I welcome this opportunity for members to consider and explore more fully our response to the independent funding review of free personal and nursing care. The debate also provides the platform for Parliament to debate and, I hope, endorse our view that it was fundamentally wrong and unjust for the United Kingdom Government to withdraw attendance allowance funding—currently valued at more than £30 million a year—from the Scottish budget following the introduction of free personal care.
When Labour said two weeks ago that it accepted all Lord Sutherland's recommendations, I hoped that that would pave the way for all parties to unite behind our efforts to recover attendance allowance funding. However, it appears that, having flirted briefly with the idea of standing up for Scotland, Labour has now reverted to type and—in the kind of U-turn that we are becoming used to from Labour—will simply toe the London line as usual, which is proof, if it were needed, that Labour has learned nothing from its election defeat last year. However, perhaps I should not give up hope completely—given the shifting sands of Labour policy positions, I am sure that another U-turn before 5 o'clock is not completely out of the question.
First, I want to offer a little piece of advice. So far, the cabinet secretary is not being very clever in trying to convince us to accept anything that she puts forward, given the kind of remarks that she is making and the tone in which she is making them.
Has the cabinet secretary ever considered how the Barnett formula works, and how it is decided how much money comes to Scotland? Has she ever considered the fact that account is taken of expenditure in Scotland and in England in
I say to Lord George Foulkes that whatever else the Barnett formula may or may not be intended to do, it is not intended to penalise and punish this Parliament for taking legitimate policy decisions. In respect of my tone and how persuasive I am to members on the Labour benches, Margaret Curran's press release yesterday confirmed that Labour would toe the London line. I for one will be delighted if Labour wants to perform another U-turn, change its mind and stand up for Scotland's interests, but I will not hold my breath.
Lord Sutherland's report confirmed that the policy of free personal care has widespread support and is delivering real benefits to tens of thousands of older people. However, he also confirmed the concerns that both we and local government have raised about the clarity and funding of the policy in its early years.
In my statement to Parliament last week, I set out the Scottish Government's formal response to Lord Sutherland's report. I confirmed that we have accepted in full his 12 recommendations. Specifically, I confirmed that we will make available from next year additional resources of £40 million per year to address the funding shortfall that he identified. Those resources will be reflected in next year's Scottish budget, so I am happy to accept the Liberal Democrat amendment. Both we and local government have agreed that there is a need to ensure that the additional funding will deliver improved outcomes for older people. We will continue to work with the Convention of Scottish Local Authorities to ensure that that is achieved.
I further advised Parliament that our actions in taking forward Lord Sutherland's recommendations will sit alongside a wider package of measures that we have been developing with our partners in local government. Specifically, we will establish a more open and transparent system that both explains how access to free personal care is managed and ensures greater clarity and consistency in relation to needs assessment and waiting times.
We will improve information for users and carers about what the policy does and does not cover, and we will introduce legislation to stop councils charging for food preparation. In that regard, I understand the sentiment behind the Tory amendment. However, I sincerely believe that if
During the questions that followed my statement, members from all parties reaffirmed the Parliament's commitment to free personal care and made a number of positive comments. Mary Scanlon rightly highlighted the importance of the Government and the Parliament acting to improve public understanding. I was grateful to Ross Finnie for his statement on the wider principles raised by the issue of attendance allowance funding. I also noted Malcolm Chisholm's important observation about the key message that arises from Lord Sutherland's report about the longer-term demographic challenges, about which I will say more later.
Today, however, I will focus specifically on the issue of attendance allowance funding. As members know, following the introduction of free personal care, attendance allowance was withdrawn from people in Scotland in residential care who received personal care payments. That decision was unjust: it was a clear reaction by the United Kingdom Government to a policy that it did not approve of and did not want to be implemented. However, as Lord Sutherland noted, the decision was also anomalous. Attendance allowance is still paid to people who receive free personal care in their own homes and to residents of care homes in England who receive free nursing care payments through their primary care trust.
There are three reasons why we must actively and vigorously pursue the recovery of attendance allowance funding. The first is to right a wrong that financially disadvantaged the Scottish Government and, by extension, the Scottish people. As a result of the United Kingdom Government's decision, the Scottish Executive was forced to set personal care payments for those in care homes at a level that compensated for the withdrawal of attendance allowance. That meant that there was no loss to individuals—the right thing to do—but the Scottish budget bore the brunt.
The savings from the withdrawal of attendance allowance were not transferred to the Scottish budget as they should have been. Instead, they were retained by the UK Treasury and, as a result, the increase in costs borne by the Executive could not be offset. There is no doubt that that
This Government, acting in the interests of our vulnerable older people, will fill that gap, but the Parliament should be clear that that does not mean that the UK Government should be let off the hook.
Lord George Foulkes has had sufficient time to intervene already.
The second reason to pursue the issue relates to the point made last week by Ross Finnie. There is at stake a wider issue of principle and of the freedom of this Parliament to take decisions in devolved areas without the interference of the UK Government.
I will of course explain the substance behind our amendment in my speech. Does the cabinet secretary acknowledge that, in his report, Lord Sutherland recognises that the UK Government was within the letter of the law, that the UK benefits commissioner has ruled that the UK Government was right, and that a more constructive approach to ensuring that Scotland gets its proper resources would be to participate more strategically with the UK Government?
I hope that the later explanation of Labour's U-turn is better than that pathetic effort from Margaret Curran.
The third reason to pursue the issue involves the long term. Over the next 25 years, the number of older people in Scotland is projected to rise from around 850,000 to almost 1.4 million. The growth in numbers is particularly concentrated among those aged over 90—the people who are most likely to require support for their long-term care.
Lord Sutherland makes it clear in his report that, to respond to the implications of that demographic change, we need to be able to consider holistically, and to target better, all the resources that are currently available to meet the costs of long-term care, whether through the national health service, local government or the benefits system.
The UK Government has acknowledged that principle in the past few days in its consultation on the reform of social care in England. I agree with the Labour amendment in that the consultation has implications for Scotland and that we need to engage with the UK Government in planning ahead for long-term care. This Government will engage, but that engagement will be easier and more meaningful if the running sore of past injustices over attendance allowance funding is
I am in my last minute.
I agree whole-heartedly with Labour's former First Minister Henry McLeish that the issue should not be a matter of petty rivalries. It should be about ensuring that arrangements are equitable, that the settled will of this Parliament on devolved matters is not undermined and that we engage with the UK Government on any issues affecting the interests of our most vulnerable older people.
As I said to Parliament last week, I am determined that we will seek the reinstatement of the funding and correct the inequity identified by Lord Sutherland. The Scottish Government has asked for the issue to be included on the agenda for the next meeting of the joint ministerial committee. In taking forward those discussions, I believe that our already strong case will be further strengthened if we can demonstrate a co-ordinated and consistent response from this Parliament.
I ask members to support the motion, which is in my name but which aims to reflect the clear view and settled will of the Scottish Parliament.
That the Parliament welcomes the publication of Lord Sutherland's independent review of free personal and nursing care and the Scottish Government's acceptance in full of the report's recommendations, including the commitment to provide £40 million a year in additional funding; notes Lord Sutherland's clear conclusion that the UK Government should not have withdrawn the attendance allowance funding in respect of self-funding clients in care homes, currently valued at over £30 million a year, and urges the Scottish Government to pursue vigorously with UK Ministers the reinstatement of this funding while longer-term work to re-assess all funding streams relevant to the care of older people in Scotland takes place.
I reiterate what the cabinet secretary said: this debate is indeed important and welcome. I also reiterate what was said last week. We thank Lord Sutherland and the members of the review group for their work, which has produced a striking and commanding report that seeks to address fundamental issues that are germane to the stabilisation of the free personal care policy and its sustainability in the longer term.
The report demonstrates that addressing
As I said after the cabinet secretary's statement last week, the introduction of free personal care by the then Labour-Lib Dem Executive was groundbreaking. There were many difficulties to be overcome, but it is significant that Lord Sutherland recognised that the policy was implemented speedily and with resolution, and that it was fully funded. However, even over a relatively short time, demographics have shifted outwith predictions, which has significant implications. It is nonetheless reassuring for all of us that Lord Sutherland has deemed the free personal care policy in Scotland to be working well. I argue that it provides a base from which to develop innovative, sensitive and effective approaches.
That said, a few key issues require to be addressed. Lord Sutherland has sent out a clarion call, and we must begin to understand and deal with those issues. In that context, I was disappointed that the cabinet secretary did not address them.
Demographic change is the most serious issue that we face. We know that, within 25 years, we will be looking at costs of approximately £800 million a year, and we must work through the full implications of that. However, Lord Sutherland has demanded that urgent action be taken now before the demographics
"begin to bite, from around 2013", which is not far away.
Labour lodged its amendment in that context. Now is the time to begin to reassess all the funding streams that are relevant to the care of the elderly. The report refers to examining
"health, social and personal care and housing support".
Now is the time for "fruitful cross-border conversations", to use Lord Sutherland's words. We urge the Scottish Government to enter into such discussions and to undertake what Lord Sutherland referred to as
"a very radical examination of the effects of demographic growth".
I accept the points that Margaret Curran makes. She is absolutely right and has correctly quoted Lord Sutherland. However, he also said that before we review wider funding streams, which we must do, we must seek the reinstatement of the £30 million attendance allowance funding, and that that should be the basis on which further engagement takes place. Does she accept that?
I was just about to address the issue of attendance allowance directly. To some extent, Nicola Sturgeon has made my case for me. In her fairly lengthy speech, she focused entirely on attendance allowance at the expense of the strategic case. I am profoundly concerned by the Scottish National Party's approach, which I am not prepared to endorse. Labour will ensure that the SNP faces the strategic challenge that the country faces. The SNP Government's approach has been to elevate the issue of attendance allowance above all other issues. Doing so does a profound disservice to the scale of the issue, which we cannot allow to go unchecked. We will not endorse an approach that fails to step up to the strategic challenge that Scotland faces. We should focus on the substantive points that are made in the Sutherland report and on the social care review that the Prime Minister launched on Monday.
I say to Nicola Sturgeon that it is unacceptable to argue that if someone does not agree with the SNP, they are somehow toeing the London line and are not standing up for Scotland. I cannot and will not endorse such an approach, and I will not let her misrepresent the arguments that are made in this chamber and by the Labour Party. That explains the amendment that we lodged.
I ask Christine Grahame to let me make a point that I need to make.
We accept and have argued consistently that the resources should come to Scotland, but I will not allow the SNP to use that argument to get into a narrow dispute with London. Rather, we should take a "fruitful"—to use Lord Sutherland's term—and constructive approach to the matter. We are much more likely to resolve financial issues in that way than if we adopt the approach that is being taken by Nicola Sturgeon, which she outlined today. I think that our approach would lead to a much more constructive settlement.
We say emphatically in our amendment that means of ensuring that Scotland receives full and equitable funding should be pursued, but not in the way that the SNP suggests. We will not authorise that approach. I presume that, if our considered amendment is so bad, we will not win any support for it. However, I am pleased to say that the Tories recognise that we are adopting a considered and rational approach. The minister must recognise that as an important signal that she does not have the full authority of the chamber to pursue yet another narrow-minded fight with London.
Labour's amendment addresses other issues, too. When Nicola Sturgeon was in opposition, she insisted that local authorities should have their
We have considerable sympathy with the Tory amendment, and we will support it because it is rational and consistent. Although it does not rescue the motion, we see the logic behind it. It raises important issues about meeting the expectations of a number of Scots, and it is vital that we address those issues immediately. Elderly citizens in Scotland are looking for a resolution to the issues that the Tories have raised. Although I hope that our amendment will be agreed to, those issues must be addressed.
Lord Sutherland and the members of his group have provided a crucial service to the Parliament, not just because of the recommendations that they have developed; not just because they have produced a strategy for the stabilisation and the crucial sustainability of the policy—if properly directed, although that is still an "if"; and not just because they have facilitated a debate that ensures a greater understanding of what the policy means; but because they have raised the issue of demographic change to the top of the political agenda.
Fundamentally, Lord Sutherland has raised a significant issue in telling us that free personal and nursing care services
"are not delivered in isolation and in most local authorities the services sit within the broader range of community care services."
He has sparked a wider debate about what we, as a country, must care about in terms of the needs of our elderly citizens. We must ensure that they can make the life choices to enable them to live lives of quality, assisted by services of the highest standard.
This afternoon, Irene Oldfather will address the key issues of the standard and appropriateness of services. That is an important debate to have, and it is deeply disappointing that the Government, rather than address the issues that matter so much in the debate, wants to focus narrowly on what will give it an opportunity to fight with the United Kingdom Government. That is deeply disappointing, and the cabinet secretary should be doing better.
I move amendment S3M-1902.3, to leave out from "and urges" to end and insert:
"however, also notes the decision of the UK Benefit Commissioners that continued payment of attendance
We welcome this debate on free personal and nursing care, which is often referred to as the flagship policy of the Scottish Parliament's first session. In moving the Conservative amendment, I confirm that it has nothing to do with blame but everything to do with fairness. We seek the support of MSPs across the chamber to ensure that there is no postcode lottery in relation to funding or payments in different local authorities in Scotland. It is neither fair nor equitable for elderly people to pay for assistance with food preparation in eight council areas while the service is free in the remaining council areas. My colleague David McLetchie will speak in more detail on that issue.
I pay tribute to the Presiding Officer—I wanted the opportunity to use the word "you", but Alex Fergusson is not in the chair—for the sterling work that he has done in supporting his constituents in successfully challenging Dumfries and Galloway Council to overturn its policy of charging for food preparation.
The £40 million to address the funding shortfall that Stewart Sutherland identified is welcome. However, I ask the cabinet secretary to ensure that the monitoring of the new single outcome agreements ensures that that money is allocated to the care of the elderly.
Another issue that I want to raise is the higher funding that is provided to people in council-run homes in comparison with the funding that is provided to those in homes in the independent and voluntary sector. I note the report's reference to the positive work that is being done by the Government and COSLA. I hope that the end result of that is that all elderly people who are eligible for free personal care are treated fairly and equitably. It cannot be right that councils pay a higher amount to residents in council-run homes than they pay to those in homes in the independent and voluntary sectors, given that all care homes are expected to achieve the same
On the issue of direct payments, still not enough elderly people or their carers are aware of the scheme. Direct payments offer people freedom and choice of care package as well as the independence to ensure that care is given in accordance with the assessment, rather than the monopoly of council-only care provision. For many people throughout Scotland, the care provided by councils is first class—the time promised is the time given—but in many instances that is simply not the case. We seek more choice.
I make no apologies for repeating my next point on integrated care homes. When the Community Care and Health (Scotland) Bill passed through its various parliamentary stages, we were given to understand that every care home would have nursing input. That might mean a nurse on duty 24/7 or a visit by a district nurse as and when required. When a frail elderly person's condition deteriorated, a move to a nursing home was not to be necessary for the person to receive the appropriate end-of-life care. However, somewhere between the bill's parliamentary stages, the care commission, guidance and the bill's implementation, we ended up with not one type of care home but three: residential care homes, nursing homes and integrated care homes. Only in integrated care homes will elderly people receive care that ranges from that found in residential care homes to that found in nursing homes. As a result, elderly people are now being kept in residential care homes when they need nursing care. Before the expansion in the number of care homes, frail elderly people were treated in NHS hospitals for their end-of-life care, with the appropriate medical and nursing input. What we have now is a lesser service, with less nursing and medical input in end-of-life care.
The selling of the family home to pay for care also needs to be examined. I had a recent case—two or three years ago—in which a 50-year-old woman who had lived with her mother all her life and cared for her at home was faced with having to sell her home or take out a mortgage to buy out her mother's share in order to pay for care. I trust that that issue will be examined along with the other financial points that Lord Sutherland raised.
Jackson Carlaw will discuss future needs in relation to demographic policy, which is an absolutely crucial issue that Margaret Curran spoke about well. I found the figures in Lord Sutherland's report quite shocking. Over the past five years, from 2002 to 2007, the average increase in the number of publicly funded older people receiving care at home was 51 per cent. The increases ranged from 0.1 per cent in Dumfries and Galloway to 212 per cent in Perth and Kinross.
I never miss an opportunity to talk about podiatry. Elderly people would undoubtedly be more mobile and less likely to need care in the early stages if they had greater access to chiropody, which is now called podiatry. I am not talking about getting someone to cut toenails; I am talking about ensuring access to a qualified podiatrist, where appropriate, who would provide high-quality foot care advice and ensure that people had greater mobility.
We will support the Government in its pursuit of fair and equitable care for the elderly and in addressing the issues raised in the Sutherland report. However, we will not support the Scottish National Party motion, mainly because it contains the phrase "pursue vigorously", which, in nationalist speak, tends to mean having a big rammy or a big constitutional wrangle with Westminster.
We will support the considered Labour amendment, not only because of the content but because of the tone. The amendment calls on the Scottish Government "to enter into discussions" with Westminster. We would always prefer that the issue of the care of the elderly was examined in a mature and dignified manner and that elderly people were put first and foremost, rather than being used as pawns in a constitutional wrangle.
I move amendment S3M-1902.1, to insert at end:
"and calls on the eight Scottish councils which continue to charge for assisting with food preparation to cease to do so forthwith and all councils which have levied such charges to refund everyone who has been wrongly charged for this service."
The position of the Liberal Democrats remains that one of the hallmarks of a civilised society is how it looks after its elderly. In common with many, we have consistently supported the policy of free personal care for the elderly.
We welcome the Sutherland review of that policy. The Cabinet Secretary for Health and Wellbeing quoted different passages of the report from the one that I will quote, which states:
"Despite some practical difficulties in its formative years", the free personal care and nursing policy
"remains popular and has worked well in the largest part, delivering better outcomes for Scotland's older people."
Of course, that was the intention of the policy.
The Sutherland report identifies areas of concern that need to be addressed, most of which are not in dispute, and distils them into 12 points, which form the basis of its recommendations. We
Recommendation 7 is that the UK Government should not have withdrawn the attendance allowance in respect of self-funding clients in care homes.
Ross Finnie will remember that the UK Government, of which I was a member at the time, made it absolutely clear that it could not make a specific grant to the Scottish Executive in respect of attendance allowances, but account could be taken of that matter in calculating the block grant. The then Scottish Executive, of which Ross Finnie was a member, accepted that. In the light of that, Ross Finnie should accept the Labour amendment today.
I do not mind entirely accurate recollections but, with all due respect, that intervention was not entirely accurate. I do not think that the then Scottish Executive was at all happy about the situation. To be absolutely blunt, the Labour Government should not have been citing rules at us; it should have been gracious enough to change the rules and make them appropriate to the devolution settlement.
I share the view of the cabinet secretary. Last week, the Labour spokesmen were all in favour of recommendations 7 and 11 but, this week, they appear not to be so keen on them. We now have 23 lines of obfuscation in the Labour amendment—I would not be so ungracious as to suggest that it might have been drafted by Lord Foulkes—to explain why Labour no longer supports recommendations 7 and 11. That is important.
There is one issue about which I do not think that Labour has been entirely clear. The Labour amendment invites the Parliament to base discussions on a review of expenditure, among other things, on the Wanless report. I have read the Wanless report carefully. The report considers five main funding options, which it narrows down to three. The first is a partnership agreement whereby the provision of every single item of care is to be shared by the individual and the state; the second is the Scottish model of free personal care; and the third is a hybrid model that falls somewhere in between. It eventually comes up with one recommendation, which is the partnership model. In other words, Wanless does not support free personal care for the individual.
One might have all sorts of doubts and reservations with regard to the present Government's capacity for entering into unseemly conflicts—I certainly hope that it will not do so on this issue—but I am not prepared to support an amendment that takes Wanless as its starting point. By doing so, it rejects the principle of free personal care for the elderly.
That is a gross misinterpretation of the Wanless report, the point of which is the need for a broad and strategic review of the policy. Indeed, that is why the UK Government accepted it. We do not support in any way the abolition of free personal care in Scotland, but we are not prepared to accept an approach that will simply lead us into disputes. Ross Finnie has not got this correct.
Ross Finnie might not have got it correct, but he knows that after setting out three possible models, including free personal care for the elderly and a partnership model, Wanless rejects the free personal care model.
In recommendation 11, Sutherland makes clear the importance of reviewing the wider issues. However, he does not suggest that, in taking a wider view of all aspects of longer-term care, one should deviate from the fundamental principle of free personal care for the elderly. That is fundamental to the issue. Having read the Wanless report, I think that Labour members will have to explain to me why it rejects free personal care and recommends the partnership model.
The Liberal Democrats support the Tory amendment. Given that the Government is seeking to clarify uncertainty and that there will be clear knowledge of what will happen, it cannot be right for councils to continue to defy the will of Parliament and, more important, to deny individual citizens the right to free personal and nursing care. Those councils should hang their heads in shame.
We welcome the additional £40 million. I am grateful that the cabinet secretary has conceded our amendment, which will ensure that the sources of that funding are much more transparent.
We support the principle of free personal care for the elderly. We—along with the Government and everyone else who accepts recommendation 11 in the Sutherland report—accept the need for a wider and more holistic review. However, we must not be boxed into an approach based on the Wanless review, which reflected—quite properly and, in some ways, very adequately—the very different conditions in England. It is not a question of a battle between Scotland and England; Wanless simply took a different perspective on the issue and reached a different conclusion on the provision of such care. The fact that Wanless
I move amendment S3M-1902.2, to insert after "additional funding":
"the source of which will be identified in next year's budget".
I congratulate Ross Finnie on his thorough and logical analysis of the issue and support the Liberal Democrat amendment. As those who recall my question to the cabinet secretary when she made her statement will not be surprised to learn, I am also very sympathetic to the Conservative amendment, especially given that one of the eight offending councils—Scottish Borders Council—is in my own patch. However, I do not wish to make a party-political issue out of this, because the council administrations that are still charging for food preparation are of various political hues.
As soon as the cabinet secretary made her statement on receipt of Lord Sutherland's report, I gave Scottish Borders Council the opportunity to remedy the situation and to stop charging for food preparation. I have tried to contact the council again on the matter; unless its silence is an indication that the situation has changed, it remains one of the offending eight councils. That said, I am concerned that if repayments for all moneys so levied were to be recouped immediately, councils would raid other coffers, given that their funding settlement has already been set.
The fact is that, if 24 councils are not charging for food preparation, someone must be in the wrong. In 2006, when the previous Health Committee was conducting its free personal care inquiry, half of the councils in Scotland were levying this charge. Since the committee's report, that number has fallen and we are now left with the penny-pinching and recalcitrant councils that I have mentioned. Those councils are dancing on the head of a pin and are not acting in the spirit of the legislation. The explanation that was put forward to the Health Committee was that
"There is a difference between the preparation of food and assistance with eating food. If we aggregate the preparation, it becomes a volume of work that has cost implications."—[Official Report, Health Committee, 7 February 2006; c 2553.]
It was always about trying to cut costs. However, the guidance at that time, before the review, referred to
"Assistance with eating and assistance with special diets. Assistance to manage different types of meal services. Assistance with preparation of food."
That was all to come under free personal and nursing care. It is as plain as a pikestaff.
As for back-payments, it might be useful for those who are affected in the Borders and elsewhere to consider taking legal action through, say, a man or woman of straw. If that is successful, reimbursement might be payable through the councils' insurance cover, thus protecting public funds. That is just a thought.
I point out to Ms Curran that the level of payment for free personal care was not raised until this Government came to power.
On the Labour Party's amendment, I object to Margaret Curran saying that the Scottish National Party's tone is wrong—I read in the papers that she accuses us of "narrow-minded disputes". I find Labour's turnaround to be depressing but predictable. I feel sorry for the Labour Party in Scotland because it is not free; every time it tries to break free, it is pulled back. Margaret Curran stated in The Courier on 28 April that the Sutherland report
"raises vital issues for the future of free personal and nursing care for the elderly in Scotland. Labour fully accepts the conclusions of the report and its recommendations."
Her statement that
"Labour fully accepts the conclusions of the report and its recommendations" was repeated in The Herald on 29 April.
So what was one of the recommendations? Recommendation 7 states:
"The UK Government should not have withdrawn the Attendance Allowance funding in respect of self-funding clients in care homes, currently amounting to £30 million a year. That funding should be reinstated in the short-term while longer-term work to re-assess funding streams takes place."
The cabinet secretary referred to that. Forgive me but, to me, that is plain English and in any court of law it would be case proved.
With the greatest respect, Christine Grahame mentioned my name several times and I think that I have the right to respond. The point that is being made is that the attendance
I am sorry, but I can only repeat the words that Ms Curran said Labour endorses:
"That funding should be reinstated in the short-term while longer-term work to re-assess funding streams takes place."
I am no spin doctor. That is what the words say. Labour has had to come back from that position for a whole load of reasons, which we could waste time discussing, but the people to whom this matters are elderly people in Scotland. Until Margaret Curran came out with her recent comments in the papers, everyone in the chamber thought that we had agreed on the issue. It is important because the funding amounts to £30 million and there is a £40 million shortfall. Scotland's old people want that £30 million now to help to fill that shortfall.
We have had problems throughout the debate on free personal care with the Labour position in the chamber—although not with the whole of the Labour Party, because the back benchers had difficulties with the position. In the debate in 2000, Iain Gray talked about targeting. I remember him saying that we must target payments
"since seven in 10 of those in long term care are already fully funded".—[Official Report, 28 September 2000; c 743.]
He left three out of 10 to pay for themselves. We had a long way to go and it was the Liberal Democrats—give them credit—who pushed free personal care through while they were in coalition with the Labour Party. That is the truth. I was here and I know that it is the truth.
Malcolm Chisholm who, unfortunately, is no longer in the chamber, made heroic efforts to claw back attendance allowance.
I would like to finish my point, as I took an intervention.
As has been reported and stated in the chamber, in a written answer in July 2003 Tom McCabe said:
"the Scottish Executive explored the issue of eligibility for attendance allowance thoroughly with the UK Government. As a result the Scottish Executive set free personal care payments for those in care homes at a level which allowed for the withdrawal of attendance allowance".—[Official Report, Written Answers, 17 July 2003; S2W-1187.]
It was built in that we would never get attendance allowance.
I hope that I can bring the debate back to the issue of treating old people with dignity, fairness and equity in the system. I make no apology for saying that today I want to consider what the policy delivers, especially for people with Alzheimer's and dementia, and how we can make it deliver better on the ground and across the sector.
To that end, I welcome Lord Sutherland's recommendation on entitlement. When we last debated the matter, in October last year, both David McLetchie and I pointed out—it is worrying that we were in agreement—that too many people who qualify for assistance are being short-changed in the implementation of the policy. Too many people who have been assessed as requiring care do not fully understand their entitlement. They do not complain when the service falls short because they think that they are getting it for free. The recommendation on entitlement is crucial and is a real step forward.
I ask the Government when it makes recommendations to clarify the policy and the issue of entitlement to ensure that old people understand it, which is vital. People with dementia, in particular, must have information presented to them in an easy-to-understand format. At the moment, they are presented with contracts and there are folders in their rooms. We need a piece of card that says not just how many hours of care the person will receive, but at what time they can expect their carer to arrive and leave, what tasks the carer will undertake while they are there, who the carer delivering the care will be—a named person—and what they should do if the carer does not turn up. That is not rocket science but, unfortunately, it is not happening. The people who are listening to today's debate want such points to be made; I hope that I can make them. If we ensure that information is presented to old people in a form that they can understand, we will empower them and lessen the opportunities that seem to exist in the present system for agencies and other people to make profit from it and to shave time off old people's care services.
Young people with dementia have the same complex range of needs as older people with dementia but do not qualify for free personal care. That issue has been raised by health committees of the Parliament for some time. Given that the Cabinet Secretary for Health and Wellbeing intends to examine eligibility criteria, I ask that consideration be given to that vulnerable group.
I turn to the quality of the service and how we
When complaints to the care commission about standards are upheld, there must be thorough reporting, so that there is greater accountability in the system. A contrast may be drawn with the education system. Her Majesty's Inspectorate of Education reports are circulated to councillors, members of the Scottish Parliament, members of Parliament, local newspapers and sundry others, and there is regular reporting in the local media on good practice and areas requiring development. Unfortunately, there seems to be one standard for the rest of society and another one for old people. I ask that consideration be given to providing information to service users. By giving them information, we will empower them.
I think back to the drive that we undertook 15 to 20 years ago to rehabilitate people who had lived in large-scale psychiatric hospitals by placing them in smaller homes and in the community. If we contrast that situation with the present one, in which the size and scale of many new care homes that are being built is such that some of them will house as many as 200 old people, we must ask whether private profit is being put before old people's care. If we believe that such an approach is not beneficial for people who have special needs or those who have a mental illness, why is it okay for our elderly people and those who have dementia to be housed in such conditions?
Most elderly people want to stay at home but, for those for whom that is not possible, how much better would a core and cluster system be? Such a system would have at its core services such as physiotherapy, hydrotherapy, occupational therapy and food provision, and three or four elderly people would live in houses clustered around that provision, thereby allowing greater social interaction and much more one-to-one care.
The need to revisit the framework of free personal care and how it is delivered gives us an opportunity to be bold in our approach and to enshrine the rights of our frail elderly in legislation. It is a sad fact that some of the things that they tolerate would not be tolerated by any other group in society. It is time for that to change, and I hope that we in the Scottish Parliament will not allow politics to be a barrier to change but will ensure
I will focus my remarks on the issue of the legality of charges for assistance with meal preparation, which is highlighted in our amendment.
It is claimed that the legislation requires clarification and, in her statement to Parliament last week, the cabinet secretary said that the present Government would introduce such legislation. However, there is nothing confusing about the legislation. The Community Care and Health (Scotland) Act 2002 states that local authorities may not charge for
"care of a kind for the time being mentioned in schedule 1 to this Act".
If we refer to schedule 1 to the act, we find that paragraph 2 mentions
"As regards the person's eating requirements—
(a) assisting with the preparation of food;
(b) assisting in the fulfilment of special dietary needs."
In short, not only are those services free but entitlement is to be determined on a free-standing basis and is not to be linked to the provision of any other personal care service such as washing or dressing.
We know that the act is clear cut in that respect, because that is exactly what certain local authorities have been told when they have taken counsel's opinion. For example, the opinion that the City of Edinburgh Council obtained concludes:
"The Council may charge for: shopping, providing food and providing frozen meals" but
"cannot charge for: chopping up meat or vegetables, mixing ingredients, cooking, reheating frozen meals, putting food on a plate, cutting up food so that it can be eaten, pureeing food, feeding and other assistance with eating, assistance with special diets and prompting to remember to eat."
The source of the confusion that has reigned is the so-called guidance on the subject that the Scottish Executive issued, which was a true master-class in obfuscation and ambiguity. It was riddled with double negatives and entirely lacked the straightforward and simple clarity of the legal opinion from which I have just quoted. That is a disgraceful state of affairs, given that the act has been in effect for nearly six years, during which time many thousands of people have been illegally charged for such services.
Thirteen councils never charged for assistance with food preparation—good for them—and 11
The Cabinet Secretary for Health and Wellbeing says that she will legislate against such charges but, as we know, that is at least a year away if not longer. In the meantime, older people in those eight areas continue to receive bills. I believe that that is wrong and that the eight councils concerned should stop the practice forthwith.
It is all very well for the cabinet secretary to say that we should have a vigorous discussion with Westminster about lost attendance allowance moneys, but the loss of attendance allowance was compensated for when the level of care payments to care homes was set by the Scottish Executive. In other words, the older people concerned did not lose out as a result.
However, the situation with meal preparation charges is quite the opposite. People are losing out, the bills are mounting up and the time to take action is now, not months or years down the line. Stopping charges that are still being levied is only one part of our amendment. The legal opinion that was taken by City of Edinburgh Council concludes:
"Although the Council acted in good faith, charges levied have been ultra vires. People who were illegally charged have a claim for repayment on the grounds that an unlawful charge falls to be reversed".
On the basis of that advice, and with the support of all parties within it, the council agreed to refund those who had been wrongly charged and paid out a total of £1.064 million to 600 people, which is an average refund of nearly £1,800 per person. We have already had the roll of shame. The City of Edinburgh Council is on the roll of honour, along with West Lothian, Clackmannanshire, Western Isles, Angus and—let us not forget—Dumfries and Galloway, which has authorised a refund programme estimated at £1.5 million. Those authorities acted on the basis of legal advice, and they did the right thing by their citizens. They should be commended for doing so. They should not be placed in a position of comparative disadvantage to those councils that are still charging illegally.
One of the strongest arguments that the original royal commission chaired by Lord Sutherland set out in favour of the introduction of free personal care related to equity among people. It was never the intention of the Parliament for there to be such wide variations in the implementation of the policy across Scotland. Although the previous Scottish Executive is far from blameless in its handling of the matter, it is regrettable that the present Government sees no degree of urgency in resolving it and apparently does not recognise the inequities that are involved in continuing to charge and failing to refund.
Although it is undoubtedly driven by cash considerations, the attitude of COSLA also deserves some criticism. COSLA knew perfectly well that member councils had clear legal advice stating that the charges were wrong, but it chose to run for cover and hide behind the smokescreen of discussions with ministers. It is up to us to blow that smokescreen away, and it is up to the Parliament to state clearly and unequivocally today that all our older people should be treated on a fair and equal basis across our country, and that this wrong should be righted, and righted right now.
The debate allows us to look forward and consider how to improve the policy of free personal care and the manner in which it is implemented. We must take care, however, not to lose sight of the great many benefits that the policy has brought to individuals throughout Scotland. It represents a major social reform, in which Parliament can take justifiable pride. The significant increase in the number of elderly people who are enjoying extended years in their own homes is something to be celebrated.
Liberal Democrats welcome the fact that the cabinet secretary has moved swiftly to accept in full the recommendations that were offered by Lord Sutherland, and I reiterate our commitment to work constructively with the Government to address the issues that Lord Sutherland raises. Although no time should be wasted in taking the shorter-term steps that the review identifies, it is vital that we simultaneously give appropriate attention and thought to the longer-term challenges that Lord Sutherland has laid out. In particular, a compelling case is made for future demand to be reviewed and remodelled regularly so that it can be accurately reflected in future local government finance settlements. A degree of uncertainty is currently associated with the projected costs of the policy, which clearly makes capacity planning difficult. I ask the minister to say in her closing speech how regularly the
More important still is the last of Lord Sutherland's recommendations, in which he speaks of the need to establish a long-term vision for dealing with the challenge of demographic change. Some members will feel that challenge to be more urgent than others do, but there is undoubtedly a broad consensus on the need for such a vision. Pensions, housing and transport are but a few of the issues that must be considered as part of an integrated and comprehensive approach to changing demography. Will the minister assure me that the Government will seek to involve all interested parties and relevant stakeholders in producing a long-term vision?
During last week's statement, my colleague Jamie Stone made the point that different parts of Scotland face different demographic pressures and that it is vital that such differences are taken into account as free personal care and its funding are reviewed. Divergences of that kind must also feature in deliberations over how best to respond to the broader questions that are posed by demographic changes in Scotland. Liberal Democrats will ensure that that is the case.
I thank Help the Aged for its briefing for the debate and will refer to a couple of points that it raises. It is clear that many older people, their carers and their relatives are confused about the policy and what it covers. I agree with Help the Aged that much more needs to be done to ensure that older people have access to clear and transparent information about the policy, the process and their entitlement. I urge the Government and councils to work together to ensure that clear and consistent information is available in the future.
Mary Scanlon touched on the provision of nail trimming through free personal care. Help the Aged has carried out research into that. I understand that nail trimming is specifically mentioned in the legislation and that the minister recently confirmed that. Therefore, it was disappointing to discover the variation in provision of that small but valuable aspect of personal care. Older people should not have to turn to expensive private podiatry services to have their toenails cut, nor is it appropriate for the NHS and councils to wrangle over who is responsible for it. I ask the cabinet secretary to undertake to write to all councils on that matter.
The review of free personal care by Lord Sutherland provides a clear route forward for building on the benefits and successes of the policy while seeking to ensure that it serves, as fully as possible, the purposes for which it was designed—purposes that continue to enjoy the support of all members. Nevertheless, that way
Notwithstanding the health inequalities that continue to blight our nation, it is to be celebrated that more of us are living longer and, in general, enjoying better quality of life than our forebears. I am reliably informed by Christine Grahame that 60 is now the new 40 and 70 is now the new 50. The increasing number and proportion of over-65s and over-90s will, indeed, provide challenges for government at all levels, but we must remember that some good news is at the crux of the challenge and we must desist from framing discussions about older people and the challenges for public policy and the public purse in pejorative terms.
That is why I welcome Lord Sutherland's independent review. In dealing with the here and now, he looks to the future and provides a framework to work towards improving the lives of those we refer to as older people. However, the hard facts of life are that old age will come to us all and the vision that we now have for older people is, in fact, a vision for ourselves. For me and many of my constituents it is, as Lord Sutherland says,
"the right service at the right time and in the right place" with the aspiration of staying in our own homes for as long as possible. If that is not possible I—like Irene Oldfather—want to stay somewhere that provides appropriate care and replicates home.
Free personal and nursing care is frequently described as a flagship policy of the Scottish Parliament. It has been noted on many occasions that the policy is admired and at times envied in other parts of the United Kingdom and the world. The work that was undertaken by Lord Sutherland is on a par with the work that was undertaken in the late 1960s by the Kilbrandon commission, which established the children's hearings system. That system has, by and large, stood the test of time and is still with us today. Lord Sutherland has indicated that free personal and nursing care is affordable, so we can be confident that that policy, too, will stand the test of time. Like the children's hearings system, it is an example of how we can do things differently in Scotland to reflect the core values that we have as a nation, which cut across the political divide.
As we know, the raisons d'être of free personal and nursing care were equity and the principle of free care based on need. Frankly, it is therefore
I am grateful to Angela Constance because, as she pointed out the other day, her election is the reason why I am here. She is a tactful and approachable person, so does she not agree that the best way in which to achieve what she wants is not to say, "Restore the attendance allowance payments," because it would entirely disrupt the social security system in Britain and the reply would be no? The same result could be achieved through the block grant—that is the way of getting something. Is it not better to try to negotiate than to beat one's head against a brick wall?
I thank Lord George Foulkes for reminding my colleagues that I have a lot to answer for.
With the SNP Government, we have seen a breath of fresh air. The Government has accepted a good report in its entirety. In the short-term recommendations in the independent review, recommendation 7 states:
"The UK Government should not have withdrawn the Attendance Allowance funding".
It is appropriate that the cabinet secretary wants to deal with the shorter-term issues now and then move on to look to the future.
The SNP Government has put its money where its mouth is: it is meeting the £40 million annual shortfall. For the first time, it has increased free personal and nursing care payments to older people in care homes and it is looking to the future to end the postcode lottery on food preparation. I am pleased that David McLetchie accepts that West Lothian Council is on the roll of honour.
The free personal and nursing care policy was and is a national expression of how we want to care for and support older people. It is despicable that the Westminster Government continues to try to thwart our collective aspirations by denying £30 million a year in attendance allowance. The debate is an opportunity for Parliament to unite and to put our case with one voice and with fervour for what at the end of the day is ours by right. To put it simply and crudely it is, after all, our own money that we are talking about.
It is unsurprising that the debate has focused mainly on the fight over the £30 million of attendance allowance money, which will not in itself make our ambitions for our elderly people sustainable, although there is no doubt that it would plug a gap. However, I am glad that some members have cut through that to discuss our policy, born in the Scottish Parliament, for free personal care for the elderly in Scotland. We knew the consequences of adopting that policy, and we had debates about its sustainability.
The Parliament's health committees have been referred to. I was a member of the Health Committee away back in 2006. In that committee's reports, there was some good reading for the then Executive. We were satisfied with policy decisions and with their implementation. We acknowledged that the policy, born of this Parliament, provided greater security and dignity to many elderly people. Not only did it allow people to be looked after in a residential environment, it allowed more people to be looked after in their own homes. The policy gave great support to carers, and it reduced problems of delayed discharge.
However, not everything in the Health Committee's reports made for pleasant reading for the Executive. The committee included members of all parties: it was led by Roseanna Cunningham and Shona Robison served her time there, as well. There was also an independent member. However, committee members came to a unanimous view. I do not know whether we will ever achieve that under the present Administration; I do not know whether SNP back benchers will be as questioning of their own Government as the members of that committee were of the then Executive.
We raised significant questions in 2006, many of which have been debated in this chamber. They concerned the funding formula, delivery of services, food preparation and feeding, and raising standards of quality. However, I would like to focus on some other areas. Shona Robison expressed real concerns about the funding formula that was put in place by the then Scottish Executive and which is now being used by the Scottish Government. As I do, Shona Robison represents an area that has a declining population. As a consequence of that decline, the number of elderly people left in such communities is disproportionately high. That issue has to be focused on.
We do not need to have a fight with London, or to have a big argument to resolve problems. We can decide for ourselves that the funding formula is unfair to areas that have declining populations
I will use my constituency as an illustration. In Inverclyde, the proportion of people who are older than 65 is increasing. In 2004, it was estimated that nearly 14,000 people were aged 65 or over—17 per cent of the total population. The number of people aged 65 or over is expected to increase by approximately 25 per cent to 17,000. As the proportion of people aged 65 or over increases, the requirement for care home places and care-at-home services will obviously increase, too. Over the next four years, the number of people aged 65 or over is projected to increase by almost a third. That increase in the number of older people is coupled with a decline in the number of younger people. Those changes magnify problems in the size of the local pool of labour that can look after older people, and in the size of the local pool of younger informal carers. In my community, the carers of people who are very elderly—the over 80s—are now reaching ages at which they themselves need to be looked after.
We are not talking about a problem that is far away; it is right on our doorstep and it affects several communities. I received a very constructive response from the Cabinet Secretary for Finance and Sustainable Growth earlier today, when he assured me that he would consider all these issues and would ensure that we do not simply provide a blanket solution across Scotland, but take account of the fact that some communities face a disproportionate impact in looking after their elderly people. Those communities suffer from significant underfunding at present. I ask the ministers and cabinet secretary in the health portfolio to give a similar commitment to recognise that certain communities have significant and serious problems and to address those communities' needs as soon as possible.
Duncan McNeil reminisced in his speech about his time on the then Health Committee, and about how Labour back benchers on the committee were prepared to ask ministers difficult questions when they came before the committee. Well, as one of the SNP back-bench members of the current Health and Sport Committee, I reassure Duncan McNeil that SNP members on the committee are prepared to ask difficult questions, as I am sure the cabinet secretary and the minister will recognise. Perhaps you should come along when you get the opportunity, so that we can show you how it should properly be done.
Well, Mr McNeil, you are welcome to come along and see how robust questioning should be done in an effective manner, which is certainly not your manner in committee, from what I have heard.
Like many others in this debate, I welcome the latest report from Lord Sutherland because it is clear that there is a range of problems around the free personal care policy. I believe that the recommendations collectively provide a package of measures that will ensure that we can resolve many of the problems that have been associated with the policy since its introduction.
I worked in care management for many years, assessing individuals who were going into long-term care or considering doing so, and my lack of enthusiasm for the financial assessments that went with the process was a constant bugbear to my team manager, particularly when I recognised that it was likely that a person would have to sell their home in order to pay for their care.
Mary Scanlon made a valid point about the need to review free personal care and its associated problems. There we see the sinner repenting, because it was the National Health Service and Community Care Act 1990, which her Government introduced, that resulted in the problem of people being forced to sell their homes to pay for their care.
I know that many of my colleagues who continue to work in care management welcomed the Scottish Parliament's decision to introduce free personal and nursing care because it removed at a stroke a massive layer of bureaucracy around financial assessments and all the rest, which cost the council tax payer a fortune and which was required to implement the policy that the previous Conservative Government had set up.
Many of the problems emanated from the failure of local authorities to have a standardised assessment and delivery process for care management. David McLetchie referred to the lack of clarity around the guidance that the previous Scottish Executive issued when free personal care was introduced, which allowed great variations in provision across the country. That said, there have always been great variations in how local
Irene Oldfather made a worthy contribution to the debate, referring particularly to the need to ensure that we implement effectively recommendation 3, for a standardised assessment and delivery process, the lack of which Lord Sutherland sees as being one of the root problems.
If we are to address overall inequalities in care, we must recognise the funding implications of free personal care. David McLetchie referred to the original royal commission under Lord Sutherland. That royal commission placed a big emphasis on equity in treatment of elderly people. However, it is also worth keeping it in mind that Tony Blair's placeperson on that royal commission, Lord Lipsey, issued a minority report that opposed many of the recommendations in the commission's report, which he said were not sustainable and did not represent the right way to go. That sentiment is the reason why Westminster decided to withdraw the attendance allowance funding of some £30 million. It did not want to go in that direction and so wanted to penalise the Scottish Parliament and the Scottish Executive, as it was at that time, for that policy.
The Labour members who were members of the Scottish Parliament at the time will recall that there was a considerable degree of reluctance on the Labour benches to go ahead with the recommendations in the royal commission's report. To their credit, it was the Liberal Democrat members of the Scottish Executive who forced the issue, along with the Tories and the SNP, all of whom supported the findings of the royal commission and were going to force the issue through Parliament. When Henry McLeish realised that he was on the losing side, he capitulated with Parliament's view.
We will take no lectures from the Labour Party, which kids on that it delivered the policy. It has actually created quite a few of the problems that are associated with it, both because of how it implemented the policy in Scotland and because it has deprived Scotland of £30 million to which the Scottish people are entitled.
I refer members to my entry in the register of members' interests.
The policy of free personal care, which was introduced in Scotland by a Labour-led Government, was visionary, courageous and ambitious. We must be just as visionary, courageous and ambitious about safeguarding the policy and making it work. I have to say to Michael Matheson that it was Henry McLeish who projected the idea at the very beginning, and that he led with the idea for the whole time he was in Cabinet and was leader of the Labour-led coalition.
No, I will not; I have hardly got into my speech.
The need for equity was, of course, at the heart of the decision to introduce free personal and nursing care. The Sutherland report acknowledged that the free personal care policy was fully funded until the end of 2005-06, and that the current shortfall is down to greater-than-expected demand due to demographic reasons.
The issue of demand-led funding is a major concern for any Government, but it is particularly so for the new SNP Government because the policies that it is developing are all demand-led. At some stage, as those of us who have been in local government or the Scottish Parliament for a while will know, the chickens will come home to roost. Demand-led funding has inherent dangers.
In a moment.
Christine Grahame talked of "narrow-minded disputes". When we examine in detail what is happening in SNP and Liberal Democrat councils across Scotland, we can see the utter hypocrisy of the SNP. I will revisit that point later, with particular reference to one or two councils.
Lord Sutherland had an answer to the funding shortfall: reinstatement of the attendance allowance, which has not been paid to those who are in care homes since free personal care came into effect. He speaks of how that would work, although there are apparently other ways in which we can tackle the problem. There is, however, a serious drawback to his suggestion. The key objection is that the top-up is a short-term fix—The Herald said that earlier in April—and, as the review commission acknowledges, it would stabilise the policy only for the next five years, which is when the demographics would really begin to bite. Much more than £30 million will be needed then because the problem will be much more profound.
Ross Finnie did not take account of that vital point in his speech. However, we have to think about the big picture. I remember Lord Harry
David McLetchie said all that I wanted to say, particularly in regard to meal charges. I agree with him that the cabinet secretary should require councils to take action now to ensure that funding comes into play. The SNP is letting down local authorities and pensioners in failing so far this year to plug any of the gaps in free personal care funding that Lord Sutherland highlighted, which is fundamental.
More urgently, ministers must take account of all the points that Help the Aged has made. I agree with Help the Aged that the consequences of the Macphail ruling in relation to self-funders' access to free personal and nursing care should be examined further. There are fears that that group of people will be put at the bottom of the waiting list because some people might argue that their needs are not being met.
I seek clarification on whether the waiting times targets will be considered as an option to deal with the delays between referral and assessment that were identified in the Scottish Parliament's Health Committee inquiry into care and the report on free personal care by Hexagon Research and Consulting. The public has high expectations from a much-trumpeted policy, leading to a greater demand and therefore to a much higher cost than had been envisaged. It is now clear that those costs will increase even further, with the number of very elderly people in the population now expected to be vastly more than was projected in 1999.
The Sutherland commission's recommendation that clients and carers should have a clear understanding of their entitlement and the minimum standard of service that they can expect was well covered by Irene Oldfather—I do not need to go further into it.
The key point is the hypocrisy of the SNP and the Liberal Democrats, which is evident in what is happening in Fife. When Fife Council was controlled by Labour, every year the social budget was overspent—to the tune of £6 million last year—yet Labour's team always put money back into balances at the end of each financial year. Last year, almost £3 million was placed in balances when Labour lost office.
I ask members to compare that to the accountancy approach of the SNP and Lib Dem-controlled council, under which frail elderly people now pay £7 for each shopping delivery when previously, under Labour, it was free. Each frail elderly person now pays £11 an hour for their care package when, under Labour, it was under £4 per week. A disabled person under the age of 65 is
I am pleased to participate in today's debate and am glad of the opportunity to join in discussions about a policy that parliamentarians who were here in 2002 are right to be proud of.
It was a landmark achievement to remove the costs and stress associated with growing old and infirm and requiring residential care or care in one's own home. It proved that the Parliament had come of age and that parties could work together for the benefit of the people and summon the gumption to travel a radically different route to that proposed and followed by Westminster. It showed that where consensus prevailed, the people benefited.
However, despite the policy being implemented with the very best of intentions, it has had its flaws, its unintended consequences and its critics. We have heard about the pressures that an ageing population will have on the policy; about food preparation problems from Christine Grahame; and concerns about nail trimming from Help the Aged. Perhaps Mary Scanlon will be pleased to learn that my sister is a podiatrist, so I understand how essential her skills are to the elderly population. That is why it is right that the SNP Government, sticking true to a manifesto commitment, commissioned an independent review of free personal care. I am heartened by the tone of Nicola Sturgeon's motion, which shows that the Government is reacting positively to the Sutherland report by accepting in full all its recommendations, and by her intention to work with COSLA to ensure openness and transparency on waiting times.
I thought that most of us in the chamber would want to echo the consensus of the past and would try to be as constructive as possible to ensure that this flagship policy does not wither on the vine, but flourishes as intended. I assumed that most members would welcome the Scottish Government's intention to pursue vigorously the attendance allowance that the UK Government so callously withdrew. It just goes to show that one should never assume anything, because it is clear from the Labour Party's amendment, which scrubs from the cabinet secretary's motion the bit that will allow her to pursue the attendance allowance, that the supposedly socialist Labour Party has performed yet another remarkable U-turn and
The Labour motion also appears to be mixing up Wanless reports—I think that the one cited in the motion was done not for the Government but for the health charity, the King's Fund. I share Ross Finnie's concerns about that review.
As we have heard, Lord Sutherland's review categorically states:
"The Review Group considers that the Care Development Group was right to view Attendance Allowance in care homes as a UK contribution towards personal care costs."
It also says that the Scottish Government should
"In the short-term seek the reinstatement of the £30 million in Attendance Allowance withdrawn to those in care homes at the time of introduction of the FPNC policy in Scotland and for those arrangements to stand until the wider assessment of funding streams for long-term care at a UK level ... can be made."
If we have a £40 million shortfall and we are due £30 million, we should ask for it. That sounds like a sensible plan of action. Just because the Scottish Government is going to engage in dialogue to get the money back does not mean that it cannot work constructively with the UK Government on a longer-term review of care provision and benefits.
Margaret Curran, in her amendment, fails to see that point. Alex Salmond cited in his statement to Parliament yesterday examples of when the Scottish and UK Governments have worked together and when the Scottish Government has shown itself ready to co-operate with Westminster to meet the challenges that the countries face. The issues about free personal and nursing care, attendance allowance and wider long-term reform should be no different. Henry McLeish recently said, in an interview on "Good Morning Scotland", that parliamentarians should be putting petty, party-political squabbling to the side, that this was not a petty discussion about a small amount of finance and that every political party in Scotland should be supporting the move. I agree with him whole-heartedly on that.
The new politics currently enjoyed in Scotland should be about doing what is right, not what political masters in London say should be done. The people of Scotland voted for a devolved Government that has responsibility for and a duty of care to its people. The people of Scotland want their representatives to stand up for what is right and, as Christine Grahame said, not to continue to have their policies constrained by what goes on in London. That is exactly what the Sutherland review wants the Scottish Government to do. It has identified a legitimate flaw in the policy of the Department for Work and Pensions to keep the money and it has suggested that the Scottish
Throughout my first year in the Parliament, I have heard accusation after accusation that the Scottish National Party does not care for the most vulnerable in society. The elderly are one of our most vulnerable groups; they are due our care and their dignity must be maintained. The SNP is clear that, by implementing Sutherland's recommendations and, importantly, by getting back Scotland's money to help implement free personal care properly, it will do its utmost for that group. It is also showing the people of Scotland that it is willing to stand up for our country and not shy away when Scotland's interests are jeopardised.
It is depressing that some have decided to break the consensus in the Parliament, to ignore a key recommendation of the Sutherland report and to question the Government's motives in standing up for this country. The debate need not have descended into the partisan bickering that Henry McLeish warned against; it could have been much more. I hope that the Labour Party amendment falls tonight and I am confident that the cabinet secretary and her team will do their best to secure our attendance allowance. I know that those who should be in receipt of it will be grateful for their efforts.
There is a real chance to make this flagship policy work and I look forward to the updates that I am sure the Government will provide as it seeks to make free personal care for the elderly a policy for us to be proud of.
I have listened to the debate with the greatest of interest and I agree that it is relevant to us all. I am proud of my party's role in bringing about the policy in the first place. It was groundbreaking stuff at the time of its introduction and, as Lord Sutherland said, by and large it is working well.
My first point is about the title of the report: "Independent Review of Free Personal and Nursing Care in Scotland". Lord Sutherland is no shrinking violet or lickspittle of any political party. A great deal of thought and effort has been put into the independent review and members should therefore treat its recommendations with the utmost seriousness. That is the premise from which I start. I will comment briefly on some of the contributions made so far.
The cabinet secretary went straight to the core of the problem, which is, as we know, the
I do not think that the attendance allowance is the core of the problem either, but it is mentioned in Lord Sutherland's 12 recommendations, each of which is important. We should not look upon his recommendations lightly.
Margaret Curran made good points in her speech. She said that the free personal care policy was groundbreaking and drew our attention at an early stage to demographic change, which I will come to later.
Mary Scanlon, in trusty form, pursued issues that she has been steady on over the years, such as higher funding for council-run homes and the selling of homes to pay for care. She made her points eloquently.
My colleague Ross Finnie outlined my party's position on free personal care. As I said, I stand with him.
Irene Oldfather made a thoughtful speech—surely every member recognises that—which I compliment her on. She went to the heart of things, which is that what really matters out there are the old people who use the services. Her point about people being advised what to do if a carer does not turn up cut straight to the core of where we are. What do people do? It is a big worry. I am sure that all members visit old people and that we all know that wee things that may not seem too big to us are mighty big in their minds. I say well done to Irene Oldfather.
David McLetchie made a full and excellent speech in which he took us through the issue of charging for preparing meals. Shame on the eight councils that are still charging, as he said. I hope that the way in which he and members of all parties have highlighted that issue today will start to move those councils away from what they are doing. They know that the cabinet secretary has the stick of legislation in her back pocket and that that stick can be used when necessary. We shall consider that over the summer. In the meantime, I hope that the councils in question will abandon such a foolhardy and straightforwardly cruel policy.
I turn to two issues that are important to me, one of which Alison McInnes, who is no longer in the chamber, has already hinted at. We must consider
That takes me to the second and final issue that I want to deal with. We shall find out what happens at decision time, but in whatever way we progress from such an excellent report, there will be issues that undermine our best intentions. I will give one small example from Lochinver, which is in the west of my constituency. There is a very small respite care home for the elderly there called the Assynt centre. Until perhaps a year ago—I am not sure of the dates—that centre offered respite care or residency for seven days a week but, for reasons that I do not know, the previous Highland Council decided to cut the services that were offered so that they were offered on five days, with perhaps six weekends when people could stay. If one talks to local people in Lochinver, one will find that that place could be filled right now. The bottom line is that, despite the best intentions behind the free personal and nursing care policy, old people from Lochinver on the west coast must go all the way to Migdale on the east coast for their respite or residency. There is something wrong if people in their declining years cannot be among the beloved hills and straths from where they come. I will not be so glib as to say that that has been a shocking SNP mistake, but there is a problem and I do not know why it is a problem. I would be grateful if the cabinet secretary could meet me to discuss it at some time, although not today. It is not a big problem in the scheme of things, but it makes a big difference to old people in my constituency and is undermining the good intentions that lie behind the Sutherland report and all that will follow from it.
I apologise to colleagues for a lack in my usual preparation for the debate. I have been preoccupied today with a family health matter that, if I were to indulge in a bit of black humour, would perhaps require me to declare a personal interest in the matters in hand.
The debate has been well informed and sometimes cantankerous, the latest in a long series of debates concerning the matter of which the Parliament is perhaps most proud—the achievement, supported by all parties, of decisive action in the interests of Scotland's elderly through the introduction of free nursing and personal care.
I recognise that no one party has ownership of the issue, as all parties supported it; therefore, seeking to use it to embarrass any party would be, however tempting, something of a cheap stunt. I thought that Michael Matheson's speech was particularly sour in that regard.
Yes, the Sutherland review has arrived at trenchant conclusions, but the appropriate response from all of us—given that the conclusions have been generally welcomed and accepted on all sides—is to act to ensure that further progress is made in support of those who are in need. As Mary Scanlon said, and as the Labour amendment states, we should enter into discussions with Westminster in a mature and dignified way. We support the Government in its efforts to secure the £30 million that has been withheld and we hope that it proceeds in a manner that ensures a successful outcome.
Certainly, I believe that the Government has grounds for optimism. After all, if £2.7 billion can be found at the drop of a hat in a fruitless effort to salvage the reputation of the Prime Minister ahead of Labour's expected defeat by the Conservatives in a Westminster by-election for the first time in 26 years, it ought to be possible, without visiting a by-election on Labour members in Scotland, for £30 million—which is trivial by comparison—to be found by the Treasury to meet Lord Sutherland's judgment. Lord Sutherland states that the money should be reinstated in the short term, which implies a sense of urgency, while accepting the need for larger work to proceed in reassessing the funding streams, which speaks to the Labour amendment.
I turn to some of the issues that have been raised by members during the debate. Mary Scanlon returned to the subject of integrated care homes and made the point that she has made before. David McLetchie spoke at length on the subject of our amendment, just as he did in response to the statement last week. I am sure that he will be invigorated by Helen Eadie's endorsement this afternoon. It is a matter on which he has led in recent times and we make no apology for our demand today that those eight councils that continue to charge should take the intentions of the Government—expressed last week and again today—as the signal to stop doing so now, ahead of any legislation, and to refund all those who have been harangued into paying, quite wrongly, for assistance with food preparation. I repeat David McLetchie's assertion that, although legislation may be required to clear up the confusion, it is not a confusion in law but a confusion that has been created by Scottish Executive contortions on the matter. Indeed, one wonders where an individual who specialises in such policy contortions might find employment today.
Ross Finnie hugely exaggerated the emphasis that the Labour amendment places on the Wanless review. He got his just come-uppance from Helen Eadie for having the temerity so to do.
I quote briefly from the Wanless review. Under the heading "Assessing the options", it states:
"The frontrunners differ in important ways."
It refers to "The partnership model", the "Free personal care" model and "A limited liability model". Under the heading "Choosing a funding system", it states:
"On balance, the Review considers the partnership model the best option".
Which words does the member believe that I have misunderstood?
We are not being asked to endorse the Wanless review; we are being asked to support the Labour amendment, which merely notes the review's recommendations in the context of a wider debate.
I agree with what Irene Oldfather had to say about young people with dementia—a sector that is small at the moment, but which is set to grow.
I welcome the return of Duncan McNeil to the chamber in such good voice. Perhaps he took the advice of the late Denis Thatcher, who, when asked by the Duchess of York why she was getting universally bad press, replied, "Have you tried just shutting up?" Perhaps Duncan McNeil's loss of voice last week was, in the circumstances, helpful to him. Nevertheless, I am glad to have him back in full voice. He spoke on Inverclyde, where not only are the elderly expected to increase in number, but the overall population is expected to decline significantly. The issue of free nursing and personal care is significant in that local authority area.
"I do not think that the attendance allowance is the core of the problem either", despite the fact that he had just said,
"The cabinet secretary went straight to the core of the problem, which is, as we know, the attendance allowance."
That is surely a U-turn even faster than those to which we are becoming accustomed in the Parliament.
In closing, I return to the point that I raised in my question on the Government's welcome statement last week. In acting to improve matters in practice, we all have a responsibility to those who will follow us. I agree with Margaret Curran—who made this case with characteristic passion this afternoon—on the demographic trends and predictions, which most members have seen. Many of us know the
The policy of free personal and nursing care is proudly advanced by this generation to ensure that those who went before us who did so much are rewarded with a standard of care to which we feel all should be entitled. However, the policy should not be seen as a signal to those who follow us that we or they can be casual or reckless in life about our health and lifestyles in the certain knowledge that the state is now set up to pay up. If free personal and nursing care is to be a gold standard, it is essential that we bring about a culture in which people understand that the policy has been achieved to ensure that those who need such care receive it but that all of us, throughout our lives, must act responsibly to minimise the need to access such care in the first place.
There is a concern about the future affordability of the policy. In truth, we can offer only our best guess on that. Changes and advances that could massively affect the future position—for good or ill—could occur at any time. However, to make the policy affordable and sustainable, we need to avoid being rosy-eyed about the future by ensuring that, whatever future funding streams are eventually set up, it becomes part of the public grain that we all have a duty to the national health service to act responsibly.
On a point of order, Presiding Officer. I seek your guidance. In the summing-up speeches, several members have been named who contributed to the debate but are not now present in the chamber. It may be that they have sought leave not to be here, but I ask you to look into that. I have always understood that those who contribute to a debate should be present for the summing-up speeches.
This has been a curate's egg of a debate. It will have been a wasted opportunity if the Parliament is unable to unite around the Labour and Conservative amendments, which provide a reasoned approach that will allow the Parliament as a whole—all of us together—to approach the UK Government to discuss the attendance
No, I must carry on. The minister will have a chance to respond in her summing up.
The Labour Party is clear that it supports free personal care, but we had hoped that this welcome debate would provide an opportunity to consider the situation that the Parliament faces. Lord Sutherland has made it clear—this also emerges in the Wanless report—that, as a country and as a United Kingdom, we are faced with demographics that we can only guess at.
Let us remember that when the original Sutherland report was approved and the policy of free personal care was implemented, the funding that was put in place was based on demographic information in a report that was published in 1998-99 and that, within six years, those figures were wrong—the demographics were underestimated and the costs rose much more quickly than they were expected to. If that can happen in six years, what is the likelihood—given the sort of medical advances that we are seeing—of even greater changes in the five-year period over which Lord Sutherland believes the policy is fundable? Within those five years, changes could occur that would cost huge sums of money.
My point is that the debate should be about how we can take forward a policy on which we are unanimously agreed and which provides dignity to old people. It is regrettable that, instead, the SNP has tried to use the debate as an opportunity to kick Labour. That is what the SNP has been about, and it will suffer for it.
There has been a certain amount of rewriting of history by Labour members. If we recall the first session of Parliament, it becomes clear that Labour has never really been in favour of universal benefits. When the announcement was made, Susan Deacon, who was the Minister for Health and Community Care, refused to back the policy. Tom McCabe had to come to the Parliament and do it for Labour. Labour has never been in favour of the policy. A lot of hypocrisy is coming from Labour members.
Mike Rumbles is trying to rewrite history. I accept that there were divisions in the Labour Party, but we have to consider why. There
In the 1980s, in Scotland, there was long-term continuing care for the elderly as part of the health service. The Conservative party decided that that was not the way to proceed, for some good and some bad reasons. The result was that people who had planned their old age were unable to meet the requirements, so they had to sell their homes and so on. That led to the Sutherland report. Some bits of history are crucial. I am not denying that we were divided on this issue, but the division was on whether the policy was sustainable in the long term. We cannot come up with policies that we will have for only a few years; policies have to be long term.
Labour's amendment states clearly that we feel that we need to enter into discussions to try to achieve short-term reversal of the attendance allowance policy, but not to regain the attendance allowance as it stands, which would be impossible. That is why it refers to the benefit commissioners. We are talking about a benefit that goes to individuals, but any money that we got back would have to come within the block grant, not to individuals, because that would be against the benefits rules. The UK Government is not going to unravel the benefits system for the sake of a very small number of Scots whose position has been altered by this Parliament's policy.
No, I need to make progress because I am almost halfway through my time.
There have been thoughtful contributions. I thought that Irene Oldfather's speech was the best I have heard in this Parliament for a long time. To use Jamie Stone's words, it really did go to "the core" of the issue.
The debate is about the dignity of the elderly, equity and fairness and the clarity of the policy—which the cabinet secretary failed to mention in her speech. A lot of people still think that free personal and nursing care means that if they go into a home, everything is free. We heard nothing from the cabinet secretary about clarity of expectations, to which the Sutherland report referred. She did not mention that aspect of the report, although she accepted the recommendation. We heard nothing from her about improving local accountability or about ensuring that the costs are monitored and reported accurately. I welcome the fact that the cabinet secretary accepts those recommendations, but she did not address them in her speech.
The Conservative amendment, to which Mary Scanlon and David McLetchie spoke so persuasively, makes it clear that the Parliament's message today is that charging for food preparation must cease now, not tomorrow when the Government has the chance. The Sutherland report has made clear what the situation is. I accept that there have been inequities in the policy. The charging to which the Conservative amendment refers is not the only inequity that has not been addressed until now. Having made the statement that the Government now accepts that the policy is clear on that, it should not expect individuals to sue the remaining councils, which they will have to do unless the Government sends a clear message. The whole question of equity is important.
Other members made helpful speeches. Helen Eadie's comments about waiting times were important, and I ask the Minister for Public Health to provide a clearer answer to that question when she sums up. Last week, after her statement, the Cabinet Secretary for Health and Wellbeing was asked what she meant when she said that those assessed to have critical and serious needs would be dealt with within six weeks. Surely everyone who is assessed should be dealt with. There must be equity in waiting times.
This was an opportunity to have a really good debate on all the issues that are raised in the Sutherland report, which we all accept. Some members attempted to have that debate but, apart from Angela Constance, those on the Government side simply reiterated the same points about the attendance allowance.
I urge the Parliament to agree to the Conservative amendment, which relates to food preparation, and to coalesce unanimously around Labour's amendment, which proposes that we enter into discussions with the UK Government to get this money back. After all, we all accept that that is appropriate. If we do not do that, the SNP will forgo the opportunity to send a clear, unanimous message from this Parliament on how these issues might be addressed.
Today's debate confirms that the free personal care policy continues to have strong support in the Parliament and that there is a shared desire to ensure that it operates effectively. People now receive for free the care that they would previously have had to pay for. That applies not only to people whose care is entirely arranged
The Scottish Government is committed to addressing the issues that Lord Sutherland's report highlights. As a result, we will meet the additional £40 million per year funding shortfall from 2009-10 that Lord Sutherland has identified, take forward specific action to improve local and national information systems at national and local levels to ensure greater transparency in future costs associated with the policy and—as the Cabinet Secretary for Health and Wellbeing stated in her opening remarks—renew our efforts to improve public information and understanding of the policy.
We will clarify the legislation and guidance on cross-boundary placements, work with COSLA to ensure an effective performance framework for long-term care services for older people within the single outcome agreement approach and introduce legislation to clarify once and for all the issue of food preparation.
We meet COSLA regularly. I have to say, though, that Margaret Curran has a brass neck coming to the chamber to demand funding for local authorities for this financial year when, year after year, the Administration of which she was a member did not give them even an inflation increase. I think that that shows a little bit of weakness. For the first time in all those years, local authorities have received an inflation increase—and we have given it to them.
We have agreed the need for a wider set of joint work streams to review demographic pressures and other practical issues that will have an impact on the current and future demand and cost of care. That work must start now, ahead of the next five-year review that has been recommended by Lord Sutherland and to which many members have referred.
As the cabinet secretary noted, a number of well-documented problems with the policy need to be fixed. Current difficulties of interpretation and variability have emphasised the need for more clarity and consistency in what people can expect. Lord Sutherland concludes that such difficulties have, to a degree, overshadowed the policy's success and continue to undermine its operation. Our job is to fix those problems and, with local government's assistance, we will do so.
I agree with Margaret Curran on one thing: the need, as Sutherland has recommended, to reassess all the funding streams. However, I must take issue with her on another: had she read the motion, she would have realised that its focus—and that of the debate—is the attendance allowance. Given her failure to deal with it when she was part of the previous Administration—let alone set up a review to address the issues that we are discussing today—she has no credibility on the funding issue she tried to raise.
Mary Scanlon seems to have a bit of a hang-up about "pursue vigorously". The phrase means what it says and it is what the people of Scotland would expect us to do on their behalf to retrieve the resources. To be helpful, I will quote the words of Malcolm Chisholm when he was the Deputy Minister for Health and Community Care:
"Let no one be in any doubt that we are pressing the case strongly for resource transfer."—[Official Report, 27 September 2001; c 2875.]
I do not see much difference between "pressing the case strongly" and "pursue vigorously". Far be it from me to ponder on words, but I suggest to the Tories that there is little difference between Malcolm Chisholm's approach in 2001 and the approach that we want their support for today.
Absolutely. It is only 10 per cent of total spending on elderly people, but we must put the right policies in place to ensure that we sustain them into the future. We will do that.
Ross Finnie made a considered speech. He hit the nail on the head when he pointed out that Labour is trying to hide behind the Wanless report, which explicitly rejects free personal care and well and truly exposes Labour's position. I will elaborate on that point in response to Richard Simpson's comments. Not only is Labour's position exposed on that ground, pages 9 and 20 of the UK Government's consultation on the reform of social care in England state that any changes to benefits
"that may emerge will not affect existing benefit recipients".
It explicitly rules out any effect on attendance allowance.
Irene Oldfather made a considered speech and I recognise her long-term interest in the issue. Entitlement is key and it is important that public understanding is assisted by simple and clear information, particularly for people with dementia and their carers. I totally accept the need for that and will take the matter forward, as I indicated to her at lunch time at the cross-party group on dementia.
I recognise that Michael Matheson draws on his experience in the care sector. He usefully reminded us of Lord Lipsey's minority report and the way that it followed through to the UK Government's political position over free personal care.
The Sutherland review found that, although the UK Government followed the letter of the current law,
"It is clearly contrary to equity that entitlement to AA has stopped for those in care homes in Scotland, while it continues for those residing in care homes elsewhere in the UK."
Attendance allowance is a UK state benefit for individuals throughout the UK. It is a contribution towards personal care costs and, as such, should cover those services for individuals in Scotland too. That money rightly belongs to Scotland and with the Parliament's support we will seek to recover it—not through any back-door pretendy words that hide behind an issue that has no bearing on the matter whatsoever, but through taking up an explicit, united position that we want those resources back for the elderly people of Scotland. If members do not support our motion, they will be exposed for their position.