends a very powerful message to every organisation that deals with older people, and to every older person, that they have a Parliament and an Executive that they can be proud of.

It is easy to discuss in an abstract way issues that affect our society and our community. However, this Parliament and this Executive will put legislation on the statute book. They have also invested substantial amounts of public funds. It seems to me that that combination of legislative commitment and financial investment is the surest sign yet that we have a new politics in Scotland. That new politics is working. It is good to see from every quarter of the Parliament today support for this vital piece of legislation.

This is an important day for Scotland and an important day for older people. Every parliamentarian here should take some credit and have some pride. Politics can be a tough business, but the satisfaction is that devolution is making a difference to ordinary people the length and breadth of our country. It is a privilege to have been part of that process—a process that is now nearly complete. However, as colleagues have said, the hard work is about to start.

Let me finish on a challenging note. This legislation is about to be enacted and that is tremendously encouraging but, for the 1,200,000 people who will be over 65 by 2031, the journey is just beginning. Their needs are high upon the political agenda in Scotland—as high as I have ever known them to be. The contribution that has been made by Westminster—pensions, heating and other opportunities—linked with the marvellous work of the Executive and the Parliament shows real partnership for real progress. It will affect those in our society whom we have always championed, but who have been a bit frustrated because we have never been able to go as far as we have gone today.

All in all, it is good news from the Scottish Parliament. I hope that all the officials and everyone charged with implementing the bill will get on with the job and ensure that the hard work that has been done by the committee, the Parliament and the Executive will be turned into early results in every community in Scotland and for every older person who needs our help.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party 4:31, 6 February 2002

I, too, welcome the passage of the bill, which is an important piece of legislation. It represents a considerable improvement in the quality of life of carers and those in our society who require care.

The bill contains many provisions and we have debated them at every stage. The regulation of charging for home care services, the promotion of choice for users of care and the promotion of joint working between health bodies and local authorities are just a few of the important provisions that will be passed today. Inevitably, one provision stands out above the rest: the implementation of free personal care. As Henry McLeish rightly said, the implementation of free personal care is a victory for the Scottish Parliament. The victory is hard won, but it should stand the Parliament in good stead for the future. The concession by the Scottish Executive at stage 2 to provide a clear definition of free personal care in the bill is an important step. It will help to embed firmly the policy of free personal care in the legislative programme.

In our satisfaction that free personal care is now on the statute book—and we should take a great deal of satisfaction from that—we must remember that the Parliament still has an important job to do. It is our job to be vigilant. All members are committed to free personal care. However, there are enemies of free personal care out there and the Scottish Parliament has a duty to ensure that the policy that was hard won by us is not undermined by others. We know that there are forces in London that want to see the policy fail. Their decision to remove £23 million in attendance allowance has already resulted in a delay to the implementation of the policy. We know that there are others—particularly on the Labour side of the argument—who might want to undermine the policy in future. Our duty in the Scottish Parliament is to ensure that that does not happen. Unity of purpose is what has made free personal care a reality today. Unity of purpose on the part of the Parliament is what should ensure that no one in Scotland gets away with undermining the policy and our victory.

Today is a day for mentioning and congratulating those who have brought the policy to fruition. I have already mentioned the Parliament. Great credit must go to the pensioners and their representative organisations across Scotland—without their pressure, free personal care would not have become a reality. Many people have deservedly been mentioned during today's debate for the part that they have played in bringing about free personal care. I pay particular tribute to Kay Ullrich, my predecessor as SNP health spokesperson and an original member of the Health and Community Care Committee. She did much, particularly in the early days of the Parliament, to advance the policy and to ensure that we reached the point that we are at today.

Today is a time for rejoicing in free personal care. On behalf of a party that has consistently argued for that policy, I finish by again welcoming the passage of the bill.

Photo of Murray Tosh Murray Tosh Conservative

I have been relaxed about the time until now. A couple of additional members have pressed their request-to-speak buttons and we are back on course—ordinarily, we allow three minutes per speech and I ask members to adhere to that.

Photo of Janis Hughes Janis Hughes Labour 4:35, 6 February 2002

I begin my contribution as a member of the Health and Community Care Committee by thanking the clerks and everyone involved with the bill. The clerks to the Health and Community Care Committee seem to have to deal with more legislation than all the other clerks combined, although perhaps that is just how it appears.

The bill is the culmination of many months of hard work by many people and I welcome its imminent—I hope—passing. The headlines in the past few months have focused on the provisions concerning personal care, about which we have heard today from many members. That aspect of the bill is obviously great news for Scotland's elderly people and is a further example of the Executive's commitment to caring for our older citizens.

I say to Nicola Sturgeon that there is no indication of any attempt from Labour members to undermine the policy through the three-month delay. We in the Labour party accept the experts' argument that another three months are necessary to enable us to put the policy into place in the way that we would wish. I give the commitment that there is no undermining of the policy. We will welcome 1 July, when the commitment on personal care will finally fall into place.

The bill is about much more than personal care, however. In particular, I am thinking of—and I make no excuse for mentioning this again—the position of carers in our communities. There are 620,000 carers in Scotland. Carers Scotland estimates that that figure will rise to almost 1 million by 2037. Obviously, it is important to provide support services for those carers. I am pleased about the work that has been done to ensure that the bill recognises carers. The Executive is to be commended for introducing legislation aimed at helping those who do so much to help others in society. I particularly welcomed the stage 2 amendment that explicitly included carers aged under 16. Members may recall a members' business debate in Parliament last year that focused on the issues surrounding young carers. I am delighted that the bill now recognises the important role that young carers play.

Today, we heard mention of the Princess Royal Trust for Carers. That organisation's work has shown that we can identify the carers in our society. I hope that today we will pass legislation that will help us to do that through local authorities and health services. The fact that the Princess Royal Trust for Carers' initiatives have recognised 6,000 carers who would not otherwise have been recognised shows that carers can indeed be identified. We all know that too many carers are slipping through the net and are not getting the support that they need, so I am glad that the bill has been amended to change that.

Another important aspect of the bill is joint working. Carrying on from the Regulation of Care (Scotland) Act 2001, the bill seeks to improve joint working across health and social care boundaries and to promote partnership between agencies that provide health and social care. I welcome that initiative.

In conclusion, I welcome the passing of such an important bill. I look forward to seeing it put into action to improve the lives of those who need it most.

Photo of Ben Wallace Ben Wallace Conservative 4:38, 6 February 2002

The bill is indeed a good-news story for the Parliament. The Scottish Conservatives believe that free personal care represents not only socially just funding for the elderly—

Photo of Mike Rumbles Mike Rumbles Liberal Democrat

Does Mr Wallace still believe that?

Photo of Ben Wallace Ben Wallace Conservative

Oh yes. Mr Rumbles should not believe everything that he reads in The Scotsman .

Photo of Murray Tosh Murray Tosh Conservative

I would not linger, Mr Wallace. Mrs Scanlon took up much of your time.

Photo of Ben Wallace Ben Wallace Conservative

I hope that, as a result of the bill, we will see an end to the historical debates between—

Photo of Margaret Jamieson Margaret Jamieson Labour

Ben Wallace has welcomed free personal care. Will he clarify whether that is the view of the Scottish Tories or the view of the UK Tories?

Photo of Ben Wallace Ben Wallace Conservative

I would be delighted to clarify that. If Margaret Jamieson had read The Herald , she would have seen that Iain Duncan Smith is thinking of adopting the policy in the south of England. We do not hear what the Labour party is doing in England.

Last month, I attended a meeting of the Faculty and Institute of Actuaries, which was an exciting occasion. I was there with members of the Labour party. The actuaries did not let Nicola Sturgeon in—she was not as interesting as they were, so they kept her out. At the meeting, representatives of the Labour party at Westminster were still fundamentally opposed to free personal care. There is opposition in our party, but at least I am honest about that; the Liberal Democrats have voted against free personal care on two occasions. There is division with our party in the south, where some Conservatives do not want free personal care; up here, there are people who do. That is devolution and we are pleased that we have it today.

Lord Sutherland said at the meeting that he feared that free personal care would be fudged in the long term. He feared that the circle was not complete. Until it is complete—which will involve addressing joint boards, platforms of delivery and ring-fenced funding—there is a fear that those in all unionist parties who are opposed to free personal care will work against it. I would like free personal care to be adopted in the rest of the United Kingdom, because it is good news.

I finish by asking the minister a question about eligibility. As we have progressed with the bill, I have been contacted by a number of constituents who fear that they will lose attendance allowance, when in fact they are still eligible for it because they are not paying for any care. I ask the minister to ensure that people are informed of the changes that will come about when free personal care is introduced so that they know whether they will lose attendance allowance.

Thanks should be given to the Health and Community Care Committee and to the parties that campaigned for a long time for free personal care.

Photo of Murray Tosh Murray Tosh Conservative

No, the member is finishing.

Photo of Ben Wallace Ben Wallace Conservative

I also thank Henry McLeish for standing up against considerable opposition in his party to achieve the provision of free personal care. I say to him that establishing free personal care in this Parliament is not a bad legacy. I would be proud if I had done that. Thanks go to the Parliament and the Health and Community Care Committee. The bill is a good-news achievement for today.

Photo of John McAllion John McAllion Labour 4:42, 6 February 2002

I, too, welcome the bill and in particular the critical role that my good comrade Henry McLeish played in delivering it. I thought that his speech was the high point of the debate this afternoon. It is a shame that he had to wait until he was out of high office before he got a compliment from me. I think that that is a reflection on me, rather than on his time in high office. The bill is good and its enactment will make Scotland a better place in which to live. All members of Parliament, rather than any group in it, should be pleased that they have played a role in passing the bill.

I will direct my remarks at one aspect of the bill—free personal care for the elderly, which, as everyone knows, has been the subject of some controversy and indeed was the first policy area to put a strain on the relationship between this Parliament and the Westminster Parliament. There are those, particularly at Westminster, who make much of the cost of free personal care—£125 million a year—and of the fact that all elderly people, rich and poor alike, will be able to benefit. Their argument is that the £125 million could be put to much better use by being targeted on more deserving groups, such as the poor elderly who cannot get a place in a nursing home because their local authority does not have the funding to pay for that place.

That argument is not without substance—I think that any parliament should always make its priority those who are in the greatest need. However, it is often the case that the people who argue that resources should be targeted on the poor are those who resolutely refuse to raise taxes to target funding and investment on the poor. I am wary of those who argue that, because someone can well afford to pay for personal care, they should be made to pay for personal care. I once heard that approach described as "hyena socialism"—the rich are made to pay only when they are wounded, infirm, elderly or in need of some kind of care, whereas when they are fit, young and fully enjoying their wealth, they get away scot free.

I am in favour of making the fit-and-well rich pay, too, not by charging them for services that they do not receive, but by taxing them. That is what is required to square the circle. It is matter not just of regret, but of shame that the highest rate of income tax in this country remains the same as it was under Baroness Thatcher. That continues to reflect badly on us.

At the Health and Community Care Committee's meeting this morning, the chief medical officer for Scotland described a founding principle of the NHS—that it should be free at the point of use and funded from general taxation. We should consider free personal and nursing care for the elderly in that light. If the choice is between a universal welfare state with concomitant higher taxes and a targeted, means-tested welfare state with concomitant lower taxes, I am for the universal welfare state and the higher taxes. I hope that the Parliament is, too.

Photo of Dennis Canavan Dennis Canavan Independent 4:45, 6 February 2002

I warmly welcome the bill and particularly the proposals for free personal and nursing care for elderly people, which are in accordance with the recommendations of the Sutherland report. I urge the Scottish Executive to stand by its commitment. There have been too many delays. I hope that no further delay will occur and that the Executive will stand by its commitment to implement the recommendations fully by 1 July.

I also hope that the Scottish Executive will continue to press the Westminster Government for payment of the £23 million a year that the Benefits Agency will save on attendance allowance. I was dissatisfied with the First Minister's reply when I raised that matter at First Minister's question time on 17 January. He quoted a statement of funding policy that as Minister for Finance he had negotiated with the Westminster Government. That agreement was meant to deal with a decision of this Parliament that would mean more expenditure by Westminster, but we are dealing with a decision of this Parliament that will mean less expenditure by Westminster. Westminster will save money because of this Parliament's progressive policy of providing free personal and nursing care for elderly people. Sutherland recommended that, but Westminster rejected it.

One reason why I supported the establishment of a Scottish Parliament throughout my political life is that I believed, as I still do, that a Scottish Parliament could deliver a fairer deal for the people of Scotland than Westminster ever could. The bill is a good example of that. I hope that, in time, people—not only in this country, but in other countries—will see the Parliament as a standard-bearer and setter of higher standards of care for some of the most vulnerable and deserving members of society.

Photo of Bill Butler Bill Butler Labour 4:47, 6 February 2002

I am grateful for the opportunity to put on record my whole-hearted support for this progressive bill. It is obvious from the speeches of members of all parties that there is general agreement on the positive effects that will flow from the bill. The bill will improve the lives of many of our fellow citizens and so deserves the chamber's unanimous support, which I am sure it will receive.

The bill will provide the necessary legislative framework to improve care services and to provide free nursing and personal care from 1 July 2002. It is the statutory embodiment of the 39 recommendations of the care development group. The Executive accepted all 39 recommendations, with the comprehensive support of all members.

The bill will allow all the essential points in the care development group's report to be put into practice. It will implement free personal care and allow for a continuing emphasis on shifting the balance of care towards enabling people to remain in their own homes, if they choose to. Moreover, the introduction of free personal care will be accompanied by substantial additional investment in the provision of care for older people. It is fair to congratulate the Executive on providing those resources.

Part 2 of the bill concerns joint working, which is essential. It will enable ministers to require NHS bodies and local authorities to enter into joint arrangements for service provision and resourcing. Such an integrated approach is reasonable and essential and is much to be welcomed.

Today, we can all be justly proud of the new institution that is the Scottish Parliament. The bill demonstrates what can be done when the needs of the people whom we seek to represent are not obscured by unnecessary and ultimately irrelevant party-political considerations. Today, the Scottish Parliament will make news for the right reason. It will have made a positive difference to the circumstances of many of our constituents—that, after all, is why we are here. The bill is a good piece of work and I commend it to the chamber.

Photo of Donald Gorrie Donald Gorrie Liberal Democrat 4:50, 6 February 2002

Like other members, I welcome the bill and pay tribute to the ministers, members of the Health and Community Care Committee, MSPs and people outside the Parliament—including those in pressure groups—for what they have achieved.

I ask the minister to give an assurance that young carers will be the subject of particular attention. The Health and Community Care Committee is to be commended for amendment 19. The amendment, which was lodged by Janis Hughes, will help to address the needs of carers who are children.

Some time ago, we had a good members' business debate about young carers, in which members who had visited and had discussions with young carers highlighted two problems. First, young carers slip though the net in greater numbers than do adult carers. As a result, many young carers are not identified. Many of them do not see themselves as carers—they have not heard of the term. All they know is that they have a sick mum, for example, whom they look after. Health, education and social work departments and possibly the police need to make much more effort to identify young carers. I hope that the authorities will work in a joined-up fashion to hunt out young carers.

Secondly, many young carers say that they get a raw deal at school, where their problems are often not recognised. If a young carer arrives at school late, perhaps because they have been looking after a family member, they are regarded as a kind of troublesome truant. We need to make a special effort to ensure that schools are up to speed on the issue. We also need to ensure that schools assist in identifying young carers and that they co-operate and are involved in helping them.

I hope that the Executive will assure us that it will get the various agencies involved to take the issue seriously. If the bill helps young carers, it will improve life in Scotland.

Photo of Hugh Henry Hugh Henry Labour 4:52, 6 February 2002

I thank everyone who has been involved with the bill over the past four and a half months. That includes a great many people. Within the Parliament, I thank all four committees that were involved with the bill at stage 1. I thank in particular the Health and Community Care Committee, which did so much work on the bill at each stage, providing excellent questions and stimulating debate and detailed scrutiny of the draft legislation. I thank the clerks to the committee and the other parliamentary officers who helped with the bill. I thank the members of the bill team who worked long and hard to make it a success. At times I marvel at how they, and committee staff, manage to meet almost impossible deadlines. I also thank the large number of members of the public, voluntary groups and other organisations who have made an important input by participating in the consultations on the bill's provisions and in the parliamentary process.

However, it is clear from the letters that I am receiving that not everyone fully understands who will benefit and what the effects of the bill will be. Many people already receive free personal care; the bill extends that entitlement. We are preparing an information campaign to ensure that older people, their families and carers are informed of what the policy will deliver. As members have indicated, the bill has received widespread support. It is a major step forward in improving care in Scotland.

Shona Robison and Janis Hughes mentioned carers. My colleague Mary Mulligan has already apologised for the late lodging of certain amendments. In the spirit of consensus, I should point out that the blame for that lies fully with Janis Hughes. Her dogged determination to protect carers' interests and to ensure that carers are not fobbed off led to detailed negotiations and discussions and subsequently to the late amendments, which are purely and simply meant to protect the position of carers in Scotland. I pay tribute to Janis for her work.

Mary Scanlon raised a number of detailed points and questions that unfortunately cannot be answered in this stage 3 debate—I think that she was making up for all the weeks when she did not have a voice. Nevertheless, some of her concerns will be addressed in the coming months and I am sure that members of the Health and Community Care Committee will raise them again as they continue to scrutinise the development of free personal care provision.

Several members mentioned joint working. The issue was well discussed at stage 2 in the committee. Joint working is absolutely necessary. Although I hope that such working will develop on the basis of co-operation, we have ensured that, where joint working is not effective, we can implement further measures.

Ben Wallace mentioned the fact that he had met the Faculty and Institute of Actuaries. It has been suggested that actuaries are people who think that accountancy is too exciting; in that case, meeting Ben Wallace must have been an orgasmic experience for them. I also listened with interest to John McAllion's definition of hyena socialism, which would probably take some of our debates on to a more voracious level.

In response to members' questions, I can say that there will be no further delays. We are fully committed to meeting the bill's objectives; the money is in place and we look forward to working towards the bill's implementation. I regret Nicola Sturgeon's slightly negative contribution. She turned the Parliament's moment of pride over such a major achievement into another opportunity to criticise and to have a whine about Westminster.

Although the bill represents a substantial piece of work, a great deal more still has to be done after today's debate. I stress the importance of the on-going implementation work and the regulations that will follow in the bill's wake. I am sure that the Health and Community Care Committee is looking forward to giving both its careful scrutiny.

As Henry McLeish and other members have pointed out, we should recognise the achievement that the bill represents and the improvements in care that we will be able to deliver as a result of it. The bill is part of the biggest package of support to older people that the country has ever seen. With the introduction of free personal care and other aspects of care delivery, alongside measures such as concessionary travel across Scotland and central heating programmes, the Parliament is simply repaying the sacrifice that our parents' generation made in the creation of a welfare state. Although, as John McAllion suggests, people of our generation might be selfish in how they prepare for their old age, I am proud that we have done something to repay our huge debt to our parents' generation.

I thank everyone for their support and their efforts over the past couple of months, and I ask the chamber to join me in voting for the bill to be passed.