Free Personal Care

– in the Scottish Parliament at 2:15 pm on 14 June 2007.

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Photo of Alasdair Morgan Alasdair Morgan Scottish National Party 2:15, 14 June 2007

The next item of business is a debate on free personal care. Before I invite Nicola Sturgeon to open the debate, I ask members to be aware that there are still active court proceedings in relation to an issue to do with free personal care in Argyll and Bute. Members should not refer to the details of that particular case.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party 2:58, 14 June 2007

I welcome the opportunity to open this debate and I make clear from the outset that the new Government supports the policy of free personal care. The debate provides us with an important opportunity at the start of a new session of the Parliament to reflect on the policy's aims and to consider carefully the action that we must take to ensure its fair, consistent and sustainable implementation throughout Scotland.

I commend the previous Administration and local authorities for the action that they took—and that local authorities are still taking—to shape and deliver the policy. Free personal care is a policy that was born out of strong cross-party support and that sets Scotland firmly in the vanguard of social care development. We have an obligation to ensure that the policy is built to last.

Is the policy working? Broadly speaking, the answer is yes, but the detailed answer too often depends on where someone stays. In addition to the wealth of anecdotal evidence—I dare say that we will hear much anecdotal evidence in this debate—two main studies support that point of view. The first is the Health Committee's care inquiry report on the implementation of free personal care. That report, which was published in June last year, strongly supported the policy, as does the Parliament, but it identified a number of problems that need to be fixed.

The second study is a substantial independent evaluation that was published at the end of February. It found that the vast majority of people involved receive their payments for personal care services without undue delay or complication. I very much welcome that and fully recognise the important role that local authorities have played in delivering it, but the report also found that there are variations in local practice and, like the Health Committee's report, identified specific issues that need to be addressed.

The evaluation report made a number of recommendations to ensure that implementation of the policy is further improved. The previous Executive accepted those recommendations, and discussions about their implementation have begun with the Convention of Scottish Local Authorities. Although we support and will continue with that work, it needs to be stepped up a gear if real progress is to be made.

More than 50,000 older vulnerable people currently benefit from the policy of free personal care, but action is required to enhance delivery and to ensure that everyone who is entitled to free personal care gets it, without undue delay.

It is worth noting that some people—not inside, but outside, the chamber—have always wanted to see the policy fail. They claimed from the outset that the policy was unaffordable and unworkable and that it was not sustainable in the long-term. I assure them that, under this Scottish Government, not only will the policy be enhanced, it will be secured for many years to come.

As we pledged in our manifesto, we will establish an independent review to investigate the level and the distribution of resources to local authorities. We stand by that commitment. I can announce today that the review will be chaired by Lord Sutherland, who chaired the royal commission that paved the way for the introduction of free personal care. On behalf of everybody in the chamber, I put on record our thanks to Lord Sutherland for the continuing commitment that he demonstrates to the long-term success of this policy.

Local authority input to the review will, of course, be crucial. I envisage that the review will begin in the summer and should conclude by March. I have, however, asked Lord Sutherland for an interim report by September. It is possible that the review could identify a need for extra financial provision. If that is the case, the initial findings will be fed into the spending review as appropriate.

The members of the review group and their precise terms of reference will be announced shortly, but I want to confirm today that I have asked them to look at the level and distribution of resources and at the longstanding imbalance between Scotland's and the United Kingdom's finances, going back to when the policy was introduced—namely, the issue of attendance allowance. In parallel with that, my officials will open discussions with officials in the Department for Work and Pensions to explore the possibility of an agreed and amicable settlement to that issue.

The issues surrounding the implementation of the policy are not just to do with the funding available to local authorities and its distribution among them. The evaluation report also identified various practical issues that need to be addressed. We made a commitment in our manifesto to ensure that free personal and nursing care will be implemented properly across the country and we will deliver on that commitment. To ensure that the policy is implemented consistently and equitably, I have asked officials to engage with local authorities to develop proposals jointly with them.

A number of policy strands need to be clarified. They include food preparation, assistance with medication, waiting lists and a more balanced approach to eligibility criteria. I recognise that resolution of the food preparation issue and, indeed, many of the other issues that I have mentioned might require legislation. I also acknowledge that some people, particularly in local authorities, believe that some of the difficulties are due to flaws in the original legislation. I want to make it clear that I am willing, if necessary, to go down the route of legislation if that is deemed the best and most appropriate way of fixing this problem.

I believe that positive engagement with local authorities will lead to an approach to implementing the policy that is more consistent than the approach we might have seen in the past. That will result in better outcomes for our older people—which, after all, is the most important issue.

Local authorities have signalled that they are keen to work with the Scottish Government to resolve what are in many cases tricky areas. I warmly welcome that response, and my colleagues and I look forward to constructive engagement with local authority leaders.

The third main area that we need to tackle is payments for personal and nursing care to self-funders in care homes, which, since the policy was introduced in 2002, have remained static at £145 per week for personal care and £65 per week for nursing care. In the meantime, the cost of a care home place for a self-funder has increased. As a result, the value of free personal and nursing care payments to those who receive them has been eroded. That situation is unacceptable, and must be resolved.

There have of course been consistent calls in and outwith the chamber to increase the payment levels to reflect better the cost of providing these services. In line with another of our manifesto commitments, I can announce that, from April 2008, we will increase the payment for personal and nursing care in care homes in line with inflation. I think that that is right and fair, I know that it is affordable, and I believe that it is in the best interests of older people throughout Scotland.

Photo of Mike Rumbles Mike Rumbles Liberal Democrat

I very much welcome that announcement, but I wonder whether the cabinet secretary will clarify whether the increase next April will be based on inflation over the six years from the introduction of the policy, or on inflation over one 12-month period.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

We will increase the payments in line with inflation from next April for the future. That important commitment will be welcomed not only by care homes and local authorities but, crucially, by older people who rely on those payments to get the care that they need and deserve. I am very proud indeed to be able to honour that manifesto commitment today.

In conclusion, I reiterate that, as long-term advocates of the policy of free personal care, we as Scotland's new Government are absolutely committed to the policy's success now and in the future. It provides help and gives peace of mind to thousands of people at a time of their lives when they need them most. As I have said, the steps that I have outlined today fulfil another important manifesto commitment. Much more important, they put free personal care—a policy that in Scotland we were right and proud to pioneer—on a stable and sustainable footing for the long term.

I hope that, in taking this action, the new Scottish Government will enjoy the support of all sides of the chamber.

Photo of Lewis Macdonald Lewis Macdonald Labour 3:08, 14 June 2007

I am pleased to take my first formal opportunity to welcome the Cabinet Secretary for Health and Wellbeing and the Minister for Public Health to their new roles. Over the past couple of years, Shona Robison and I have had some full and frank exchanges in the Health Committee, of which I will say more in a moment. I look forward to such constructive, if robust, exchanges continuing in the Health and Sport Committee this time round.

I welcome the cabinet secretary's recognition of the success of free personal care and acknowledge the importance of resolving some of the difficult issues to which she referred. I welcome some of the announcements she has made although, given the substance of some of them, it is perhaps a pity that she did not bring them to Parliament in the form of a statement rather than simply set them out as pieces of information in a subject debate.

The cabinet secretary's deputy was a member of the Health Committee that undertook post-legislative scrutiny of free personal care and published its inquiry report a year ago this week, so ministers will be familiar with the response of the then Executive to that inquiry—indeed, Nicola Sturgeon referred to it. They will also be familiar with the Joseph Rowntree Foundation's report on free personal care in Scotland, which was published last year. Shona Robison will recall scrutinising "Evaluation of the Operation and Impact of Free Personal Care", which was commissioned by the former Administration in response to the Health Committee's report and published in March this year.

As Nicola Sturgeon has confirmed, ministers are aware of all those reports and evaluations from the past year or so, as well as of the steps that have been taken and the measures that have been set in train to respond to them. We look to ministers to do more than simply set up another inquiry; we look to them to act to resolve some of the difficult issues. The cabinet secretary has indicated how she intends to do that in one or two cases, but there are other areas that give me some cause for concern.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

I remind Lewis Macdonald—he will have picked this up from my speech—that the recommendations of the evaluation are being taken forward without further inquiry. They are work in progress. The independent review, which is to be chaired by Lord Sutherland, will look into a separate important matter: the level and distribution of resources. Will the member welcome that?

Photo of Lewis Macdonald Lewis Macdonald Labour

I am happy so to do. I welcome the clarification that the forthcoming Sutherland inquiry will be about those resource issues alone.

I have no doubt that, in her speech, Nicola Sturgeon

Photo of Lewis Macdonald Lewis Macdonald Labour

It is a shame that a statement was not made available prior to Nicola Sturgeon making her speech—all members could have benefited from knowing the content of what she had to announce today.

I was pleased to listen to Nicola Sturgeon's speech, and I noted some of its content, although I also noted one or two things that were not there. She acknowledged, as did the Rowntree Foundation report and the Health Committee, that free personal care has been very successful in supporting, in particular,

"People with conditions such as dementia and people of modest means".

It has not resulted in

"a reduction in informal care".

Furthermore,

"Free personal care may have supported increases in care at home."

That is all in line with wider health and care policy objectives, and the policy might also have helped to reduce delayed discharges from hospitals. I welcome the confirmation of the new Administration's support for that broad approach.

The previous session's Health Committee raised several issues and made a number of recommendations. In the context of what Nicola Sturgeon has said today, one of those stands out: the recommendation that

"The Scottish Executive should undertake a thorough review ... of the resources required by local authorities ... to ... finance free personal care. This may require an increase in funding, or more equitable distribution amongst local authorities."

I remind Nicola Sturgeon that ministers in the previous Administration accepted that recommendation. Although her review is welcome, it is in the context of delivering on something that we undertook to do—to follow the recommendation of the Health Committee and review the working of free personal care. As Nicola Sturgeon knows, we undertook to work, with the Convention of Scottish Local Authorities, to address funding and other implementation issues. I welcome her confirmation that that work is continuing.

As Nicola Sturgeon is setting up an inquiry that, she tells us, will take almost a year to consider the issue of resources, it is worth saying—as was set out in the papers that the minister and her colleagues would have seen in preparation for the Health Committee meeting of 6 March this year—that the work that we had undertaken on resources was carried forward to the point where it could be made available to committee members. The outcome of that work was not kept secret; it was included in the Executive's evidence to the Health Committee, which the committee considered on 6 March.

For the removal of doubt, I will remind ministers what the review of funding showed. In the first full year of funding the new policy, 2003-04, local authorities spent £197 million on free personal and nursing care, and they were allocated upwards of £219 million. In 2004-05, expenditure was of the order of £222 million, and grant-aided expenditure was upward of £229 million. Total GAE, between existing support for free personal care at home and new funding provided under the policy for free personal and nursing care, went up from £219 million in the first full year to £254 million in 2006-07, which is an increase of £35 million, or 16 per cent, over four years. The comments that the cabinet secretary made about the need to keep individual payments up to the level of inflation should be set in the context of those figures.

I detail those figures for the record, and to demonstrate that some of the work of the review of funding for free personal care has already been done or was under way during the previous session of Parliament. If ministers are serious about improving and strengthening the policy, they will focus on the issues on which a need for further progress has been identified, rather than go back over old ground.

There are some pretty clear pointers about what needs to be done on funding, including some from the work that the previous Executive undertook. Funding for free personal care has risen above the rate of inflation in the past four years, but the level of demand has risen rapidly as well. Ministers do not need an inquiry to tell them that local councils will have a strong case for increased allocations in the forthcoming spending review. I certainly approve of the cabinet secretary's aspiration that, for the spending review, there should be as many accurate statistical data as possible on which to base decisions on future funding.

Photo of Mike Rumbles Mike Rumbles Liberal Democrat

The member mentioned that the previous Executive gave more money to councils, but it did not give more money to individuals. The previous Administration did nothing to increase that money, nor has the present Administration. In the past five years, including the announcement that we have just had, nothing has been done to address that issue.

Photo of Lewis Macdonald Lewis Macdonald Labour

I understand Mike Rumbles's point entirely—his intervention is timely. Shona Robison will be aware that, in an exchange that she and I had in the Health Committee on 6 March, it became apparent that, at that time, work was in hand to examine whether the payments made to care home residents of £145 per week for personal care and £65 for nursing care were enough to meet the needs that they were intended to address. I told Shona Robison that

"the element for personal care has perhaps been greater than the actual spend ... and the element for nursing care has perhaps been less than actual spend."—[Official Report, Health Committee, 6 March 2007; c 3458.]

I said that the two elements together were fairly close to balancing out. Mike Rumbles has paid close attention to those matters over the years, so I am sure that he will be aware of that.

Perhaps the minister will tell us in her closing speech whether that earlier work has continued and whether the emerging findings to which I referred in the Health Committee have been borne out in the continuing work. Perhaps she will also say whether she agrees with the previous Administration that the right time at which to consider whether to uprate those elements is the forthcoming spending review. The cabinet secretary announced an intention to uprate, although Mike Rumbles challenged her on whether that will acknowledge any possible potential for underresourcing in the previous period. My view is that there has been no such underresourcing, but work was being undertaken in the Health Department to examine the matter during the previous session of Parliament, so I am interested in hearing whether that work has been completed.

I commend to ministers the conclusions and recommendations of the evaluation to which Nicola Sturgeon referred. As she acknowledged, it made recommendations on issues such as funding, waiting and assistance with the preparation of food. I am pleased that that work is continuing. I hope that ministers, in seeking to strengthen free personal care, will do so by building on the solid foundations of the work that has already been done. I hope that they will do so in partnership with local government, as Nicola Sturgeon said, but also using the expertise of the Scottish Commission for the Regulation of Care and voluntary organisations such as Age Concern Scotland and Alzheimer Scotland. I hope that ministers will acknowledge that it makes no sense to separate implementation issues from funding ones or to postpone reform of or improvements to the detail of the policy to a time beyond the conclusions of the spending review. It is critical that the implementation and financial issues are joined up.

I hope that the debate will not focus on external funding that might be attracted from funding streams that are reserved to Whitehall departments. In the cabinet secretary's opening remarks, we heard no new argument or evidence about reopening those issues that seems likely to be persuasive. Instead, I hope that the debate will focus on what the Scottish ministers, the Scottish Parliament, Scottish local authorities and other stakeholders can do to improve the delivery of free personal care in Scotland.

Photo of Mary Scanlon Mary Scanlon Conservative 3:19, 14 June 2007

I, too, welcome Nicola Sturgeon to her post as Cabinet Secretary for Health and Wellbeing. I thank her for her first meeting with the Tory team last night, which I attended once I found where the ministerial offices are. I wish her all success in her crucial post. I also thank Nicola Sturgeon for the advance copy of her speech in today's Daily Mail , Times and other publications, as well as for the opportunity to hear it on the radio. I remind Mike Rumbles that his party was in the previous Government—it may not have felt like it at times, but he needs reminding of that.

Although I spoke in Des McNulty's members' business debate last week, this is my first speech in a debate in the chamber after a year out. I have therefore resumed maiden status.

I want to echo the views and the approach of my party and its leader. We will work positively and constructively with the minority Government, and with all other parties, to make this Parliament work better for the people of Scotland. On no issue will that be more important than on health. We welcome the new challenges.

The transformation of the nationalists from abrasive and confrontational in opposition to fountains of charm in government is quite difficult to believe—especially if, like me, members have recent experience of them in their former guise. Our approach to the new minority Government is in stark contrast to the previous approach of the nationalists, who never called, never wrote. In fact, they went as far as passing a motion of non-co-operation at their conference nearly 20 years ago, confirming that they would never call, never write, never work with the Tories, never liaise with us and never be partners to any agreements with us. However, in the new, reprogrammed, nationalist politics, I trust that the First Minister, a man who recognises an act of unpardonable folly when he sees it, will now persuade the nationalists to embrace the new politics and—who knows—even the Conservatives. The First Minister may wish to call this "Mary's clause", given the high profile he gives me at his conferences.

The Community Care and Health (Scotland) Act 2002 was the flagship piece of legislation in the first session of the Scottish Parliament, so why—as the cabinet secretary asked—five years down the line, are we still wrangling in councils, in courts and with COSLA over the interpretation of the act? Why is Highland Council spending more than £11 million on free personal and nursing care when it receives only £6.5 million from the Executive?

The issuing of guidance that contradicts the act has undoubtedly led to much confusion, and the legal rights of people to free personal care are still somewhat uncertain. Margaret Smith was the convener of the Health and Community Care Committee at the time, and Richard Simpson and Malcolm Chisholm were members of it. The committee worked on the bill and I would argue that the legislation was not flawed; it was the guidance that was flawed. The guidance contradicted the legislation. I stand by the legislation. It was not ambiguous.

At all stages of the committee's proceedings, members were told that all care homes would be integrated care homes with nursing provision. We were assured that, as an elderly person's condition deteriorated and more nursing care was needed, they would not be moved from a residential home to a nursing home. We were assured that one integrated care home would provide the appropriate level of care at all stages.

Somewhere between the passing of the act and its implementation, something went wrong. In Scotland, we have three categories of care home: residential care homes, nursing care homes and integrated care homes. All are funded differently, depending on the level of care provided. What happens is that a person is assessed and placed in a residential care home, but as their condition deteriorates, they continue to stay in that home, even though it cannot provide the more complex care that is needed. The spirit and intention of the bill was quite different from what has been implemented under the act.

The SNP states that it will provide an additional £6 million each year for care home places. Would that money not be better used to bring some equity into the system, which would ensure that many care homes remain financially viable, open and available for placements? It is likely that there would not be such a shortage of care home places if they were all funded at the same level. I realise that that might require a memorandum of understanding with Westminster, but I do not think that that will be impossible. The basis of this issue lies in a Westminster act of Parliament.

With no exceptions, all who gave evidence to the Health and Community Care Committee stated that there should be a single budget for health and social work.

Photo of Mary Scanlon Mary Scanlon Conservative

It is my maiden speech dear. [ Laughter. ]

Conservatives have called for such a single budget for eight years now, and I hope that the new nationalist Government will take it up.

I will address the uptake of direct payments. I know that the previous Government, including Mr Rumbles, supported them, but I am not sure that it did quite enough. Uptake has been slow; it is still less than 2,000 for the whole of Scotland. Surely carers and the cared-for need to know that they can manage the budget, choose the care provider, monitor the care received and ensure that it is in line with the assessed need. Direct payments put them in control of that care, and we all have a responsibility to promote them.

That brings me to waiting lists. More than half of all local authorities operate waiting lists for free personal care, but there is another, hidden, waiting list—the long wait for assessment. That back-door method of managing the waiting list is unacceptable and, given the Cabinet Secretary for Health and Wellbeing's promise to rid us of hidden waiting lists, I trust that she will now examine the waiting list to get on to the waiting list.

When the 2002 act was passed, we were told that anyone who was assessed as in need of free personal care would get it, but if they have to wait to be assessed, that delays their inclusion in the waiting list. It also helps councils save money, but it does not fulfil the promise and intention of the act.

For the third time, NHS Highland has pulled back from proceeding with the new build at Migdale hospital. The hospital predominantly cares for the elderly in Sutherland, which has the highest increase in older people in Scotland. The existing hospital building is seriously deteriorating, leading to the possibility of closure, and the land that is currently allocated for the new hospital could be sold. The lack of decision is increasing uncertainty and community anxiety.

I look forward to working with Malcolm Chisholm, Lewis Macdonald, Ross Finnie, Karen Gillon and others on the Health and Sport Committee, convened by my old friend, the feisty Christine Grahame.

Photo of Ross Finnie Ross Finnie Liberal Democrat 3:27, 14 June 2007

I am fairly well aware of the normal parliamentary protocol for following a maiden speech. However, Presiding Officer, I may require your guidance on dealing with the position in which someone has returned to maiden status, particularly when the maiden appears to be suffering from a severe deprivation of telephone callers and people writing to her.

Photo of Alasdair Morgan Alasdair Morgan Scottish National Party

I am not sufficiently experienced to rule on that.

Photo of Ross Finnie Ross Finnie Liberal Democrat

We can all have some sympathy with that, although we expect the Presiding Officers to be the fount of all knowledge on parliamentary procedure.

I congratulate Mary Scanlon on her maiden speech. I am glad that she is keen to work with a small, select band of us over the next few weeks and months. We look forward to that.

The publication of the Sutherland report, "With Respect to Old Age: Long Term Care—Rights and Responsibilities", in 1999 was a seminal moment in the long-running debate in this country and the United Kingdom as a whole on how our society deals with personal care for the elderly. Although Sutherland's recommendations might, in some cases, have been regarded simply as common sense, they pointed to a new and different line. In particular, the report examined different definitions and considered splitting long-term care into living costs, housing costs and personal care.

My only reservation is that it was perhaps unfortunate that the political parties—and, indeed, those involved in wider communication—adopted the phrase "free personal care", which was often misunderstood as suggesting that all the elements that Sutherland identified—living costs, housing costs and personal care—would somehow become free. That has given rise to a deal of confusion.

The Scottish Liberal Democrats did not just welcome the report warmly, but adopted it in our 1999 manifesto, in which we made a commitment to achieve the recommendations of the Royal Commission on Long Term Care for the Elderly. We were delighted to be part of the Government that introduced the Community Care and Health (Scotland) Act 2002, which implemented that policy.

After a policy has been in place for a number of years, it is right and proper to see whether it is as effective as was originally intended and whether there are aspects of it that we rue. However, there is a danger that, in reviewing it, we will lose sight of the fact that there is good cause to rejoice in the major success of the introduction of free personal care, as defined.

The cabinet secretary mentioned the numbers. It is good to pause to consider those 50,000 people. Nine thousand self-funders have been helped in meeting their care-home costs, of whom 6,000 have been helped with running care. More than 42,000 people receive personal care services at home without charge. Of course, we have gone beyond that, because the introduction of the policy has had the additional benefit of reducing delayed discharge and providing support for carers. As the cabinet secretary said, the independent report made it clear that people have received their payments for personal care services without undue delay or complication. We should celebrate all that.

It would be time, five years on, to look at any policy, but I say to the cabinet secretary that we must be careful in our language. I do not think that the policy of free personal care, as based on the Sutherland report, requires to be reinvented. I question whether we require yet another inquiry and I certainly hope that we will not be distracted by the question of attendance allowances. That might be a perfectly legitimate political argument that the Scottish National Party Government wishes to pursue—it has raised it before—but I hope that it is not the central issue in considering whether we go forward with the development of free personal care as a policy, because it could be considered separately. That is entirely up to the SNP Government.

The cabinet secretary has announced her intention to apply inflation to the rates starting from April 2008. It would be churlish not to acknowledge that, if she believes that that can be funded, it will make a difference to individuals in the years ahead. However, as Lewis Macdonald pointed out, we must distinguish between the rate that is applied to the individual and the real levels of funding provided by the previous Administration. The Convention of Scottish Local Authorities raised concerns about the level of that funding in 2002 but, after the announcements that the previous Administration made in 2004-05 and 2006-07, it acknowledged that the policy, in its own terms, was being funded properly.

Photo of Ross Finnie Ross Finnie Liberal Democrat

I think that I will run out of time quite shortly.

Photo of Ross Finnie Ross Finnie Liberal Democrat

You are very gracious. Thank you.

Photo of Keith Brown Keith Brown Scottish National Party

I thank Ross Finnie for taking the intervention, with some encouragement.

On the point about the funding being adequate, will the member explain why the previous Executive allowed Labour authorities—such as Clackmannanshire Council—to charge illegally for the preparation of meals over a number of years before dealing with the matter? Surely local authorities would not have had to charge had the funding been right in the first place. The previous Executive did nothing.

Photo of Ross Finnie Ross Finnie Liberal Democrat

That is certainly not true. A number of local authorities chose to interpret the intention of the statute in different ways. That is, and has been, reprehensible. I accept that that is a major problem, but the previous Executive certainly did not approve of it. I will also touch on how local authorities dealt with the time for assessment and the time for which care could be available, and invented their own waiting lists.

The cabinet secretary referred to the emergence of different types of waiting time and the different interpretations of what is meant by assistance with the preparation of food and assistance with medication. However, we have now had three reports on those matters, including those of the Joseph Rowntree Foundation and the previous Health Committee. I confess that I did not hear a compelling reason in the cabinet secretary's statement for requiring a further report. The Government should use the evidence from the previous reports to identify the problems and to propose ways of addressing them. There is an issue about there being different levels of distribution of the resource, but the cabinet secretary has evidence on that from the COSLA pilot studies. The only new element to be handed to the proposed inquiry is that of attendance allowances. I hope that, in her winding-up speech, the Minister for Public Health can give us a compelling reason for holding an inquiry rather than simply getting on with addressing what are real problems—we do not suggest that they do not exist. I do not understand why, given that three previous reports have identified the problems, we require a separate report; nor do I understand why the cabinet secretary cannot say how she will deal with the problems.

The free personal care policy is important to the people of Scotland, particularly because of our demographics, and it is essential that the policy is sustainable. We welcome the cabinet secretary's commitment to the general funding of free personal care and to funding improved access to it. I hope that there will be no protracted inquiry and that practical steps towards making the policy more workable will emerge sooner rather than later. We generally support the Government's attempts to make the policy more sustainable.

Photo of Dave Thompson Dave Thompson Scottish National Party 3:37, 14 June 2007

As I have not yet spoken in a debate led by the Cabinet Secretary for Health and Wellbeing, I congratulate her on her recent appointment. I welcome her earlier announcement of increased funding for free personal care. I also congratulate the Minister for Public Health on her appointment. I wish them both well as they tackle the difficult issues that will confront them over the next four years.

I have never spoken in the chamber before and it gives me great pleasure to stand here today and make my maiden speech. I have dreamed of this since I was 16—although the chamber did not exist then. What did exist was the dream of many people such as me of a Parliament for Scotland. Now we have that Parliament and it is growing and developing. Now, I dream of making a speech in a fully independent, grown-up Scottish Parliament. I know that my dream will come true.

I have the great honour of representing the Highlands and Islands, which includes Moray, where I was born and brought up—although Moravians dinna really see themselves as Highlanders. As a Lossie loon who has lived and worked in the Highlands for 24 years and who has also lived and worked in Na h-Eileanan an Iar—the Western Isles—for 10 years, I hope that I have learned a little about the challenges that we face in this most beautiful and diverse region.

We have much going for us in the Highlands and Islands in terms of our natural resources. We have fishing, farming, forestry, rocks and gravel, water, oil, gas, aquaculture and renewables coming out of our ears. We also of course have whisky. However, all is not well. Many of our young folk still leave, which is why we have 10,000 missing 16 to 29-year-olds and low wages. Much of our work is seasonal and part-time. We educate our young for export, which is why our unemployment rate is low. Many of those who stay have little hope of a bright future and virtually no hope of a home of their own.

We also have an increasingly elderly population because we are all living longer and because many choose to retire to the Highlands and Islands. That brings its own problems. There is an increasing demand for more care in the community to allow our older folk to stay in their own homes for as long as possible—if only to stop the state getting its hands on that prized asset. It is right to help people to maintain their independence for as long as possible, but we must also ensure that adequate residential care is available in their local communities for those who need it.

The Government is committed to delivering free personal and nursing care for the elderly, but it must be available to all, equally, including those in rural and remote areas. The right to such care in all communities is important. The elderly must have the comfort and confidence of knowing that their needs will be catered for in their locality, even after they are no longer able to stay in their own home and have to enter a residential care home. For many, that will not be a problem, as there will be plenty of choice in their local community, either in the private sector or in local authority facilities. That is not the case for everyone, however, as rural and remote areas with sparse populations will not attract the private sector. Public sector residential care homes are so important because they will be the only choice. That is why I am so pleased that Highland Council, which is run by an SNP and independent administration, has decided to look again at the privatisation of a number of care homes across the region with a view to keeping them in-house.

It is great that the new council has moved so quickly on the privatisation of care homes. I hope that it will also reconsider the decision by the previous administration to close Graham House, a residential care home in Dornie on the west coast, and replace it with a facility that will have no residential or respite care capability. Should that go ahead, there will be no residential care facility in Lochalsh—public or private—for local elderly folk who need such care. That is not acceptable. If the closure goes ahead, it will mean that many of the elderly who need residential care may be placed in Broadford hospital on Skye, when they need not be there, or may be placed many miles from their home, their friends and their family. I ask members to imagine that they were born, brought up and spent their whole life in Lochalsh and were told in their 80s that they were to be sent nearly 100 miles away to Invergordon, on the other side of the country, to live in a residential home where they know no one and where their friends and family would find it impossible to visit them regularly. They would end their days far from all that they know and love, in lonely isolation. Is that how we want to treat our old folk? How does that square with our equal opportunities obligations? Homes such as Graham House must be kept open. There is a proven need for Graham House, as there are six elderly people currently in residence, a further six who have already been sent elsewhere and another 12 coming to the age when they will need residential care. What we need to do in Lochalsh is to replace Graham House with a larger and better residential home as our population gradually ages.

Of course, Graham House also provides valuable respite care, so that carers can get a short break from the stress and strain of caring. Carers do a wonderful job. They save the country a fortune and they deserve all the help that we can give them. At lunch time today I attended the launch of the carers guide and the cross-party group on carers. I look forward to working in that group over the coming years.

Of course, keeping homes such as Graham House open comes at a cost, but if we are to live up to our promise that health care is provided as locally as possible, we must support councils such as Highland Council that have problems in providing such facilities in rural and remote areas. At the end of the day, it is all about equality. The elderly in Lochalsh deserve treatment equal to that of the elderly anywhere else in Scotland. As the cabinet secretary said, it should not depend on where someone stays: personal care must be available everywhere in Scotland. The closure of Graham House will be a disaster for the community in Lochalsh. I am pressing Highland Council to reconsider its decision. I also hope that the cabinet secretary and the minister will respond sympathetically to the needs of councils such as Highland Council in their efforts to provide local residential care in rural and remote areas in the absence of the private sector.

Photo of Richard Simpson Richard Simpson Labour 3:44, 14 June 2007

I declare an interest as a consultant psychiatrist and a ceased interest in a nursing home, albeit one that is in England.

I am pleased to be back speaking in a main debate, but I cannot claim maiden status for my speech, as I have already spoken in a members' business debate. I welcome Mary Scanlon, who lost none of her touch in her year out, and I congratulate Dave Thompson on his first speech and on his clear and stark references to his constituency. Rural communities require a different solution and one size does not fit all.

Without going into too-great detail, I will make a couple of comments about the history of free personal care. We took a different route from that of the other nations of the UK. The Parliament was pretty united on that route and that was entirely appropriate.

The Conservative Government in the 1980s was wrong to change policy suddenly so that citizens who had based lifelong plans on existing policies were deprived of long-stay national health service units for the elderly, which were at that time the main place to which people who needed nursing care went. That Government provided no alternative and thereby created over 20 years the need to introduce free personal care, which was introduced following the Sutherland report.

I supported free personal care, but not all members of my party did, as they felt—correctly—that the poorest people were already looked after. Those who are wealthiest have never bothered with a system or required support, so the situation did not affect them, either. However, I was concerned about the people whom I called wise virgins—hard-working people who had perhaps been encouraged to buy their council houses, who had some savings over the £18,000 capital allowance and who faced the distress of going into care that would require money and for which they had not planned.

My other reason for supporting free personal care was that the system discriminated against people with dementia. People who had cancer or a degenerative physical disease might be looked after in hospitals, hospices—which were increasingly supported from the 1970s onwards—or at home. All that was supported by good-quality NHS nursing care. However, someone who suffered from dementia was liable to end up in private care or local authority care for which they would have to pay. Such discrimination was inappropriate.

I agree that, as the cabinet secretary said, the Parliament can be proud of the policy. However, when we introduced it, we acknowledged that there was considerable debate about what the costs might be, which was uncertain. The question was whether the policy would be sustainable. Given that, the new Administration's commitment to ensure long-term sustainability is welcome. The previous Administration tried to achieve the same thing.

We must acknowledge that, by 2030, the number of over-75s will have increased by 75 per cent. I hope that the proportion who are disabled and who require care will continue to reduce by between 0.3 and 1.1 per cent per annum but, nevertheless, the number who will require free personal care will increase substantially, so I say to the cabinet secretary that sustainability is not about today or tomorrow, but about the long term. I am sure that the cabinet secretary recognises that.

When the policy was introduced, the other problem was attendance allowance. We were slightly wrong-footed on that by not calling things by names that might have allowed us to retain the attendance allowance, so I for one welcome Sutherland's reconsideration of that. However, that ship has probably sailed and is unlikely to return to harbour.

Having spent four years out of Parliament, I will adopt throughout the session the theme that the Government and the Parliament have good ideas that they wish to implement for the benefit of all Scots and which often attract wide cross-party agreement. Legislation that has good intentions is passed but, as Mary Scanlon suggested, guidance is often less good and more flawed. That is understandable when we are trying to implement the intricate changes that are needed as a result of much of our legislation, but it results in implementation by our local institutions of various sorts that is often patchy, bureaucratic and subject to misinterpretation. That applies not just to free personal care, but to a wide range of issues that I have experienced in the four years in which I have been out of Parliament. I will return to that theme in several debates over time.

We need to look carefully at the implementation of the scheme. The Executive must review the matter constantly, and it is entirely appropriate that we have had the Audit Commission and the responsible committee examine it. However, I wonder why some measures have not been introduced timeously. For example, different local authorities have different eligibility criteria. Why, when we implement policies, do we invite each local authority to interpret the guidance in its own way? Why do we not ask one authority—not necessarily COSLA—to set up a working party to determine the specific eligibility criteria, which can then be adopted by all authorities? Alternatively, we could invite COSLA to enter into an agreement with us on the precise eligibility criteria.

In 1999 I visited Aberdeenshire to examine the implementation of the care needs assessment package—single shared assessment. The package has still not been implemented throughout Scotland, despite marked efforts by the previous Executive to do that. Six or seven years on, Carenap is only just being implemented across the country. A single shared assessment system could produce a much more even approach to eligibility and to needs and priority assessment.

There are other issues that need to be addressed, and the various reports that have been published have been important in that regard. Keith Brown raised the issue of meals, and it is good that that has largely been dealt with. Assistance with medication, which was mentioned in the evaluation report, is another important issue that must be examined. Many elderly people have to take a multiplicity of medications; if they suffer from early dementia or have memory problems, it is difficult from them to manage that. Assistance with medication that does not involve nursing care is an important issue.

I will end with some questions to the minister. Will the Executive continue to develop the important care and repair programme, to which £10 million was committed in 2007-08? Will it require local authorities to collect and analyse data on unmet need, especially for home care, respite care and day care? Will it promote carers' awareness of their important right to assessment? Will it try to ensure that the perverse incentives to authorities to delay introduction of free personal care are removed, as they were in England and Wales, leading to a much more rapid reduction in delayed discharges? Will it also do more to promote direct payments, which is important? Although the number of such payments has increased substantially, the level is still half that in England. Finally, will the cabinet secretary place the terms of reference of the new inquiry in the Scottish Parliament information centre as soon as possible, so that we can examine them in appropriate detail?

Photo of Christine Grahame Christine Grahame Scottish National Party 3:53, 14 June 2007

I, too, offer my congratulations to the maiden speakers in the debate. Mary Scanlon's sabbatical has certainly recharged her batteries. I beg her not to take another one, as I am not strong enough for that. When I look round the chamber at the colleagues who will be members of the Health and Sport Committee—some of them are not here—I see a robust and interesting committee ahead of us.

I welcome the speech by the Cabinet Secretary for Health and Wellbeing. We need a rigorous appraisal of the delivery of free personal care. This is not a party-political issue, as everyone's heart was in it from the start. The policy was a wonderful statement in favour of elderly people in Scotland, but its delivery has not been what any of us anticipated. I welcome especially the independent review of the policy's implementation by Lord Sutherland. In 1999, as a fresh MSP, rather like Dave Thompson today, I went to meet Sir Stewart Sutherland, as he was then, because I had read "With Respect to Old Age: Long Term Care— Rights and Responsibilities". I asked him about help with heating food and dressing, and he made the issue seem straightforward to me—how wrong can one be? He said that help with heating food could include using a tin-opener or potato peeler for a person who could not use them, and that help with dressing might mean doing up the buttons on their jacket or tying their shoelaces. It should not be beyond the wit of anybody to put those things into guidance in a way that would ensure that provision was uniform throughout all our local authorities. I will come to guidance and the role that committees have to play shortly.

On 28 November 2001, during stage 1 of the Community Care and Health (Scotland) Bill, Malcolm Chisholm said, quite rightly:

"Equity and fairness are the final two principles on which the bill is built."—[Official Report, 28 November 2001; c 4221.]

However, as we know, that is not what has been happening.

Richard Simpson mentioned medical treatment. The schedules to the act say that

"If the person requires medical treatment, assisting with medication, as for example by—

(a) applying creams or lotions;

(b) administering eye drops", they should not be charged for that care. Those are just two examples. The point is, people were supposed to get help if they are on multiple medication. The same thing applies to the section on feeding. The schedules talk about

"assisting with the preparation of food".

Again, we are back to the tin-opener test. If someone needs help to open a tin of baked beans so that they can put them on their toast, that counts as assistance with the preparation of food. Similarly, the schedules talk about "assisting with getting dressed". If someone needs help to do the zip up on their dress or do up the buttons on their coat, that is assistance with getting dressed and it is for the professionals who visit someone to make an assessment of whether an elderly person needs that assistance.

Most elderly people are extremely proud. They are not going to stand there asking for assistance with the preparation of food or with getting dressed if they are capable of doing those things for themselves. Everyone in the chamber who is fighting against the vagaries of age that stop us doing more and more things knows that people do not give in when that happens. It is a huge issue that some local authorities have been hiding behind a fig leaf in order to save funds. I am being consensual, but I am also being honest—that has been an issue.

A letter from Lewis Macdonald to Shona Robison that was written on 13 June 2006 and has been placed in the Scottish Parliament information centre talks about the extraordinary number of people—nearly 1,600—who were waiting for home assessments in Edinburgh at that time. Someone who is waiting for an assessment is not getting better; they are getting worse. They are getting worse not only because of the lack of an assessment but because of the emotional stress and damage that can be done to someone when nothing is being done for them and they do not know when something is going to happen.

The situation is perhaps even worse when people who are assessed in hospital go home and find that there is no one in the social care sector who can pick up the work that needs to be done to ensure that the person's home receives aids and adaptations and that social workers and health visitors are provided. Those people sit in their homes until they have to be reassessed and, at that point, it is discovered that they have not improved and that, instead, they have become more institutionalised and their care needs have risen.

Somebody talked about joint budgets. There are huge arguments between social work departments and health boards about whose budget the money is supposed to come out of. In that regard, I point out that it is all our money. The personal care is not free—those people have paid for it through their taxes and national insurance contributions. Let us have a budget that works in the interest of the people who require help.

The previous Health Committee—whose record I hope the next one can live up to—produced an extensive report into the delivery of free personal care. The committee asked local authorities how much they received in 2005-06 for free personal care and how much they thought they had spent on free personal care. We have already heard the extraordinary figure from Aberdeen City Council, which said that it got £6 million and spent £12 million. Moray Council got £2.5 million and spent nearly £6 million. North Lanarkshire Council got nearly £6 million and spent £15 million. Those are huge gaps. The figures might be unrealistic, of course—I do not know; that is something that the inquiry must consider—but the issue is certainly an important one across Scotland.

When we delivered free personal care, it was a fine moment in the Parliament. That is what makes the current situation more galling and disappointing and makes it more urgent that we do what we said we would do and ensure that the act delivers what it said it would deliver and what we all thought it would deliver when it was passed.

Photo of David McLetchie David McLetchie Conservative 4:00, 14 June 2007

My contribution will focus on the sorry saga of assistance with meal preparation as an aspect of free personal care, a point that was raised by Keith Brown in an intervention and one that, I am sorry to advise Richard Simpson, has largely not been dealt with in the past four years. It is very much a live issue.

The failure to implement that aspect of the free personal care policy on a consistent basis across Scotland over the past few years is little short of disgraceful. Although COSLA's approach is far from blameless, there is no doubt that the primary responsibility lies with the former Scottish Executive and the morass of contradictory and confusing guidance that it issued to councils over that period.

The Community Care and Health (Scotland) Act 2002 that was passed by the Parliament stated that

"assisting with the preparation of food" should not be charged for. There were no ifs, buts or qualifications to that. All the ifs, buts and qualifications came in the Scottish Executive guidance that was published in 2002 and 2003, which was supposedly clarified by further guidance in 2004 but which was most certainly not clarified. Astonishingly, there was yet another failure to clear up the confusion in May 2006. We had double negatives mixed with double entendres, as a result of which we have the patchwork of provision throughout Scotland that we see today.

Calls by individual members and by the Health Committee for the Executive to sort out the matter either fell on deaf ears or were subjected to the usual Executive delaying tactic of announcing another review. I note that that policy remains in vogue notwithstanding the change in Administration.

In short, we have created a postcode lottery. If we fail to provide equal access to a service that Parliament has said should be a universal entitlement, that is a denial of equal opportunities to our citizens. Now that the Equal Opportunities Committee is to be convened for the first time by a Conservative, I hope that it will take the opportunity to examine free personal care and other services in which what someone gets is determined by where they live and not what they need.

Few emerge with any credit from the saga, but I pay tribute to the councils in Edinburgh, West Lothian and Dumfries and Galloway. Spurred on by the constituency cases that were raised by members such as me, Bristow Muldoon—who is no longer with us—and the current Presiding Officer, Alex Fergusson, those councils did the right thing by the older people who live in their communities. Not only did the councils cease charging for assisting with meal preparation, they instituted reviews of cases in which people were wrongly charged in the past and made refunds to them. I pay tribute to the councillors of all parties in those authorities who took the decisions and to their staff who have worked hard and are still working hard to put the matter right.

In Edinburgh, more than 500 people have been assessed as being entitled to refunds averaging some £1,800 each. Other cases are still being examined. To date, that has cost the City of Edinburgh Council about £1 million. I understand that West Lothian Council has refunded nearly £400,000.

If those councils have been models of good sense and practice, it is regrettable that they have failed to persuade other COSLA member councils to act likewise. COSLA has done little more than blame the Scottish Executive. It failed to seek a legal opinion on behalf of all its member councils, notwithstanding the fact that exactly the same legal issue arose in every part of Scotland. It also talked about seeking a judicial review but then failed to follow that through on the basis that, apparently, it could not find five individual cases on which to found an application for review to the courts. If COSLA had bothered to ask any MSP, it would have found no shortage of candidates from among our constituents who were prepared to protest about how the policy was being implemented.

The rub of the whole matter is money, as it almost invariably is. While Edinburgh and West Lothian have made refunds to people who have been wrongly charged, other authorities have hidden behind the protective shield of the Scottish Executive because they were concerned about the financial implications for their budgets. That course of action was not brave or right, but perhaps it was understandable, given the inadequacy of the overall funding provision for free personal care.

In the previous session, I called on the Executive to make a special funding allocation to councils to finance refunds for everyone who had been wrongly charged since July 2002 for the aspect of the personal care policy that I have mentioned. I repeat that call today. In addition, I ask the cabinet secretary for an assurance that the Executive will, in determining its funding allocation to councils for personal care services in the future, ensure that costs that are attributable to assisting with the preparation of meals are fully covered by the overall allocation. We should resolve from now on that no older person in Scotland who receives care services in their home will be charged for assistance with the preparation of meals and that everyone who has been wrongly charged as a result of the chaotic implementation of the policy will receive the refund to which they are entitled. The previous Executive dithered and delayed on that for the whole four-year session. If the current Executive takes action to sort out the problem, it will deserve credit for doing so and will receive our full support.

Photo of Jim Tolson Jim Tolson Liberal Democrat 4:06, 14 June 2007

I welcome Nicola Sturgeon and Shona Robison to their new posts. I am sure that they will find their tasks tough, but they are brave to take them on and I wish them well.

As members know, the previous Labour-Lib Dem Government brought into being free personal care with the aim of providing it to those aged over 65 who need help to meet their basic needs, such as dressing and toileting. In fact, if it had not been for the Liberal Democrats, the matter would not have seen the light of day, far less be taken successfully through Parliament.

Many of my constituents in Dunfermline West have benefited from free personal care. Even more wanted it but did not qualify for it. Let me be clear: people who receive free personal care do not want it for the sake of it; they would much rather be healthy enough not to need it. However, it is our duty to ensure that the needs of those who are not healthy enough to take care of their personal needs can get the help that they deserve.

The implementation of the free personal care legislation, like that of many new pieces of legislation, has not always been smooth. There has been confusion about what services are and are not included. I am sure that local authorities would welcome further Executive guidance on that. Furthermore, we must get to the bottom of why some local authorities operated waiting lists and why services cost more in some areas than in others.

However, those are teething problems that should not detract from the overall success of the free personal care policy. Many local authorities have had difficulties with it, but the previous Administration provided an additional £153 million to address the issues that arose and to cover the extra costs.

I am glad that the Government wants to enhance the service, but it must do more than talk the talk. Like the Liberal Democrats before it, it must deliver.

Photo of Stuart McMillan Stuart McMillan Scottish National Party 4:08, 14 June 2007

I, too, welcome Nicola Sturgeon and Shona Robison to their jobs as Cabinet Secretary for Health and Wellbeing and Minister for Public Health. I am sure that they will do a tremendous job.

I also welcome the debate and Nicola Sturgeon's announcements on the review of the free personal care policy and the increase in payments for personal and nursing care in care homes.

Photo of Trish Godman Trish Godman Labour

Will you lift your microphone a bit, Mr McMillan? I cannot hear you.

Photo of Stuart McMillan Stuart McMillan Scottish National Party

Okay. I am sorry.

The health of the nation, including that of our senior citizens, is of paramount importance. I am sure that Nicola Sturgeon's announcements will have a longer-term positive effect on delivering the key policy of free personal care, which was backed by every party that is represented in the chamber. I am delighted that the SNP Government is again delivering on its manifesto pledges—as we all know, quite a few manifesto pledges have been dealt with in recent weeks.

I am sure that all members want the free personal care policy to be a success and that they have been concerned by reports in the media in recent years about poor-quality care and a lack of funding. I am also sure that they will want to address the varying interpretations of "care" by local authorities that have been reported. I sincerely hope that any review of free personal care establishes recommendations that are workable and can be implemented.

Free personal care is about more than just providing a level of health care to people. For those who live in the community, it is about allowing senior citizens to have independence and freedom. It is about preserving dignity and providing assistance in equal measure. For those who live in care homes, it is about ensuring that the care that they receive meets their needs and enables them to live a comfortable and happy life. I, for one, believe that our senior citizens deserve the dignity and respect that the introduction of free personal care was meant to safeguard. It is important to ask why there has been a continual struggle by senior citizens to have their rights highlighted and brought into the public eye. They do not feel that they have been listened to or taken seriously.

Many activities have taken place that have helped our senior citizens, and those should be welcomed. However, providing pre-election gimmicks only exacerbates a delicate situation. The introduction of free personal care was lauded as a positive step towards reducing pensioner poverty, which is a reality in Scotland. Free personal care was never going to eradicate that problem, but it was seen as a major step in helping our senior citizens. We must ask ourselves what has gone wrong with the policy and how it can be fixed.

Every member will have received a policy briefing from Help the Aged, in which major concerns are highlighted. The use of waiting lists by local authorities is an issue that struck me. If local authorities have used waiting lists as has been reported, it is imperative that that is investigated. It must be examined whether not enough funding was given to local authorities; whether it was underestimated how many people would require free personal care; or whether money for free personal care was directed to other services by local authorities.

A further point that needs clarity is the charges for the preparation of food. I spoke to a couple of experienced SNP councillors about today's debate and asked them about the experiences that had been highlighted to them. Their main point concerned the preparation of food, which Keith Brown and David McLetchie have spoken about, and they stressed the need for clarification of the rules. Up to half of Scotland's local authorities have charged for that service, although some local authorities refunded the money that they had charged after they were challenged. That highlights to me the fact that there is a major problem with, and a lack of clarity about, the current rules.

I do not believe that local authorities have been duplicitous. I do not believe that any local authority wants to be classed as operating against the spirit of the legislation. I am sure that every local authority would welcome a clarification of the rules and further legislation if that is required.

A further issue that should be highlighted is the withdrawal of the attendance allowance. After the introduction of free personal care, £30 million to £40 million was withheld by Westminster. It is important that that issue is redressed. Devolution was established to allow the Scottish people and the Scottish Parliament to introduce domestic policies for Scottish issues. The introduction of free personal care was such a policy. I think it unfair, therefore, that people who receive free personal care have been punished because the Parliament introduced a policy with such a fine objective. I am sure that the current Westminster Government will be a bit prickly when the Scottish Government raises the matter with it.

I welcome the announcement of the review, which will be chaired by Lord Sutherland. I also welcome the increased payments for personal and nursing care in care homes from April 2008. We cannot allow the policy to continue under a cloud and expect the problems to go away. The decision by the SNP Government to review the policy will, I am sure, be welcomed by every member and every party.

Photo of Trish Godman Trish Godman Labour

I remind members—yet again—that all mobile phones and BlackBerrys should be switched off when they are in the chamber.

Photo of Jackie Baillie Jackie Baillie Labour 4:14, 14 June 2007

I hesitate to interrupt the love-in that was going on between the Tories and the SNP. Mary Scanlon's presence in the chamber is, as ever, entertaining. While she was speaking, I was reflecting on the fact that the collective age of the Health and Sport Committee is in the region of 400 years. Its members include Malcolm Chisholm, Christine Grahame, Ian McKee, Mary Scanlon and Ross Finnie as well as one or two of our younger—perhaps I should say less experienced, as the Presiding Officer is glaring at me—members. Given all their experience, I am sure that the policy of free personal care will be safe in their hands.

I welcome the comments of the Cabinet Secretary for Health and Wellbeing and her announcement of the Executive's independent inquiry into free personal care. I also associate myself with Lewis Macdonald's comments about the inquiry and I welcome the cabinet secretary's clarification. Existing data sources and work streams can provide some answers on how personal care should develop, and such information should be harnessed immediately, so that progress can be made and the experiences of older people in communities throughout Scotland can improve sooner rather than later.

I invite the cabinet secretary to consider Argyll and Bute Council, because solutions for the council's area need not await the inquiry's outcome. In highlighting the key concern to older people in my area, I will talk carefully about matters that are in the public domain. Presiding Officer, I am sure that you will guide me if I unintentionally stray into areas that I should not cover.

I focus on the reality of being old in the Argyll and Bute Council area. My mailbag is full of stories about waiting lists for free personal care, lack of services, services that have been withdrawn, carers who are unable to cope and older people who have ended up in hospital because they were not given the right care at the right time. It would be understandable for us to conclude that there are insufficient funds to go round and that the stories in my mailbag reflect a national problem. However, that is not at all the case. I could count on the fingers of one hand the complaints that are made about West Dunbartonshire Council, compared with the sackloads of complaints that emanate from the Argyll and Bute Council area. The problem was clearly made entirely in Argyll and Bute.

It took some time for me to consider the issue—

Photo of Jackie Baillie Jackie Baillie Labour

I ask the member to give me time to develop my point.

In a nutshell, Argyll and Bute Council is not spending the money that the Executive gives it each year for the care of older people. Under a budget heading of "home care/personal care for older people", the Executive provides £12 million each year as grant-aided expenditure. Most local authorities spend more, because they accord older people's services a high priority. How much of that £12 million does the cabinet secretary think that Argyll and Bute Council spends? The answer is half of it—£6 million. The Executive says that the council needs £12 million to cope with older people's needs, but the council ignores the Executive and diverts the money elsewhere. Where is the missing money? I implore the cabinet secretary to investigate the matter. Two years ago, underspend on social work services was £3 million, but underspend under one heading alone is now £6 million, despite the smoke and mirrors from the local authority and the one-off addition of £1 million to its budget last year. The lack of finance is reflected in the lack of capacity in the levels of management staff.

Concern about the matter was such that the Social Work Inspection Agency was sent in to make a full inspection of services for older people in Argyll and Bute Council. I look forward to the publication of SWIA's report and I understand that informal feedback to the council fully justifies my concerns. I hope that the cabinet secretary will use the report's publication to encourage the new Argyll and Bute Council—a coalition of independents and the Scottish National Party—to take positive action to restore the budgets at least to the level that the Executive provides and to restore the quality of the service to the standard that we should expect for our older people. There are very good staff in Argyll and Bute, but they do not have the support or the resources to do their jobs. In the absence of a rigorous improvement plan from the council, will the cabinet secretary consider using her powers of intervention to direct the local authority, in the interests of older people in Argyll and Bute?

A case on free personal care in Argyll and Bute is awaiting a decision from the court—I will be careful about how I refer to the case, Presiding Officer. The case was considered initially by the Scottish Public Services Ombudsman, whose decision went against the council. The council then appealed to the Court of Session. As we await the court's judgment, it would not be appropriate for me to discuss the details of the case. I reflect instead on two matters. First, let us consider the resources that have been used by many public agencies—the council, the ombudsman's office and the courts. The internal costs and the costs of legal council and court time amount to at least £250,000. Would it not have been better and perhaps much more cost effective to make personal care available? Secondly, I pay tribute to the family that brought the case. Their father passed away during the consideration of his case, which is regrettable, but they have courageously pursued the matter.

I was brought up to believe that the mark of a civilised society is how we treat our older and most vulnerable people. I ask the cabinet secretary to ensure that older people in Argyll and Bute are part of a civilised society.

Photo of Ian McKee Ian McKee Scottish National Party 4:20, 14 June 2007

First, I declare an interest: as one of the few members in the chamber who is over the age of 65, I might well need some free personal care myself.

I congratulate Dave Thompson on his excellent maiden speech and Mary Scanlon on accomplishing the remarkable achievement of being a born-again maiden. I look forward to serving with Mary Scanlon on the Health and Sport Committee. With her and Christine Grahame as members of the committee, my education as a new MSP will proceed in leaps and bounds.

In my many years in medical practice, the advent of free personal care for the elderly was one of the major advances. The Community Care and Health (Scotland) Act 2002 is undoubtedly one of the most important pieces of legislation that the Scottish Parliament has passed. I pay tribute to the Government of the time for introducing the measure, which gained widespread support. In particular, I pay tribute to Malcolm Chisholm, who led the parliamentary care development group, which added flesh to the bare bones of the early recommendations.

The days when health workers and social workers argued about whether bathing someone was a therapeutic or a social exercise are now gone, or at least they should be. The sad fact is that up to half of Scotland's local authorities are, in effect, rationing free personal care by using waiting lists. As we have an ageing population, things will get much worse unless something is done to make progress.

Free personal care is not simply an issue of helping old folk, although that is a compelling cause. Such care helps them to stay at home and avoids the need for expensive long-term residential care. It allows them to return home sooner from hospital, which frees up much-needed hospital beds and consequently helps to reduce hospital waiting lists. Carers get some respite from their duties, which might enable them to carry on for longer than they would otherwise. I have seen carers become so worn down—both physically and mentally—that they had to throw in the towel. A little extra help when it is needed can make all the difference and enable the carer to soldier on. Free personal care actually saves money, which is freed up to be used in other fields.

Why do some local authorities operate waiting lists? Why do some elderly people have to wait months before they are even assessed? Why do some local authorities charge for the preparation of food while others do not? We urgently need answers. For the reasons that we heard, we need an inquiry, and I was delighted to hear that Lord Sutherland of Houndwood, whom we all admire immensely, has agreed not only to advise but to chair the committee that will be set up to investigate and report back. I welcome that news from the cabinet secretary. However, I draw her attention to the fact that, in Scotland, there are between 1,350 and 1,650 people with dementia who are aged under 65. Should not those people, whose needs are just as great, also be eligible for free personal care? I would be grateful if the Minister for Public Health would consider that idea in her response.

I await with eagerness the outcome of the Government's endeavour to have repatriated to Scotland the money that was previously dispensed in the form of attendance allowance benefits. That endeavour has been falsely portrayed in some quarters as an attempt by the SNP Government to pick a fight with Westminster; I think that that was the subtext of some of Ross Finnie's remarks. However, that glib characterisation ignores the support for repatriation from many different sectors in Scottish society. Only this month, Help the Aged characterised the UK Government's withholding of attendance support money as unjustified and unfair.

As First Minister, Henry McLeish said in a statement in September 2001 that such a transfer of funds should take place and that he was confident that it would happen. Alas, his confidence was misplaced. I hope that members who accepted his leadership then, such as Ross Finnie, will follow the logic of their position and support such a move now. Richard Simpson said that the ship has left the harbour and that it is too late to call it back, but the people of Scotland elected the SNP as the major party in the Parliament to call back the ship and make the case for Scotland to get its money back.

Too often, free personal care has been undermined by a variety of arguments and inadequate guidance. It is time to address the important issues to ensure that the elderly in our society receive the care and attention that they deserve.

Photo of Jamie Stone Jamie Stone Liberal Democrat 4:25, 14 June 2007

I will dwell briefly on the points that have been made by each member in a most interesting and informative debate.

I thank the cabinet secretary for her magnanimous support of the previous Administration's work. She made a number of interesting points, including the fact that 50,000 older people now benefit from this policy. She also announced Lord Sutherland's forthcoming interim report, which, if I understood her correctly, will be fed into the spending review.

Lewis Macdonald welcomed the broad approach that was being taken, and the cabinet secretary's intervention was useful in clarifying what the Sutherland review will do.

Mary Scanlon's speech was unusual, and it has certainly broadened my idea of what a maiden speech should be. However, it was witty and amusing, and the joke about unpardonable folly was both well made and well received.

A major theme that was raised by Mary Scanlon and firmed up by other members during the debate is that there seems to have been some confusion over the guidance and that different authorities have interpreted it differently. Ms Scanlon also drew attention to the three categories of nursing home—residential, nursing and integrated—and the rather regrettable fact that there is a lack of co-ordination in the approach to all three.

I sought to intervene on Mary Scanlon to highlight the issue of Migdale hospital in my constituency, which I raised with the cabinet secretary this morning. Work on that project, which will also deliver provision for the elderly, has been delayed yet again. On the back of Dave Thompson's remarks, I should also point out that there are concerns about services at two other facilities for the elderly—Caladh Sona and the Assynt centre; provision at Assynt has already been reduced from seven to five days a week. Some weeks ago, I wrote to the Highland Council to ask that it reverse its decision; I await its reply, and sincerely hope that it will do so. As Dave Thompson pointed out, the issue is the local delivery of services. I believe that he mentioned that people in Lochaber have to travel to Invergordon for care. Such distances are impossible for elderly people who, after all, expect to remain in familiar surroundings with those whom they know and love.

As my colleague Ross Finnie made clear, we should remember that the title of free personal care that was adopted for the policy has been misleading and has, indeed, led to some confusion. In his intervention on Mr Finnie, Keith Brown mentioned that Clackmannanshire Council charged illegally for the preparation of meals, and his point was picked up by many other members.

I have referred to Dave Thompson's speech twice already, but I must thank him for his courteous and thoughtful maiden speech.

Richard Simpson gave a nice, precise and useful explanation of where—in his opinion and in the opinion of many others—free personal care was being targeted. As he rightly pointed out, it was targeted not at the poorest or at the richest, but at those who, for example, might have bought their council house and had been able to save a little money.

Christine Grahame said that, to save their budgets, some local authorities had used what I believe she termed a fig leaf. I think that that is true and, indeed, Jackie Baillie raised the same issue in her speech on the situation in Argyll and Bute. Ms Grahame also made the important point that the joint working between social work departments and the NHS is nowhere near as co-ordinated as it should be. To return to the constituency issue that I mentioned, I hope that, in considering the situation at Migdale hospital, Caladh Sona and the Assynt centre, ministers will also examine whether the co-ordination has been not exactly as it should be. I do not want to make unnecessary accusations, but I think that that might well be the case.

David McLetchie and others drew our attention to meal preparation and Jim Tolson, in his brief speech, made the entirely accurate point that one might be able to talk the talk but, at the end of the day, we need delivery. The SNP Administration has made a good start and we have listened to what it has said. However, we will keep an eye on delivery and on whether its proposals are making a difference for people not only in my constituency, but all over Scotland.

Mary Scanlon and others have spoken in the past about the delivery of frozen meals to the elderly. I believe that there is evidence that that is not always the most suitable system for some elderly people, and that there could be food hygiene consequences.

Jackie Baillie raised the considerable issues around Argyll and Bute Council. If the figures that she cited are correct, the situation is pretty damnable. Despite the Administration's best intentions—and whatever its colour—it is too bad if funds are channelled but do not come out the other end to the intended recipients.

Ian McKee spoke about waiting lists and food preparation. It is always nice to hear fresh thinking in the chamber, and he also made a particularly important point about dementia sufferers, some of whom are below the age of 65. We might have missed a category in the past. There is food for thought there.

In the spirit of the new politics, I say that the Scottish National Party Government has made a good start. However, we await the outcomes. To echo what Ross Finnie said, we hear what the SNP says about an attendance allowance inquiry, but I ask ministers not to let that distract them from what is already a Rolls-Royce service. Perhaps the wheels need attending to, but let us not take our eye off the ball when it comes to what we are really trying to do.

Photo of Jamie McGrigor Jamie McGrigor Conservative 4:31, 14 June 2007

I congratulate Mary Scanlon on a beautiful iron maiden speech. I also congratulate my fellow Highlands and Islands MSP, David Thompson, on his maiden speech. He made some good points about care homes, in particular in relation to Graham House. It seems that we all share the aim of having our elderly and vulnerable citizens cared for in circumstances that are most appropriate to them, with those citizens and their families having as much say as possible over the type of care that they receive.

I have seen at first hand how elderly people's quality of life at home can be vastly improved when they get support and help. I have also seen the opposite scenario, as described by Jackie Baillie in relation to Argyll and Bute, with elderly patients languishing in hospital beds, often in pain, because they could not get referred to a nursing home or could not get the home care packages to which they were entitled. They could not have cared less whether that was the fault of the council or of the Executive; they just felt cheated, ignored, abused and betrayed. The doctors and hospital staff felt frustrated and let down, because they saw at first hand the awful result that the political blame game had had on the welfare of their patients.

The minister will be aware that I recently lodged an oral question:

"To ask the Scottish Executive what discussions it has had with the independent elderly care home sector about increasing care home places in the Highlands and Islands."—[Official Report, Written Answers, 7 June 2007; S3O-86.]

A number of points arise from the written answer that I received and from concerns that have been raised with me. Does the minister recognise that many independent care home providers feel that they are not working on a level playing field in competing with council care homes, as some other members, including Mary Scanlon, have mentioned? Does the minister address those concerns? Does she recognise that the independent care home sector has a crucial role to play in providing the extra care home places that are needed, especially in my region, the Highlands and Islands? Does she recognise that that is all the more important now that free personal care is with us?

In recent years, the fees that have been paid to independent care homes have been restricted. Referrals have been reduced, and local authorities have used care in the community policy to reduce their spend on independent care homes. In Highland and Argyll and Bute, council-run care homes cost at least twice as much to run per person per week as what is paid to independent homes—whether private or voluntary—and they are generally full. Why are councils not making more use of the independent sector? It makes no sense—it would be cheaper for them to do so.

I understand that Highland Council and Argyll and Bute Council are market testing their direct services. As I have just said, those direct services cost well in excess of the sums that are paid to the independent sector for the same service. Local authorities have hidden behind COSLA guidelines in setting the fees that are to be paid to independent providers.

Photo of Jamie McGrigor Jamie McGrigor Conservative

In a minute.

That led, in 2005-06, to Argyll and Bute Council increasing the cost of its homes by 30 per cent, while restricting the increase for independent homes to 2.7 per cent, in line with the national guideline from COSLA—so much for local autonomy, which seems to work only in one direction. The situation has led to closures in the independent sector, which are the last thing that we want, as future demand for care home places will only increase now that we have free personal care.

David McLetchie dealt ably with the issue of charges for food preparation. The problem was created by the Liberal-Labour Executive, which gave contradictory and confusing advice to councils on what was and was not chargeable, which has resulted in a postcode lottery. In Argyll and Bute, the council charges for meal preparation. Further, I heard only yesterday from a constituent—Mr Duncan McIntyre, a senior citizen from Strone, near Dunoon—who has 10 hours of care, including help to make breakfast and tea, for which he was charged £36 a week, which, he told me, has risen suddenly to £100. In the past, his £41 attendance allowance covered the payment, but it now falls far short. That 140 per cent rise is even backdated from 26 May. He also has to pay £50 for messages and cleaning if he wishes to remain independent. He asked me why people in other parts of Scotland pay nothing for the same services. That does not seem a fair, equitable, inclusive Scotland, does it, minister? I very much hope that the free personal care system in Argyll and Bute, which was dire, will improve.

The Scottish Conservatives acknowledge that every elderly person, once assessed as needing care, is entitled by law to receive it. Waiting lists must be tackled as a priority and ended at the earliest possible opportunity. We believe that all Scottish councils should refund people who have been charged wrongly. As the fault lies firmly with the Scottish Executive, it should make a special grant allocation to councils to cover the cost of refunds. If the Executive does not do that, current council services could be affected, which would be grossly unfair.

The cabinet secretary seems to accept that, because the level of payments has not risen for the past six years, there has been an erosion of the benefit. Therefore, increasing the level in line with inflation from next April will do nothing to reverse the erosion of the past six years, so the damage will go on being there. Can she not do something about the damage that she talked about?

Photo of Lewis Macdonald Lewis Macdonald Labour 4:38, 14 June 2007

I add my congratulations to those members who have made their maiden speeches, whether for the first or the second time. We have had a lively and full debate in which we have heard about the benefits of free personal care and the ways in which it supports people at an age and stage in life when they are particularly vulnerable. The policy removes financial pressures and concerns from them and their families when there are other matters that need their attention and, importantly, it supports the integration of health and social care services while putting the service user at the centre. For all those reasons, all the parties in the Parliament are committed to making free personal care work.

We have also heard about the problems of implementing the policy in ways that benefit vulnerable older people as and when they need personal and nursing care services. The decision to implement the policy in partnership with local councils had broad support in the Parliament. The principle of local discretion in delivering services should not be set aside lightly. Nonetheless, the policy is a national one that should, broadly, deliver benefits equitably throughout Scotland. It is entirely appropriate to consider evidence and to act to put right any problems that local delivery partners have in making that happen. Equally, it is perfectly in order to review the financial mechanisms and funding formulas that are used to allow councils to deliver free personal care, and it makes good sense to do so in the context of preparing for a spending review.

Members on the Labour benches have no difficulty with the proposition of a review of how best to deliver personal care. We welcome such a review in principle. However, how will that review be conducted? When will it be completed? What will it seek to achieve? We and other stakeholders want to hear the answers to those questions.

It is a pity that Nicola Sturgeon did not make a statement to Parliament today; indeed, her intervention during my opening speech bore out that point. There is a reason why ministers should make new policy announcements in the form of a statement, and there are good reasons for the convention of sharing that statement with other parties an hour before the statement is made. That was the approach taken by previous Administrations and I hope that this Administration will return to that approach in future—not to place ministers at a disadvantage, but to allow for detailed questions and answers and informed examination of what is proposed.

Photo of Christine Grahame Christine Grahame Scottish National Party

Does Lewis Macdonald agree that we all had a greater opportunity than usual today to contribute to the debate? When there have been ministerial statements, very few members get an opportunity to comment. What happened today allowed us to debate and develop the issues.

Photo of Lewis Macdonald Lewis Macdonald Labour

That is a fair point, and it was entirely open to the Executive to use its time to provide both a statement and a debate if it considered the issue a priority and important to the people of Scotland. The Administration may wish to find another opportunity to allow us to address these matters.

When the minister closes the debate, I ask her to tell us a little more about the proposed review, given the amount of work that the Scottish Executive Health Department had already done to assess costs and address implementation issues. We need to hear more about what value will be added by the additional inquiry that is proposed. What other evidence does the minister believe remains to be found? When will she reveal who will serve on the review? Who will represent the interests of older people and carers? Which representative organisations of service users will be consulted in finalising the review's remit?

The cabinet secretary's announcement was trailed very well in the press, as members know. However, what was not trailed was the length of time that she intends the inquiry to take. As has been said, it should now be possible to resolve issues that have already been examined in detail. Members will know that the previous Administration had undertaken to seek to resolve those issues in the context of the forthcoming spending review. The cabinet secretary said that she expected an interim report in September but did not expect a fuller report until next year. She also said that the focus of the work would be exclusively on resources. How will the findings of the Sutherland review be included in the wider consideration of the spending review? Why does the cabinet secretary believe that it will take nine months to review the issues when so much work has already been done?

I have already said that resolution of these important and complex issues should not be postponed or delayed and that implementation issues should be considered alongside funding issues rather than being considered separately. The cabinet secretary expects her inquiry to report to ministers in two stages. It is important that she takes the opportunity to come to Parliament before the summer recess to allow a debate and a vote. If she has the time, I invite her to do so; she will want to tell members about the inquiry's remit and about the people whom she intends to be on the inquiry team. That might offer the opportunity for the debate that Christine Grahame rightly suggested we should have—a debate during which members could express views on the remit and on the cabinet secretary's proposals.

I hope that the minister will be able to confirm today that the review of these serious issues will not get bogged down in endless debate over the reserved issue of attendance allowances for people in care homes. Members who are accustomed to negotiating difficult issues will know that reopening a closed negotiation usually requires new evidence, a new argument or a new offer. I hope that ministers really have something new and substantial to discuss with the Department for Work and Pensions. I would like to hear what that might be. It would be wrong to open such discussions if there were no prospect of making progress. It would be even more wrong to fail to make progress on the critical issues involved in free personal care just because of failure to make progress on relatively marginal issues.

I remind the ministers that £23 million a year is less than 10 per cent of the total cost of the policy. From the beginning, that £23 million—or the equivalent sum—was fully funded from the Scottish Executive's own budget. In view of the budgetary provision that has been made since the introduction of free personal care, and in view of the very significant increase in the total funding for the Scottish Executive, I would be astonished if this Administration were saying that it could not manage to fund free personal care from its own resources, as has been done in the past.

If new funding formulas are to be agreed, if changes in the law are required to resolve outstanding issues—we have heard about some of those this afternoon—and if more resources are to be found, those matters should go forward together in the interests of service users, carers and older people in Scotland. That should happen in the context of the spending review because separating the financial and implementation issues will simply not do.

Photo of Shona Robison Shona Robison Scottish National Party 4:45, 14 June 2007

This has been a helpful debate. A number of important points have been made; we will reflect on those and take them forward.

There has been a large degree of consensus that the policy of free personal and nursing care has been a success and that the people of Scotland have welcomed it. It currently touches and improves the lives of more than 50,000 older vulnerable people. Like many members, we regard it as a positive policy that provides an appropriate basis for the long-term care of the elderly in Scotland and delivers the desired outcomes effectively. People are receiving for free the care that many would previously have had to pay for. That, in turn, encourages people to live in their own homes for longer and enhances their physical and mental well-being.

Overall, it is fair to assess the policy as having been good for older people, but there are a number of well-documented problems that need to be fixed. Christine Grahame and others highlighted those in the debate. We all recognise those problems, which is why we are engaging actively with local authorities to make sure that we develop the policy to best effect, adding real value and clarity where they are needed.

Together, we and our local authority colleagues must build on the strong foundations that exist. We must ensure that we are equipped to deliver an equitable and reliable quality of service to our older people, regardless of where they stay. Therefore, we have formed two working groups with Executive and COSLA officials. Key stakeholders will be brought on board as necessary. The implementation group will consider issues arising from the implementation of the policy—including the eligibility criteria to which Richard Simpson referred—and will identify best practice to improve consistency of delivery across Scotland. The joint improvement team is reporting to COSLA on a peer review of free personal care that it has conducted. That will be a valuable source of information. The strategic group will consider strategic issues that might need legislation or some other high-level intervention to solve them.

We need to raise the bar in terms of delivery and to ensure that a consistent approach to implementation of the policy is adopted. I want good practice to be shared among local authorities to enable us jointly to improve quality of life for many older people. We owe them that.

I appreciate that some aspects of the policy are clouded; we will replace that uncertainty with clarity. Different interpretations of certain aspects of the policy have led to some councils charging for services while neighbouring local authorities provide the same service for free. That is not right and it is not fair. David McLetchie, Stuart McMillan, Keith Brown and others referred to food preparation as an illustration of that problem, and I remind them all that the cabinet secretary made it clear that she is considering a legislative solution to it.

Executive officials will work closely with local authorities and other stakeholders to move forward on all the issues, and I want differences to be resolved quickly. We need to be sure that we are directing sufficient resources at those who deliver the service. It simply would not make sense for us to ask local authorities to deliver a very important piece of policy if they were financially ill equipped to do so.

Photo of Mary Scanlon Mary Scanlon Conservative

Why is the Executive proposing further legislation when the legislation that was passed was crystal clear, as David McLetchie and others have said? The problem was with the guidance that the previous Government issued, which contradicted the legislation, which was further contradicted by more guidance. The legislation was clear and unambiguous.

Photo of Shona Robison Shona Robison Scottish National Party

Part of the problem is that the legislation was not clear; that is why we have debates about it. Different people have interpreted it differently, which is why the cabinet secretary said that she will consider legislating to ensure that there are no differing interpretations.

Photo of Johann Lamont Johann Lamont Labour

Is the policy is the responsibility of the Cabinet Secretary for Health and Wellbeing? I ask that because I have received a written answer from her indicating that she has not yet met COSLA. The ministers seem to be giving COSLA a key role in their approach, yet it appears that they have made that announcement without discussing it with COSLA.

Photo of Shona Robison Shona Robison Scottish National Party

I assure the member that officials have been in constant contact with COSLA, which I will meet in the very near future. We have joint responsibility for taking forward the policy. It is important that Johann Lamont, Lewis Macdonald and others acknowledge that work is already going on; there are things that we want to take forward immediately, and that is what we will do.

The emerging findings on resources will be considered as part of the spending review, but there is a wider issue around Lord Sutherland's review, which will specifically look at the level of resources and their distribution to local authorities. That has not been done comprehensively. There are immediate issues that can be taken forward, but we will take a wider look at the long-term sustainability of the policy. Everyone should welcome the greater transparency around the funding that will result from that.

Photo of Lewis Macdonald Lewis Macdonald Labour

Am I to understand that the minister is not working with COSLA on the level of resources and their distribution to local authorities?

Photo of Shona Robison Shona Robison Scottish National Party

COSLA will be involved in the long-term review that Lord Sutherland is taking forward. We are in constant negotiation and discussion with COSLA about the immediate issues that we are taking forward. As I said, some immediate issues have to be, and will be, taken forward, but the long-term sustainability of the policy also needs to be clarified. Members have mentioned sustainability in relation to how we will pay for the policy over 10, 15 or 20 years, given the demographics, which, of course, need to be looked at.

It would be unfair to local authorities and older people if we were to use a distribution formula that failed to hit the mark in meeting people's needs. The review will inform us about whether change is needed in that area.

I think that it was Lewis Macdonald who asked for the terms of reference for the inquiry to be placed in the Scottish Parliament information centre. The cabinet secretary is happy to make them available in SPICe once they are finalised.

I acknowledge fully the significant role that local authorities have to play. After all, free personal and nursing care is delivered by local authorities in Scotland and I warmly welcome their positive contribution.

Photo of Jamie McGrigor Jamie McGrigor Conservative

The minister mentioned councils delivering free personal care. What will she do in the areas where they are not doing so?

Photo of Shona Robison Shona Robison Scottish National Party

Of course we want to ensure consistency in the delivery of free personal care, which is what this is all about—that is why we are here this afternoon. This Government will ensure that care is delivered consistently throughout Scotland. The financing of that has to be looked at to ensure that it is equitable and that the distribution is right. Those issues were raised in the previous Health Committee's report, as the member is probably aware. The committee wanted a more in-depth review of the policy, which is what we will deliver.

We know that delivery of the policy has not been easy, given the complexities of the legislation. Nevertheless, the policy has, largely, been delivered to good effect, although in certain areas there are real problems, which we need to resolve. I look forward to working closely with local authorities to do that.

We should all want the very best for our older people, who are the most vulnerable in our society. Our aim is clear: we want to improve the quality of their life and their physical and mental well-being. I believe that the strategy outlined today will do that and put beyond all doubt what we want to achieve. We want cohesive services, clarity, early interventions and efficient delivery of services. Taken together, our actions will benefit many older people now and in the years to come.

I want to deal specifically with a couple of issues that members raised in the debate that I have not yet touched on. Mary Scanlon and Jamie McGrigor both referred to the independent care home sector. We believe that that sector has an important role to play, but we also want to ensure that people are retained in their own home for as long as possible. If people require a care home, we want to ensure that places are available in the right locations. We recognise that we must ensure that care home places are where they need to be.

Ross Finnie and Jackie Baillie referred to getting on with things. As I said, we will do that. Stewart Sutherland's independent review will look into the wider issues of the level and distribution of resources and their long-term sustainability. The attendance allowance is an important issue, but it is only one of many that the review will have to consider.

Over the next few months, the Government will do a number of things, the first of which will be to establish an independent review to investigate the level of resources and their distribution to local authorities. [Interruption.]

Photo of Alex Fergusson Alex Fergusson None

Order. An awful lot of chatter is going on.

Photo of Shona Robison Shona Robison Scottish National Party

As the cabinet secretary said, Lord Sutherland will chair the review.

We will ensure that free personal and nursing care for the elderly is implemented properly across the country. We will increase the payments for personal and nursing care in line with inflation from April 2008 and we will reopen with Westminster the issue of the attendance allowance. We believe that around £30 million needs to be transferred to the Scottish block for subsequent reinvestment in Scotland. I would be extremely concerned if anyone in the chamber disagreed with that.

Let me reassure older people, their families and their carers. Free personal care is safe in our hands and we are determined that it will continue on a strong and sustainable footing. It is a positive policy that has received all-party support, and I hope that that support will continue. Since the legislation was passed in 2002, it has assisted many thousands of vulnerable older people. I believe that, with the list of actions outlined today, older people will be better served. The Scottish Government will not only enhance free personal care provision, but secure its place at the heart of our social care agenda for many years to come.