Caring for Scotland’s Older People

– in the Scottish Parliament on 9th June 2011.

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Photo of Tricia Marwick Tricia Marwick None

Good morning. The first item of business is a debate on motion S4M-00234, in the name of Jackie Baillie, on caring for Scotland’s older people.

Photo of Jackie Baillie Jackie Baillie Labour

I welcome the opportunity to open this debate on caring for Scotland’s older people. I can think of nothing more important that deserves the Parliament’s urgent attention.

We often remark that a society is judged by how it treats its young people, older people and most vulnerable people. Given the events of the past few weeks, I am afraid that we have been found wanting in the case of caring for our older people. Although much of the debate will focus on the challenges that we face, we must not lose sight of the fact that there are some really good care homes and excellent care providers across Scotland. However, it is a matter of considerable regret that some are just not fit for purpose.

In the past fortnight we have witnessed shockingly poor standards of care at the Elsie Inglis nursing home, the case of the most appalling treatment of Mrs V at Ninewells hospital in Dundee and the potential that Southern Cross Healthcare will go into administration, which threatens continuity of care for 4,700 of its elderly residents. There has been one problem after another. It appears from my mailbag that those are not isolated incidents, and that concerns about standards of care are emerging in different parts of Scotland.

Elsie Inglis nursing home is but a stone’s throw from Parliament. The poor standards of care there have resulted in two residents dying and six being admitted to hospital. There have been distressing reports of residents sleeping on stained and ripped mattresses and being forced to eat food with their hands, and of open wounds and sores being evident. In 2010 alone, there were 20 separate recorded outbreaks of infection affecting 72 residents. Yet, just a year earlier, the Scottish Commission for the Regulation of Care inspected the home and gave it a good report. Relatives of old people studied those reports before securing places in the home for them, believing that it would provide their loved ones with a good standard of care. They have little confidence in those reports now.

How could something go wrong so quickly? What will happen in the future under the new risk-based approach to assessment? The care commission joined with the Social Work Inspection Agency on 1 April to create a new body: Social Care and Social Work Improvement Scotland—otherwise known as SCSWIS. It is not exactly the most user-friendly title, but I believe that it is right to bring together inspection and improvement in seeking to raise the standards of care across the sector and the country. What was not right was to start the new organisation off with an overall budget cut of almost 25 per cent and, by the end of this year, a staff reduction of just under 20 per cent—that is a recipe for trouble.

Let us remember that the new care inspectorate is not responsible for inspection only of care homes for older people, but that it also inspects a range of children’s services and other adult services. So, the new organisation is starting out with a huge range of responsibilities but fewer resources to deal with them effectively. We have moved to a position in which the new care inspectorate will base its inspection regime on a system of online self-assessments, with targeted unannounced inspections of a smaller number of care homes. There is to be a greater maximum period between inspections for better-performing services and more focus on poorly performing services. We are therefore moving from a position in which there were twice-yearly inspections to much less frequent inspections in cases of good-performing homes.

Although that may, on the face of it, seem to be entirely reasonable, it is less than clear what would trigger more attention from the inspectorate. How is risk determined? I would hate to think that there could be a scenario in which people who are skilled at filling in self-assessment forms could escape inspection for longer periods but may not operate to the standards of care that we would deem acceptable.

Might I offer a little observation on self-assessment more generally? It was a system of self-assessment that was in place for health boards to report on their activities in relation to hospital-acquired infections and it was a system of self-assessment that underpinned infection control in NHS Greater Glasgow and Clyde and which operated in the Vale of Leven hospital, which witnessed the worst outbreak of Clostridium difficile in the United Kingdom, so members will forgive me if I am slightly cautious about self-assessment systems.

I will go back to the care centres and take the Elsie Inglis care home as an example. It had a good report; there were no problems a year ago. The first intervention of the inspectorate appeared to be in April, but I know from relatives who have e-mailed me that there were concerns in October last year. Was the care commission aware of that? Could it have acted sooner? Would the new risk-based assessment approach have helped or hindered the process? If problems were identified more than six months ago, it is unforgivable that action to close the home was taken only in the past fortnight.

If we are serious about inspecting and improving standards of care, we need to ensure that the new inspectorate has the resources to do so. It cannot start life with one hand already tied behind its back. I welcome the cabinet secretary’s personal commitment to making care of the elderly a priority. I had hoped that that would have been the case during the past four years of the Parliament, but I welcome the renewed focus. However, I would be grateful if she would outline what that “personal commitment” will mean. What differences will be made to policy? What resources will be in place? How can the cabinet secretary ensure that the standards of care remain the highest possible? I respectfully suggest that a welcome sign of her intent would be to reverse the budget cut to the new care inspectorate, but from her amendment I see that she is unlikely to do so, and that is truly disappointing.

In the context of the recent news about Southern Cross care homes, will the cabinet secretary consider giving the care inspectorate responsibility for addressing the financial viability of care providers as a condition of continued registration? The situation at Southern Cross is serious. The possibility of the company going into administration has been known for some months now. With 98 care homes and 4,700 residents, Southern Cross is the largest private care provider in Scotland. There were more than 3,000 staff in Scotland, but after yesterday’s announcement of job losses, there will be 400 fewer, which will have a direct impact on the quality of care. Frankly, Southern Cross is putting its shareholders’ interests before the care needs of its elderly residents. That is shocking and should be condemned by all parties in the chamber. It is becoming increasingly likely that Southern Cross will go into administration and our paramount consideration should be the continuity of care for the elderly residents.

The scale of that challenge is such that it cannot be left to 32 individual local authorities; it must be for the Scottish Government to develop the contingency plan. I know that some local authorities have done little in the way of contingency planning, while others openly acknowledge that they will be unable to cope with relocating all the elderly residents because they lack local capacity. Others have said that they will need to use hospital beds, which will take our policy on care for the elderly back decades.

Local authorities also point out that they have powers to take over the running of care homes in emergencies, although few can afford to do so. That might not be required for every Southern Cross care home, but it might apply to a few where there is no local capacity. In those cases, will the Scottish Government make emergency resources available, should that be necessary in the short term?

Last week, the First Minister said that the cabinet secretary was in “daily” contact about Southern Cross, but we have discovered that, by that point, only two meetings had taken place: one in March and one in April, and those were with Scottish Government officials. That information came from a written answer to my colleague Neil Findlay on 2 June, which was the very same day that the First Minister said that contact was “daily”. There is a real need for urgency in the Scottish Government’s approach. Sitting on the sidelines waiting to see what will happen is not the proactive approach that I expect the Government to take in ensuring that our older people are protected and cared for.

I will comment briefly on the case of Mrs V at Ninewells hospital. She suffered from dementia and died in hospital at the age of 80. The indignity of her treatment was quite extraordinary. Mrs V was not given any food orally and when she became distressed at that, the response was to medicate her. In the space of 16 days, she was administered with 95 separate doses of sedative. Her care and treatment were described by the Mental Welfare Commission for Scotland as

“degrading, unnecessary, and may have breached her human rights”.

I welcome the new dementia care standards, but we must ensure that those standards are the norm across every health board and in every hospital and care home, so that what happened to Mrs V does not happen to any other older person.

For me, what all those cases have exposed is that older people and their relatives feel quite powerless and confused in navigating our care systems. They place their loved ones in homes after following all the advice, reading all the inspection reports and even visiting the homes themselves, but that still does not offer comfort. They complain but feel that nothing is done and are not convinced that lessons are learned more widely across the system. They need someone who is very much on their side—someone who is independent of Government and who can look across care and hospital services and give voice to the wider concerns of older people more generally. In short, they need an older people’s champion. By working with all levels of government, voluntary organisations such as Age Scotland and older people themselves, such a person could help to drive fundamental change. I hope that the Government will give that proposal serious consideration, and I will be happy to discuss it further with the cabinet secretary.

I turn to prevention and resources. In many areas of Scotland, local authorities are struggling. For the first time, they are making cuts to care services and introducing charges, which is resulting in some older people cancelling services such as community alarms. Different approaches to charging are being adopted by neighbouring local authorities—a service that costs £30 in one area can cost £300 in the area next door. I first raised that issue two years ago, but those differences still exist.

The national eligibility framework for determining who should receive care sets out priorities. Understandably, those who are in the most acute and critical need are top of the list, but there are swathes of people with lower-level needs who will not be provided with a service because budgets are just too tight. I hope that the Government will ensure that local authorities collect data so that we can capture and identify the scale of the unmet need. That approach flies in the face of everything that we in this Parliament and the Government have said about prevention. We all know that prevention is the real prize. Even though prevention is cost effective, and it is much better for the individual to be sustained in their community without the need for more formal care, cuts are being made to some community-based services that do not cost a lot of money, and which have the potential to save in the long term. It is a matter of regret that prevention on the basis of what is happening on the ground remains an aspiration rather than a reality.

Many of the organisations that are involved in the provision of care at local level are leading the way in preventative work, but they are being squeezed, too. The terms and conditions of staff who work in the voluntary sector are being substantially diminished. Some care staff are being asked to take a wage cut from £17,000 a year to £13,000 a year, while others are being asked to work on zero-hours contracts—they are being asked to do more, but they are being paid less. Worryingly, there is evidence of the emergence of cuts to training budgets, with the result that care staff are being forced to do their own training in their own time and to fund it themselves. It is inevitable that that will have an impact on the quality of the care service that is provided, so there is an urgent need for us to look again at procurement policies and to put in place minimum standards that seek to protect the quality of care.

I turn to the challenge ahead. Before the debate is over, we will all have swapped figures to illustrate the scale of the demographic change that we face. Whether we cite the statistic that there will be 75 per cent more 75-year-olds in about 15 years or the one that the number of people over 60 will rise to 50 per cent of the population by 2033, what is clear is that the status quo is not an option. Scotland’s population is getting older and we are living longer.

However, not all of our older people need care. About 90 per cent of them are sustained in their own homes and communities with very limited input from care services, so we should think about older people not in the context of their care but in the context of what they offer our communities: experience, time and knowledge. Many of them are the volunteers who make our communities strong, but they need to know that should the time come when they need care, it will be there for them.

Labour believes that we will cope with that demographic change only by integrating health and social care and by having a local service with local accountability that is based on reformed community health partnerships and involves general practitioners, but which has one clear priority, which is to focus on the care of older people. The issue is not about structural change; it is about a better vision for the care of our older people, and I am happy to co-operate with the Government on that.

I move,

That the Parliament welcomes the Scottish Government’s new focus on the care for older people; further welcomes the commitment given by the First Minister that vulnerable residents in Southern Cross homes will not be compromised as a result of Southern Cross’s business model; notes with concern the report by the Mental Welfare Commission regarding the appalling treatment of Mrs V at Ninewells Hospital and the recent disturbing events at the Elsie Inglis Nursing Home in Edinburgh where standards of care were totally inadequate; further notes that one in 10 of the city’s care homes have been criticised and deemed weak or unsatisfactory in at least one area of assessment in the past year; believes that the 25% cut to the budget of Social Care and Social Work Improvement Scotland (SCSWIS), charged with the inspection and improvement of care standards, should be reversed; agrees that radical reform of community health partnerships is urgently required following the serious failings identified in a recent Audit Scotland report; recognises that funding prevention work will delay services for older people requiring formal care; believes that the care and safety of Scotland’s older and vulnerable people must be a major priority for the Scottish Government, and therefore calls on it to come forward urgently with plans to integrate health and social care so that Scotland’s older people and their families can have full confidence that they will receive the best possible standard of care when they need it.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

I begin by doing what I failed to do yesterday when I spoke, which was to welcome Michael Matheson to his new role and to say how much I am looking forward to working with him.

I really welcome this morning’s debate on caring for Scotland’s older people—an issue that has been so prominent in the media of late. The issues that we will discuss today are of huge concern to older people and their families, so I welcome the opportunity to address some of those concerns and to exchange ideas on how we provide the quality compassionate care that our older people deserve, in a way that protects their dignity and independence and meets what I consider—I am sure that we all consider—to be our sacred duty as a civilised society. The issue is so important. Although scrutiny is absolutely vital, and notwithstanding the tone of the opening speech, I hope that we can all strive to keep party politics to one side and to work together to focus on the solutions that we need to find.

I largely accept the sentiments in the Labour motion. I lodged an amendment that I hope will be accepted because it attempts to reflect what I believe is the broad consensus around the need to improve care for older people and to provide a system that works in all cases.

Let me set out my stall clearly: I consider improving care for older people to be a personal priority. The responsibility for older people’s services now lies directly with me as health secretary, and that includes ministerial oversight of the inspection agency. Jackie Baillie asked legitimately: what is the substance of that personal commitment? I simply point out that the last time I said that about a specific issue was in the wake of the Vale of Leven hospital situation. In the period since, we have seen a 70 per cent reduction in Clostridium difficile cases. In caring for older people, we need that same focus on working with those on the front line.

Several issues about how we care for our most vulnerable people have hit the headlines recently. They are not connected, but they have added up to give the impression that all is not well in our care system. On the whole, we provide care generally well, but doing it generally well is not good enough. We must do well by every older person on every occasion in every setting.

It will come as no surprise to members that the first issue that I want to address this morning is the Southern Cross situation. As members are aware, Southern Cross has more than 90 homes in Scotland, housing between them more than 4,000 people. Clearly, the financial situation of a company such as Southern Cross is not within the control of Government. However, as members would expect, we are monitoring the situation closely with regular dialogue between my officials, the company and the Department of Health in England.

Although the finances of Southern Cross may not be the direct responsibility of Government, I make it clear that what is undoubtedly the responsibility of both national and local government is to ensure the quality and continuity of care for any affected older person. I realise that concerns about both of those aspects of care, as well as staff concerns about job security, will have been intensified by yesterday’s restructuring announcement by the company.

On Tuesday, I met the regional director of Southern Cross in Scotland to be updated on the latest situation and the attempts that the company will make over the summer to stabilise the situation. I sought his personal assurance that care quality in Southern Cross homes will not suffer as a result of the difficulties that the company faces. That assurance was forthcoming, but make no mistake—we expect it to be honoured.

Yesterday, I met the Convention of Scottish Local Authorities to discuss the contingency planning that is being undertaken by local authorities and to stress, as Jackie Baillie was right to point out, the partnership approach to the situation that we are determined to take. I agreed with COSLA that we would formalise the national contingency planning group for adult care services. It will now report directly to me and to Councillor Douglas Yates, COSLA’s health and wellbeing spokesperson. The job of national and central Government, working together, is to ensure that whatever the final outcome for Southern Cross—which none of us can know at this time—we have plans in place to ensure the appropriate quality on-going care for all its residents.

I will keep members updated.

Photo of Murdo Fraser Murdo Fraser Conservative

I am very grateful to Nicola Sturgeon for giving way. One of the major concerns for residents is the future of the homes. Has the cabinet secretary had any discussions with other independent providers that might be interested in taking over the running of Southern Cross homes, should that company go into administration?

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

A variety of discussions of that nature are taking place, as the member would expect. I am sure that landlords of the homes will be having discussions with a range of different people. The clear preference is to ensure, in whatever way, continuity of care in the homes that older people are in. That presumption underpins all the contingency planning that is being done.

Photo of Michael McMahon Michael McMahon Labour

I welcome the fact that the cabinet secretary has spoken directly to COSLA and that discussions are continuing. Have the cabinet secretary’s officials been talking to the 32 individual local authorities, too, or are all the discussions being held directly with COSLA? Are officials relying on COSLA to pass the information to the local authorities?

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

The Government has a direct interest not only in ensuring that plans are in place overall but in ensuring that arrangements are in place authority by authority and, if necessary, care home by care home. The arrangements that we formalised yesterday will allow all the 32 local authorities to feed into the national contingency planning arrangements, which are reported directly to me and to Councillor Yates.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

I will take one more intervention on Southern Cross, but I have to make progress.

Photo of Neil Findlay Neil Findlay Labour

Thank you. West Lothian Council advises me that its contingency plans include seeking placements for residents with other local authorities, suspending respite places, moving placements from care homes to housing with care, ceasing hospital discharge purchases, and using hospital beds for care home patients. The chief executive has advised me that those actions would not achieve the number of places that will be required. What other options are being looked at?

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

I have already said, in response to an earlier intervention, that the presumption that underpins our contingency arrangements is that older people will not be moved. Clearly, a range of contingency arrangements has to be put in place. I have seen an e-mail that I believe the leader of West Lothian Council sent to Jackie Baillie, which makes it clear that when the e-mail to which Neil Findlay referred is taken in its full context, it shows that the council regards the options that he has just outlined as not being the desirable options. It is important to put that on record.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

I have a lot of material to get through, but if the Presiding Officer will bear with me, I will take an intervention.

Photo of Jackie Baillie Jackie Baillie Labour

It is really just to correct what the cabinet secretary said. For the record, I have received no such e-mail.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

I have a copy of it here, so I am sure that Jackie Baillie will take it up with the leader of West Lothian Council. I am holding a copy of an e-mail to Ms Baillie.

I want to end this part of my speech by saying that I will keep members fully updated. I have agreed to meet the Opposition spokespeople this afternoon to brief them in more detail. I know that this is an issue of concern and that members will want to ensure that they get full details of it as developments take their course.

I hope that the Presiding Officer will give me a wee bit of latitude, because I have a number of other issues to get through.

I turn to the Elsie Inglis care home. I cannot comment on all the specifics, given the on-going police investigation. However, we expect the highest standards of care from all who provide it in Scotland. The national care standards set out clearly the responsibilities for those who provide care. It is their duty to deliver those standards. We have a robust and a risk-based system of inspection, which was enshrined in the Public Services Reform (Scotland) Act 2010 and was supported in the previous session of Parliament. Its job is to ensure that where failures occur they are identified and rectified and, where necessary—if it is in the interests of vulnerable people—services cease to operate. Indeed, Elsie Inglis care home has ceased to operate.

Jackie Baillie mentioned budgets. In the interests of accuracy, I point out that SCSWIS did not start with a 25 per cent budget cut; that is a budget reduction over a number of years to reflect the fact that SCSWIS is three organisations merged into one. I give members the clear assurance that we will do whatever is necessary to ensure the highest standards of care in our care homes.

I will briefly address the Mental Welfare Commission for Scotland’s report into the care of Mrs V. The report is not generally representative of care in our hospitals, but we know that hospitals are a setting in which care for dementia patients must improve. That is why they are one of the two key areas that are mentioned in the national dementia strategy. The standards that were published on Monday seek to improve standards of dementia care in all settings, but I have specifically asked the chief nursing officer to oversee their implementation in hospital settings and I have asked Healthcare Improvement Scotland to carry out a programme of inspections to ensure that our hospitals are living up to the clinical standards for older people in acute care, which were first published in 2002. All our older people, whether or not they have dementia, have a right to expect the highest standards of care and compassion from the NHS.

The Presiding Officer is beginning to look threateningly at me, so I will end with reference to the future and the agenda of integration. We need to provide better and more consistent services with better outcomes over the next few years for more people using resources that will be under pressure for some time. The report that Audit Scotland published last week made it clear that a voluntary approach to integration has not delivered fast or far enough. We must find a way of releasing and reinvesting the £1.4 billion that we currently spend on unplanned admissions, and we need to accelerate progress in shifting the balance of care. We established the change fund to begin that process, but we must go further. I am glad that there is political consensus on the need for integration. I accept the differences around how we should do that, which is why we are examining a range of options, and I intend to seek to build maximum consensus around the issue in the coming months.

I look forward to hearing the exchange of views and ideas in the debate. I want to leave the chamber in no doubt at all that this area of policy and practice is of the highest priority for me and for the Government.

I move amendment S4M-00234.3, to leave out from “further notes” to end and insert:

“considers that these cases demonstrate the need for a robust system of regulation and inspection that provides protection for older people irrespective of where they receive their care and treatment and that listens to the views of people who use services and their carers; believes that the care and safety of Scotland’s older and vulnerable people must be a major priority for the Scottish Government, and welcomes the fact that there is a consensus across the Parliament to improve the integration of health and social care so that Scotland’s older people and their families can have full confidence that they will receive the best possible standard of care when they need it.”

Photo of Mary Scanlon Mary Scanlon Conservative

I thank the Labour Party for using its time to debate this topic and I commend Jackie Baillie for her well-considered and measured speech.

An estimated £4.5 billion—14 per cent of the Scottish budget—is currently spent every year on care for older people. With a projected increase of 84 per cent in the number of people aged over 75 in the period to 2033, that figure is likely almost to double. We therefore need to plan services and support for older people in a much more co-ordinated and proactive way than the current system, which tends more towards crisis management. As Jim Eadie said in his maiden speech yesterday, the starting point must be the £1.4 billion—a third of that budget—that is spent on emergency admissions to acute hospitals at an average cost of £3,349 per week.

The 943 care homes in Scotland provide more than 39,000 places, but there can regularly be up to 5,000 empty places in them. Each place costs around £500 a week to the public purse, which is £2,800 cheaper than an acute bed. Given the fact that those care homes are able to provide the appropriate care, tailored to the person’s needs following hospital treatment, surely that resource could be more fully utilised to benefit patients and taxpayers. In talking about care homes and SCSWIS, we should remember that there are good and bad providers in both the private and public sectors. The old days of “public good, private bad” are long gone—one has only to read the care commission’s reports to see that. I hope that the fact that 85 per cent of care homes are in the independent and voluntary sectors will not present an ideological barrier to placing elderly people in high-quality appropriate care. For years, we have heard that elderly people become more dependent and less mobile the longer they stay in hospital and, as we all know, they often fall into the delayed-discharge category.

Care homes could also provide more day care, respite care and home care. They have the knowledge and the management skills as well as the facilities to do so. Now that the cabinet secretary has personally taken charge of elderly care—which I welcome—I ask her to investigate the fees that are paid by councils for placing people in council homes, which can be up to 80 per cent more than the fees that are paid in the voluntary and independent sectors, despite the fact that all care homes must meet the same quality standards that have been set by the care commission.

Although we can criticise care homes and care at home, many elderly people are cared for in our NHS. I found it very worrying—I found it very upsetting, actually—to read “Starved of care”, the Mental Welfare Commission’s investigation into the care and treatment of Mrs V at Ninewells hospital in Dundee. It begs the question of who inspects and monitors care and treatment in our hospitals. Yesterday, Joe FitzPatrick seemed to think that because we have a dementia strategy everything is going to be all right. Surely we do not need strategies, actions plans and legislation to get nurses to feed patients. That is all that the woman needed.

It is also alarming that the case was only brought to the attention of the Mental Welfare Commission two months after the death of Mrs V, by an independent doctor who was a psychiatrist. That doctor thought that the Mental Welfare Commission had received information about his concerns, yet following the tribunal hearing it had no record of any contact. It was only when the independent doctor took action to send his report to the Mental Welfare Commission in March 2009—to register his concern that Mrs V had experienced distress and agitation as a result of being prevented from eating—that the investigation took place. The response to her agitation and distress at being starved was, instead of giving her nutrition, to give her sedation. This is our national health service. If this lady could be so badly treated and the case could come to light only due to one independent doctor’s diligence and conscience, how many more elderly people are starved of care and nutrition in our national health service? How do we all know that our parents—indeed, ourselves, one day—will be cared for, fed and treated with respect and dignity not only in the care home sector, but in our national health service?

One of the main problems for older people is loneliness, with families being dispersed and older people being unable to go out alone. That is why I cannot understand why when councils—in particular, Highland Council—look for cuts, the first place they go to is day centres, which are a lifeline for many people.

Regarding the motion and amendments, we will support the Government’s amendment, but we will not support Labour’s motion. We all supported the merger of the Social Work Inspection Agency and the care commission under the Public Services Reform (Scotland) Act 2010 because we knew that there would be efficiency savings. I do not know whether the 25 per cent is a reduction in duplication, and that is why we will not support Labour’s motion.

I move amendment S4M-00234.1, to leave out from first “believes” to end and insert:

“notes the criticisms of the community health partnerships identified in the Audit Scotland report, and calls on the Scottish Government to bring forward a comprehensive strategy to support older people that will include plans for the integration of health and social care and proposals for better utilisation of existing care home capacity in the independent sector.”

The Presiding Officer:

We move to the open debate. I remind members that they have six minutes in which to speak. We have a wee bit of time in hand, so if you take interventions we will allow you a wee bit more time beyond your six minutes.

Photo of Claire Baker Claire Baker Labour

Today’s debate addresses a significant issue that is facing the new Scottish Government. Scotland has an ageing population. People are living longer but not necessarily more healthily, and they often have increasingly complex needs in later life. The elderly population of the 21st century is much more diverse in terms of income, mobility and health than those in previous generations, so our response needs to be more sophisticated. We must face up to the realities of a changing Scotland, and the services that we provide, whether through public, private or third sector delivery, must reflect a caring and mature society.

I will concentrate on a few issues from my personal experience and my experience as an MSP for Mid Scotland and Fife. Relatives who take on the role of caring for an older person are often lauded by politicians. It is a huge task. I know that from my family’s own experience when my grandfather moved into my parents’ home. That is the way in which we all used to look after our elderly. I was at university at the time and I was not particularly aware of, or appreciative of, the commitment that was given by my parents. It can be very hard work and it is not the answer for everyone, but if families are in a position to provide that level of care, they must be properly supported through the benefits and social care system. I am sure that we will reflect more on that area during the forthcoming carers week.

While caring for an elderly parent or spouse at home, relatives aim to make that person’s life more comfortable and familiar and to retain them in a home environment. When a family pass complete care to another provider, they look for a level of care for their loved one that meets those hopes. We know from recent shocking incidents that the system can—tragically—fail a family’s trust. Of course, many care homes have good assessments. We are right to rely on such measures as an indicator of quality but, even with them, it is often the intangible and difficult-to-measure human qualities that provide families with confidence in a care setting.

That is relevant to the care home situation in Fife and the campaign that families of care home residents there are running. Fife Council has decided to close all the local authority-run care homes and replace them with private provision. I have had meetings with care home residents’ relatives, who believe that their loved ones receive a high quality of care in local authority homes and that such care is better than that in the private sector.

Fife Council is undoubtedly making an unpopular decision—more than 70 per cent of respondents to a consultation that was held in November did not agree with it. The care commission has reported that the current buildings need improvement—en suite bathrooms are the major issue—but residents’ relatives overwhelmingly argue that such facilities are not what makes a good care home; it is the level of care and the dedication of staff that make a good care home.

Local authority care home staff feel so strongly about the decision that they are prepared to consider their terms and conditions and to change working practices to save resources. Eroding staff terms and conditions is not the best way forward in improving elderly care, but we could be looking at a staff-led, co-operative model of care that provides an alternative solution not just in Fife but across the country, where other authorities face similar challenges.

As the Scottish Government will increasingly discover, it is difficult to always make popular decisions and we should not expect decision makers to always be popular. Sometimes, they must make the case for a difficult decision and build a consensus. Of course Fife Council faces a challenge—how do we ensure that older people live in high-quality accommodation that fully meets their needs and where they are properly cared for? However, the council’s proposed solution—a wholesale move to the private sector—is increasingly being questioned.

The care home sector benefits from mixed provision. Public sector provision has considerable merits, but—realistically—we could not deliver a service without a contribution from the private sector. The private sector has good-quality care homes and some excellent care homes, although we as a Parliament are highlighting today serious concerns about what happens when the system fails, regardless of the sector. We can add to that mix the growing number of third sector or partnership-led homes. For example, Abbeyfield runs a co-operative model in Kirkcaldy, and many charities are involved in care delivery, although—as Mary Scanlon highlighted—the economics of the sector can make it difficult for them to survive. Mixed provision helps to raise standards in care homes not just for residents but for staff.

Care home staff are often undervalued and underpaid. We should aim to raise the value of care staff, whether those they look after are young or old. Access to training and skills supports a more motivated and professional workforce and, overall, the public sector has a better record on that than the private sector does.

Southern Cross’s current financial difficulties should cause a rethink of Fife Council’s decision. Unison suggests that other major companies also face financial problems. The difference between the home care fees that local authorities pay the private sector and those that they pay the public sector has long been a social care financing issue that has been raised with MSPs, but it is dwarfed by the problem that we face of large social care companies that are run for shareholders’ profits and now face financial collapse. Many are concerned that this is the tip of the iceberg.

Last week, the First Minister said:

“Given the difficulties that arise when a private company is on the brink of administration and given the position in which that leaves vulnerable people in social care or the health service, the current situation should be a cautionary note for those who seem to think that private intervention is a solution in the health service or in the social care service.”—[Official Report, 2 June 2011; c 299.]

We are all concerned about the future security of healthcare. The cabinet secretary must continue dialogue with Southern Cross and be alert to concerns about other companies.

In the current environment, Fife Council should hear that cautionary note and reconsider its decision. There are alternatives—Abbeyfield in Kirkcaldy should be proof of that—and the council should commit to exploring them. The Scottish Government could take a lead in exploring and promoting alternative models to maintain mixed provision if local authorities step away from direct delivery. It should not take crises—whether financial or in social care delivery—to force an examination of the sector, but we must all be confident that the care models that operate in Scotland can meet our future needs and reflect our society’s values.

Photo of Fiona McLeod Fiona McLeod Scottish National Party

As a returning MSP, I have to say that it is a great privilege to make my first speech in what, to me, is a new Parliament. It is also an honour and a responsibility to do so as constituency member for my home area of Strathkelvin and Bearsden. In keeping with previous speeches, I wish my predecessor, David Whitton, well in his life outside Parliament.

First of all, I must declare an interest: for many years now, I have been the carer for my elderly and infirm mother, and I was an employee of Carers Link East Dunbartonshire. In those capacities, I want to thank the cabinet secretary for her personal commitment to the future planning for care of the elderly in Scotland.

Members have talked about demographics and mentioned various figures. The issue is particularly important in Strathkelvin and Bearsden and, indeed, across East Dunbartonshire, which has the fastest growing elderly population in Scotland. From a base in 2001, by 2016 the number of over-65s will have increased by 22 per cent and the number of over-85s will have increased by an astonishing 101 per cent. Although that is testament to the health, vigour and vitality of many of my older neighbours, for every one person like my father-in-law, who will be 99 in three weeks’ time and still goes swimming twice a week, there are five older people like my mum, who need help with long-term chronic conditions.

I am delighted to hear the cross-party support for the emphasis on care in the community. It is what our older folk want and, as a health librarian, I know that the evidence says that it is the best approach. However, as a carer and having worked for Carers Link, I must stress the amount of planning and thought that needs to go into all of this. At the moment, the theory is great but the practice is not always ideal, and the crux to ensuring that practice becomes as good as the theory is the integration of social and health services.

For example, we have been talking a lot about nutrition. People who live at home can have their dinner made for them, but that means that someone will visit them for 15 minutes, stick a meal in the microwave and leave them to eat it and clean up. That is simply not good enough if we are talking about supporting older folk and ensuring community spirit; indeed, all it is good for is ensuring huge profits for Marks and Spencer, as that is where we go to buy microwaveable food for our older people.

There are also what are known as tuck calls, when someone comes any time from half past 6 to half past 10 at night to put people to bed.

Photo of Neil Findlay Neil Findlay Labour

Perhaps the people in Strathkelvin and Bearsden buy food for their older people in M and S, but where I come from many certainly do not.

Photo of Fiona McLeod Fiona McLeod Scottish National Party

I apologise—I was probably being a bit flippant. All I was trying to say was that older people in such situations tend to eat something in a plastic microwaveable pack, not good home-cooked meals.

The reality is that we will have to give this matter a lot more care and attention. After all, we want our older folk to be independent. As a Labour member has already pointed out, independence must mean that they are supported in their care, not left isolated in their own homes.

Some of the current problems with care in the community are leading many service users to move in the direction of direct payments, so that they can get their needs assessed and buy in what they need. However, the approach has huge limitations. Many of those who are looking for direct payments need support in completing the process and actually getting a personal assistant. We need to spend a lot of time looking at that area. One quite technical issue that I have come across and which I will take up later with ministers is the way in which the Protection of Vulnerable Groups (Scotland) Act 2007 works with regard to personal assistants.

One in eight of us in Scotland is a carer, and we save the Government approximately £6 billion per annum. I very much want us to be seen as true partners in the care of the elderly people whom we look after when the integration of social and health care is being looked at. Please involve us in the planning and listen to those of us who support folk.

If I may talk about another place, I note that while carers are saving Scotland £6 billion per annum, the Westminster Government is giving people £59 a week for a 35-hour week in a caring role. That has to be considered at Westminster.

Last week, I raised an issue with the minister for housing, whose reply I am delighted with. A long-term strategy will be considered to ensure that we have housing that is fit for elderly folk to stay in. Adapting someone’s current home is often not the safe answer to ensuring that they can remain at home.

On benefits and Westminster, finances are a big thing for old folk who live in their own home. The winter fuel allowance is welcome, but we have to make the point to Westminster that although everyone gets the same winter fuel allowance, it costs 20 per cent more to heat a house in Glasgow or Strathkelvin and Bearsden than it costs to heat a house on the south coast of England.

When I was outside Parliament, I was pleased to be part of the getting it right for every child programme. Perhaps we now need to look at getting it right for every older person in Scotland.

We have talked about dignity and choice. It is true that our older people need dignity and choice in life. I remind members that they also need dignity and choice at the end of life.

Photo of Elaine Smith Elaine Smith Labour

I call John Finnie, to be followed by Alex Johnstone. John Finnie is making his first speech in the chamber.

Photo of John Finnie John Finnie Scottish National Party

Care of our older people has always been a priority, and older people were the major beneficiaries of the achievements of the previous Government, which delivered the lowest-ever waiting times, a fall in hospital infections and more nurses than ever.

Of course, there are aspects of caring for Scotland’s older people over which, in the meantime, we have no control. The full implications of the United Kingdom coalition's benefits changes may not yet be clear, but our older folk will not escape the attack on the vulnerable, and they will not, of course, be spared the fuel poverty that continues to blight communities in our energy-rich nation while the energy companies make obscene profits. Scottish Power’s 19 per cent price rise is a case in point.

I am proud to represent the Highlands and Islands and am very aware of the challenges that its geography poses for the delivery of public services, not least health and social care services. The First Minister’s assurance of continuity of care for Southern Cross residents has been welcomed in the Highlands, where the company has four homes and the local authority is a key customer. Last year, one of Southern Cross’s Highland homes was completely destroyed by fire—thankfully, the 59 residents were unharmed. That home is not to be rebuilt, which perhaps reflects the flawed business model. It was, of course, Highland Council that arranged continuity of care for the residents after the fire.

It has been said many times in the debate—and I have no doubt that it will be said again—that a society is judged by how it treats its older people. I welcome the increased scrutiny that is being placed on those who provide care, not least the unannounced inspections of care homes and the valuable unofficial monitoring role that is undertaken by the various friends-of groups and, in my area, the excellent Highland Senior Citizens Network.

Scotland has an ageing population, and we have a statutory requirement and, more important, a moral obligation to provide high-quality, publicly funded health and social care for them. There is no doubt that that will prove challenging in the face of unprecedented cuts from London. The largest portion of the NHS’s £3 billion-plus spend on older people is on emergency admissions, which no one wants. That compares with 7 per cent of the older people’s budget that is directed to care at home, which everyone wants.

Care at home and care homes are part of our so-called mixed economy, but I am uncomfortable about profit being associated with care and would welcome greater public sector provision in both areas. I hope that local authorities’ risk registers recognise that, unlike the reassuring words of our First Minister, the market gives no guarantee of continuity of care for residents whom authorities place in private care homes.

That mixed care economy works only where there is volume, of course. There was no shortage of bidders for Highland’s care at home contract for the 20-minute home visits in the towns and villages around the Moray Firth, but it is, of course, the council that continues to deal with the person with complex needs who lives miles up a glen that is accessed by a single-track road. Any public sector comparator for future work looks ridiculously expensive when compared with the apparently efficient private sector folk. I regret that care of our older folk is dealt with like grass-cutting or information technology contracts. Let no one be in any doubt that those companies’ primary statutory obligation is to maximise profit for their shareholders.

The statutory obligation in relation to care rests with the local authority. Although those who become dissatisfied with the level of profit—invariably, they are the same folk who seek light-touch regulation—might come and go, the public sector must and will be there to care. In some of our remote communities, there are examples of not-for-profit models of community care working and delivering the quality care at home that reduces emergency admissions. If somebody has to be taken into hospital, any discharge is accelerated by virtue of the additional support at home.

Welcome, too, are the telehealth advances, which respect people’s privacy and reduce the need for human interventions. However, although the technology has its place, social contact is vital for our older people. Lunch clubs and social groups, which are often run by volunteers, must continue to enjoy public funding. Their benefits are significant and their closure is devastating to users and to their friends and families. The social mobility that concessionary travel has given our older folk is another positive example of support.

There is no disputing that we must work to move moneys from dealing with unnecessary emergency admissions to providing quality care at home, in houses that are suitable for our older people. There are good examples of that across the Highlands and Islands where, thanks to funding from the previous Government, the first council houses in a generation have been built, with more to follow. I commend the work that Highland Council and NHS Highland have done on the lead commissioning model and the support that the Government has given that project. However, it is vital that any such major change enjoys the support of staff and their unions. It is fair to report that there might be some way to go with that yet.

Reassurance is key to caring. The Government cares dearly about the NHS. If the public sector focuses on agreed outcomes, any perceived barriers to integrating social care and healthcare will be avoided. I believe that the results that we should focus on will not be found in the share listing of those who are engaged in profiting from care; instead, they will be found in ensuring that person-centred, safe and efficient care is delivered to our older people, regardless of their location.

Photo of Alex Johnstone Alex Johnstone Conservative

I congratulate John Finnie on his maiden speech and I welcome the fact that he raised a number of constructive issues that we will need to deal with in the debate and in the five years of this session of Parliament.

I welcome back to the Parliament Fiona McLeod, who made her first speech since she was a member in the first session. She will remember that she and I were members of the Parliament that approved the principle of free personal care for the elderly, which has been a defining feature of the way in which the Parliament has dealt with the care of elderly people in the intervening time. However, I must point out that, on the day on which we finally approved that policy, my colleague Mary Scanlon made it clear that, although we in the Conservatives fully supported the ideas that lay behind free personal care, we believed that the Government of the day had vastly underestimated the costs. The terms of today’s debate indicate that Mary Scanlon was exactly right that the costs had been underestimated and that the long-term consequences would come home.

Photo of Jackie Baillie Jackie Baillie Labour

Does the member acknowledge that the overall spending on social care, particularly for older people, runs to billions of pounds and that free personal care is but a small part of that?

Photo of Alex Johnstone Alex Johnstone Conservative

Indeed, but I believe that it is indicative of the problem that our commitment to such things will always be more expensive than we hoped it would be.

I want to talk about funding and how we deal with the current crisis. Many members will want to blame somebody for the fact that there is less money around than there was before or might otherwise have been had the situation been different. The fact is that we have a large number of people who rely on funding in their later years and who will potentially suffer because there is less money around. That is why anyone who makes a special plea for a particular budget increase in an area must accept that equivalent budget cuts might be necessary to achieve it. I am the first to argue that we need to follow the approach that the Government appears to be taking of finding efficiency in systems to ensure that cuts, where they are made, are small and evenly balanced and do not ultimately target individual groups or, for that matter, individuals, who might suffer as a result.

That is why I will always argue for the idea that we need competition in the provision of care for the elderly and that we need to incorporate the idea as a key element of how we achieve not only good value for money in public expenditure but good-quality care across the board for the maximum number of people who require it.

It worries me to hear so many members’ maiden speeches—I return perhaps to John Finnie—in which they seem to say that they believe fundamentally that the public sector is good and the private sector is bad. They seem to have an aversion to profit, perhaps in this area and perhaps in others, but they do not realise that if we do not have wealth creation in our economy we will have no public expenditure at all.

Photo of Mark McDonald Mark McDonald Scottish National Party

Does the member accept the point that the private sector is good in some areas but there are other areas in which profit-driven motivation is neither required nor beneficial?

Photo of Alex Johnstone Alex Johnstone Conservative

I do not believe that there is any evidence to support the idea that the public sector is somehow intrinsically better than the private sector, and I do not believe that the quality of care in the private sector is governed by profit or loss. Our discussion today indicates that the regulatory system that is in place is sound, and we need to ensure that it improves.

Let me move on to a couple of specific issues. One area that has given me some concern is the reducing budget for wardens in sheltered housing—in Aberdeenshire at least. I picked up on the issue during the election campaign, when a number of people chose to raise it with me. I am concerned that there appears to be a trend in local authorities to prioritising cutting the cost of the services while not necessarily taking into account how best value can be achieved for the limited expenditure that is possible.

The specific case that I came across is a proposal to share warden services between two areas of sheltered accommodation that are 16 miles apart. The point of any such decision is, of course, to allow the providers to cut the number of staff or hours, but the effect is that transport will have to be provided, sometimes in emergencies or poor weather conditions, between the two sites.

It strikes me that there is an inconsistency in the way that budget cuts are being applied. Is the cabinet secretary in a position to express an opinion on how efficiencies are best achieved in areas such as sheltered housing? It is my intention to discuss the issue in significantly greater detail with council officials and some of the residents who may be affected.

We are in a difficult position. There have been a number of horrifying incidents, not least the case of Mrs V in Dundee. The issue has been put back on our agenda at a time when we must treat budgetary efficiency as a key element of how we ensure that good-quality and evenly spread public services are provided. If we do not, we could find ourselves with more such cases, not fewer. As Mary Scanlon said, we will therefore support the SNP Government’s amendment, and we hope that by going down that route we get value for money and good-quality public services and do not end up with more horrifying individual cases.

The Deputy Presiding Officer:

I call Bill Walker, who is making his first speech.

Photo of Bill Walker Bill Walker Scottish National Party

Thank you, Presiding Officer. I am proud to be the first Scottish National Party MSP for the Dunfermline constituency, which comprises both the city of Dunfermline and a number of surrounding west Fife villages.

Dunfermline is, of course, the home of Bruce and Carnegie. After a difficult period and the decline of a number of traditional industries, the area now is undergoing a modern renaissance that extends from the technical advances promised by clean coal technology at Longannet power station to the impressive regeneration and restoration work taking root in Scotland’s ancient capital of Dunfermline.

The events of 5 and 6 May seem a long time off, but I do not wish to let these dramatic days pass without recognising my political opponents in the election. The sitting MSP was Lib Dem Jim Tolson, who worked hard during the campaign. We crossed swords several times, with courtesy on both sides—at least, he was always a gentleman.

Alex Rowley followed John Park as the Labour candidate and was the bookies’ favourite; those fellows seldom get things wrong. Labour put huge effort into regaining the seat, but there was no mistaking Alex’s shattered demeanour when the result was announced. Nevertheless, his congratulations, which I now formally acknowledge, were whole-hearted. Our Tory opponent was James Reekie, a fine young speaker. He will, I hope, successfully complete his law degree studies before throwing his hat into the political ring again.

Turning to Jackie Baillie’s motion, I appreciate the welcome that it gives to the Scottish Government’s moves to improve the focus on care for older people, and to the First Minister’s commitment on vulnerable residents in Southern Cross homes. Several colleagues have taken up, and others will take up, a number of detailed points in the motion. I will refer to the lessons that can be learned from my experience with Labour in the SNP-led council on which I still serve.

I fundamentally disagree with Claire Baker’s analysis of the Fife survey’s findings. Social care needs disproportionately affect the elderly. In order to focus help on the most needy, over the past couple of years Fife Council has introduced a simple form of means test to ensure that financial help in these increasingly tough times goes where it is most needed, and not to those clients who could afford to contribute something on a sliding scale of charges.

Labour vociferously opposed that policy, which I regard as socially equitable, and in doing so caused great alarm among some of the elderly by quoting the extreme end of the charging regime as if it was the norm. Needless to say, that was not the case. Fundamentally, it is best in stringent financial times to concentrate resources on those who are most in need.

Residential care homes for the elderly, to which Claire Baker referred, are an increasing but necessary cost for Fife Council and throughout Scotland. In Fife only around 12 per cent of care residents live in council homes, with the balance living in the private and voluntary sectors. I do not care ideologically where the care comes from as long as it is the best that is achievable. In general, Fife Council’s stock of homes is ageing, with—for example—few en suite toilets in homes, whereas, in general, the opposite is the case in the private and voluntary sectors, contrary to what Claire Baker implied.

Earlier this year, in the teeth of furious Labour opposition, Fife Council took the decision to go out to the private and voluntary sectors to invite offers to build and run replacement homes, as the first three homes of the remaining stock—two of which are in my Dunfermline constituency—came to the end of their practical lives.

I can only guess at why Labour in opposition decided to oppose so noisily, especially as the last occasion on which council homes were closed was under a Labour administration, and many private and voluntary sector facilities have been built since then. Those sectors can source capital more easily, and can operate new and better homes more efficiently and less expensively, than the council can. However, expressions such as “selling off council homes”, “privatisation of homes” and even “turning people out into the street” were soon being thrown around, which caused alarm in some quarters.

I hope that we can now leave those fallacious arguments behind. The Scottish Government and councils throughout Scotland are trying to do more with less, which in practice means prioritising and focusing spending for some time to come while being as efficient as possible. I hope that the Labour Opposition will join a consensus, as Jackie Baillie implied. Otherwise, I shall feel free to remind others that the reason why these hard social and financial decisions must be made lies in the failed economic management policies of a recent former resident of both 10 and 11 Downing Street, the consequences of which we shall be living with for a good number of years.

Over the next five years I shall do my utmost further to recognise how best to observe, listen to and represent the people of Dunfermline and Scotland.

The Deputy Presiding Officer:

I ask members to keep strictly to their six minutes, as time is beginning to run away with us.

Photo of Hugh Henry Hugh Henry Labour

I share Mary Scanlon’s observation about Jackie Baillie’s speech, which was measured, thoughtful and constructive. I hope that the cabinet secretary, who is not here at the moment, will take time to reflect on her comment about the tone of Jackie Baillie’s speech. If we cannot make robust, sturdy comments about something as fundamental as the care of the elderly in our country, we are failing ourselves and the people whom we represent.

It is undoubtedly the case that, in recent years, we have seen a significant improvement in the quality of care that is provided. I can reflect back on the early 1980s, when my late aunt—God rest her—was a resident in what was euphemistically termed a care home in Shettleston. Two or three elderly women were living in the same room, with no en suite facilities, up the stairs, with no disabled access. Frankly, the place was totally inadequate. It was also a bit of a death trap, if we consider what modern fire regulations require. There is no doubt but that we have seen improvements.

There is a dilemma with regard to how we get the investment that is needed to modernise this country’s care home infrastructure. Alex Johnstone and Bill Walker reflected on that to some extent in their comments. Equally, we should take a bit of time to reflect on and, perhaps, worry about what the current system means. Bill Walker took a sideswipe at what happened in the financial crisis. Actually, the collapse of financial markets both in this country and across the world happened as a result of corporate greed and reckless decision making, not by the Prime Minister of the United Kingdom but by bankers in America, here and elsewhere. When we look at the pattern of development of care homes, we see private equity companies buying in, selling on, taking over other concerns and playing with profits, money and people’s lives.

John Finnie was right to reflect and comment on some of the dangers that are associated with that type of behaviour. It is farcical for us to be told that private business is the driver of wealth creation and wellbeing in this country but for the taxpayer to have to bail it out when it collapses, as we have seen with the banks. We are in danger of seeing a similar pattern develop with care homes. Speculation may drive them in a direction that requires taxpayers to step in to bail them out. That is why the issue of regulation, planning and standards is fundamental to everything that we require.

In her excellent speech, Mary Scanlon spoke about some of the issues that arise in both hospitals and care homes, including issues relating to the feeding of elderly residents. It quite upset me to listen to some of her speech, because it took me back to the time when both my mother and my father were in hospital and some of the things that I saw then. To some extent, it makes me ashamed that I may not have shouted loudly enough at that time, although my family and I did complain. Things that I saw and which my family experienced are still happening. My mother and father were not fed properly and had to rely on family members going up to feed them.

Such things are still happening. People who are slumped in their beds are told that it is not the job of the staff to move them up into a more comfortable position. We cannot allow people who have done so much for us personally, and who have done so much for us as a society, to suffer the indignity of the treatment that many of them still face. This is a cross-party crusade—or initiative, or however we want to describe it—and we need to put aside our differences, because if we fail those people who have done so much for us, it will be to our lasting shame.

There is a need to consider what reductions in services and higher charges mean. I am not alone in having received some very upsetting examples of what is happening to many people in their homes. We need to reflect on the integration and sharing of services. I recall from when I became Deputy Minister for Health and Community Care in 2001—Malcolm Chisholm might reflect on this, too—that those were among the issues that we were talking about 10 years ago, when we were considering the development of care in the community. We discussed the integration of budgets and the sharing of services then, and it is still not happening.

In the health service, and indeed in public services generally, we have a bureaucracy the like of which would scare us, yet we are still failing individual people in their time of need. That is not acceptable; it cannot go on. We need to work together to rectify that.

Photo of George Adam George Adam Scottish National Party

Members are about to hear something that they will not have heard from me before in 20 years of knowing Hugh Henry: I agree with Hugh Henry. In particular, I agree with his point that we do ourselves a disservice if we cannot agree on this important issue. However, I believe that the cabinet secretary was not having a sideswipe at Jackie Baillie; she was merely responding to some of the points of view that she had put across at the start of the debate.

There is a first for us all, anyway: I have agreed with Hugh Henry at the start of the debate. The amendment in the cabinet secretary’s name ensures that this welcome, important and valuable debate is more focused and concerned with the actual delivery of services and with the quality of service for our older people. We are dealing with people’s lives, and Hugh Henry put it aptly. We are dealing with families and with older people—we are dealing with people whom we know in our communities.

The current situation with Southern Cross Healthcare is concerning to me. In Renfrewshire, more than 300 individuals use the company’s services, and it has a problem. I am glad to hear that the cabinet secretary is working with COSLA and other partner organisations to find a solution. The priority is quality and continuity of care, and I have an interest in that.

This is one of the most important debates that we will have. Care for older people is one of the biggest challenges, because of the changing demography that has been mentioned a number of times in the debate. In 2031, 38 per cent of Scotland’s population will be over 65. When I first became a councillor in Paisley and Renfrewshire, at the beginning of the term, our scrutiny and petitions board considered how we could deliver services for an ageing population. We had to consider the matter proactively in order to move forward.

Jackie Baillie is correct: how we look after society’s vulnerable members defines how civilised a society we are. We all agree on that. How we get there and deliver the services is the subject of debate, but we are all agreed about how we must look after our older people.

We live in difficult economic times, and sustainability and delivery are the important things. It is not all about money. In Renfrewshire, we had success by taking a small fund of money that had been used for something else for older people to alleviate the problem with delayed discharge. That worked out. We should be talking about how we can make differences in that way, rather than just throwing money at the problems.

This is not a blame game. Too often, the public get fed up with us all for sabre-rattling and falling out with one another over issues such as this. It is a matter of delivering service—locally in particular. The people in social work departments in councils know how to deal with social care, and they can deliver the service best. It is a matter of working in such a way as to make CHPs and other organisations deliver. It is not about reinventing the wheel; it is about working with what we have and making it work for our older people.

During the election campaign, I heard from the Labour candidate in Paisley about the proposed national care service, but it was unfortunate that Labour provided no guarantees or detailed proposals on integration and costs. I have to say to Jackie Baillie that it almost seemed as if Labour was sitting on the sidelines on the issue—

Photo of Jackie Baillie Jackie Baillie Labour

If the member reflects at all on history, he will know that it was Labour that led the debate about the integration of social care. I am, of course, happy to co-operate with the Government and share our detailed plan for a national care service.

Photo of George Adam George Adam Scottish National Party

I appreciate that. It will be good to see how things progress. I was pointing out only that, in the debate during the election campaign, we heard no concrete proposals.

Scotland spends £4.5 billion every year on older people’s services. The cabinet secretary was correct to say that it is not about throwing money at various projects and that it is about intervening at an early stage. Such an approach to delivering services is not only cheaper but a better way of keeping older people in their communities, with their families and neighbours.

In my council ward in Renfrewshire there are high flats at Rowan Court, which are occupied by older people. There is a public area to which residents can come down, so that they can meet their neighbours in their community and not become isolated. The approach works well. Last year, we had a very bad winter. When we talk about services for older people, we must be careful to commend social work departments throughout Scotland. During three weeks of the worst weather in decades, members of Renfrewshire Council’s social work department made 25,000 visits. Council employees were willing to deliver a service that was above and beyond the call of duty, and we should never forget that.

As I said, caring for Scotland’s older people is one of the biggest challenges that we will face in the coming years. I am thankful that the Scottish Government and the Parliament have a good track record on care of the elderly and many other social care issues. The challenge should bring us together, rather than divide us. I will put it bluntly: we are dealing with people’s lives. The delivery of services is more important than any member’s attempt at one-upmanship. It is about the individuals whom we serve.

Photo of Alison McInnes Alison McInnes Liberal Democrat

It is clear that we all agree that caring for Scotland’s older people is the key challenge for public services, which must deal with the increasing demands that result from our having an ageing population and ensure that services are of a consistently high quality throughout the country.

It is regrettable that high-quality care is not always available to the most vulnerable people. The recent, shocking cases that involved Ninewells hospital and the Elsie Inglis nursing home raised serious concerns about the care of elderly patients. For too long there have been different levels of support in Scotland. The problem needs to be remedied urgently and providers who fail the vulnerable individuals who are in their care must be shut down. The cabinet secretary’s recent pledge to make the issue a personal priority is welcome. The recent cases, along with Audit Scotland’s recent findings, illustrate the scale of the challenge that she faces, but I do not doubt that she will strive to meet the challenge.

Liberal Democrats think that healthcare should be delivered as locally as possible and that better joint working is vital if we are to bridge the gap between health and social care. Earlier this year, NHS Grampian’s medical director warned that unless we change how health services, local authorities and individuals work together,

“the way things are now, every year from now, Scotland will have to build a new hospital with around 600 beds to be able to cope. Every single person leaving school will have to find a job within the NHS to be able to provide enough care for the elderly.”

Audit Scotland, in its highly critical report, “Review of Community Health Partnerships”, also expressed serious doubts about the drive for greater integration of health and social care—although it has been clear in this morning’s debate that that is what we must strive for. Audit Scotland found that there is a chaotic and “cluttered partnership landscape” and it called for a “fundamental review” of CHPs, which are failing to have a positive impact on local people’s quality of life.

Delayed discharges are rising again, so more people are waiting longer to be discharged from hospital. Given that a week in hospital costs £3,349 on average, breakdowns in local co-operation are hugely costly as well as bad for patients. It is also clear that people are not receiving the support that they need if they are to stay out of hospital and in the community. Multiple emergency admissions of older people are increasing, as Mary Scanlon said, and there has been mixed progress on reducing emergency admissions for people with long-term conditions such as angina.

The British Medical Association has called the CHPs “bureaucratic monoliths”, and in many areas general practitioners have completely disengaged from them. We need to see proper joined-up working between local partners, and GPs must be brought back to the heart of those local partnerships. However, work to integrate health and social care must reflect local circumstances, and we would oppose any efforts to centralise services or to impose a one-size-fits-all approach. The Government has been quiet about transferring 38,000 local authority social services staff into the NHS since it mentioned it in February; the proposals were met with anger from COSLA, which branded them incompetent. The Government’s evidence review found that a one-size-fits-all approach does not work. We will therefore continue to oppose any moves towards centralising services in a national body. The issue surely cries out for a local solution and not a centralised organisation with little local accountability and enormous costs and bureaucracy.

Better partnership working must be backed up by a genuine shift in the balance of care into the community. However, Audit Scotland reported that there has been no large-scale shift in the balance of care. We can all see that locally and know that it has not yet happened. Social care remains focused on institutional settings. More than 60 per cent of Scottish Government spending on care for older people is on care in hospitals and care homes, and almost one third is on emergency or unelected hospital admissions, amounting to around £1.4 billion a year. Only 6.7 per cent of the budget is allocated to providing care at home.

Liberal Democrats are committed to enabling older and disabled people to live independently and with dignity in their own homes for as long as possible. We will protect free personal care, which is a proud achievement of our time in government. As well as being better for the individual, supporting an older person to retain their independence is much cheaper. Care homes cost around £600 a week per individual, while the average weekly cost of a personal care package can be less than £120. When we scale that up to a rapidly growing population of older people, we are talking about significant savings to public spending.

Photo of Richard Simpson Richard Simpson Labour

Does the member accept that the Audit Scotland reports have been clear that all local authorities are moving the care that they provide to the much more intense end and that we are losing exactly what she is trying to promote?

Photo of Alison McInnes Alison McInnes Liberal Democrat

I accept that point.

An expansion of telehealth is needed to allow easier access for patients, especially those who live in rural areas, and to avoid unnecessary hospital visits. As well as having the potential to improve healthcare, the expansion of telehealth will save money, as demonstrated by the cardiopod project in Argyll, which led to a significant reduction in emergency admissions for patients with chronic cardiac conditions. Despite widespread recognition of the benefits of telehealth—committee reports have demonstrated that—there has been limited roll-out of initiatives, and successful pilot schemes are not leading to the mainstreaming of those approaches. I would like the minister to be involved in moving telehealth from being an additional extra to being a mainstream option.

I welcome the new dementia care standards and the skills framework for staff that were published this week. I ask the cabinet secretary to ensure that those are fully implemented to ensure that people with dementia are treated as individuals and with respect. In 2009, the shocking report “Remember, I’m still me” revealed disturbing shortcomings in care homes, particularly around the use of drugs and sedatives. Sadly, the recent cases show that serious problems persist. There must be no hiding place for care homes that do not meet high standards. Strict regulation must result in severe penalties for those that are in breach of the standards.

Every speaker in the debate has acknowledged that without the valuable contribution of Scotland’s carers, the health and social care system would be unsustainable. We must therefore value carers and find new ways of supporting them so that they can continue in their vital role.

Photo of Dennis Robertson Dennis Robertson Scottish National Party

I declare an interest in the debate, in that I worked in the social care sector for just over 30 years, and my mother-in-law is currently in a Southern Cross residential home.

I want to consider prevention and the resources that are available. Prevention is by far the most important aspect for me. If we can prevent many of the things that happen to our older people—for example, trips and falls within their home and accidents immediately outside it—we can prevent them from going into hospital, which is indeed very expensive. However, the cause of such things is often neglected.

Many of our older people are supported by their carers, and we often leave it to the carers to provide that continual support. That is wrong and it should not continue, because our carers themselves require our support and care if they are not to become the ones who require care. Carers’ health and wellbeing is extremely important to those whom they care for and we should ensure that we manage that appropriately.

Prevention is about basic things such as being aware, and that is where training is vital. We must ensure that every member of staff who works in the social care sector and cares for our older people in the community and residential and hospital settings has the appropriate training. That training can be very basic. It is about being aware. Has the person’s mood changed? Are they doing things that they do not normally do? Have they got stains on their clothes? Are they not hearing as well as they did? Are they getting disorientated in their home or out in the community? Those issues can flag up some basic problems. The older person might not be aware that they have picked up and are wearing the wrong spectacles and that that is causing them confusion. Someone who is not hearing particularly well might need to go to the district nurse and have their ears syringed. Those are the real problems that people can have, but they are often not picked up by the carers and the family and certainly not by our social care system. We need to focus on such elements in training, because they can prevent a great deal of harm from coming to our older people, and we can reduce the risks involved.

During the 30 years that I worked in social care, the bar was always being raised for the criteria for making interventions and putting in place the support that people need. Free personal care was a fantastic innovation in some respects and the concept was widely applauded. The cross-party consensus and support on that still exist and they are to be welcomed. However, it does not solve the whole problem. People face increased costs—for example, increased fuel costs—in staying in their own homes. For many people, it is heat or eat syndrome—we need to consider that and ensure that people are not left vulnerable.

Our social care system needs to reflect on that, too. If people need benefits to stay at home, we must ensure that they are given every opportunity to succeed in getting the benefits to which they are entitled. That is why we must support organisations such as the Scottish Council for Voluntary Organisations, which was in Parliament for a reception the other night. I was delighted to hear the Cabinet Secretary for Finance, Employment and Sustainable Growth giving his endorsement to SCVO and expressing his hope to work with it in the future. That is incredibly important for the wellbeing of our older people.

We have heard today that one size does not fit all, and that is true. My Aberdeenshire West constituency is very rural in many aspects, and the approach to the rural sector needs to be a bit different from that which is taken in the cities. A lot of additional costs are incurred in rural areas. Getting to people can often mean a longer journey, and it can take a whole day for an older person to get to and from hospital. Often, people’s nutrition is not taken into cognisance when they are away from home for a whole day; that is especially important for people who have diabetes.

When we are looking at care for our older people, we need to ensure that we take a joined-up approach. I welcome the Government’s joined-up approach to the strategies that it is taking forward.

Dementia is on the increase and I welcome the reports that are coming out. I applaud Alzheimer’s Scotland for its proposed strategies and I look forward to working with that organisation in my constituency.

For the health and wellbeing of the older people in our community, we must ensure that we focus on the carers and those in the voluntary sector who provide care for older people in our communities. I would welcome a discussion with the cabinet secretary on how we proceed with that.

The Deputy Presiding Officer:

I am afraid that interventions must now be confined to within the six-minute speeches.

Photo of Chic Brodie Chic Brodie Scottish National Party

First, I compliment the Labour Party on bringing the motion to the chamber. It is an important motion and, although I might not question its intent, I question some of its content. For example, I do not believe that there is a new focus by the Government on care for the elderly. There has always been a focus on care for the elderly. That focus is not new; it is being refreshed, and that refreshment is healthy.

Although we must never diminish the seriousness of situations such as those involving the Elsie Inglis care home, Southern Cross and Ninewells, we must be very careful that we do not throw the baby out with the bathwater. I will give two examples of why that is the case. First, for the past eight years, following the massive stroke that my partner Mary’s mum had, I have had the privilege—it has been a privilege—of pushing her in a wheelchair up and down Ayr High Street nearly every Saturday afternoon. I risk an intervention when I say that she knows the price of clothes at Marks and Spencer. She is declining mentally, but she is healthy, generally happy, feisty, at times very independent mentally, and clean and tidy, and her wellbeing is a tribute to the carers in the council-run South Lodge residential home in Ayr and its partnership with the local health service and health providers.

Secondly, last Friday, we were invited to a dance at the Royal Air Forces Association Club in Prestwick, where we met a lady—she was a lady—who was 92 years old and who, as a singer, had entertained the troops in the second world war. She was vibrant and bright, and she danced most of the night away. Although I accept that that might not be a usual circumstance, it highlights the need for us to—indeed, it demands that we—keep refreshing our thoughts on the elderly and the care that they require. In my book, looking after them is not all about organisation, reorganisation, process or cost, although it is partly about that; it is about creating and attaining or achieving a cultural shift and a change in attitude to the elderly—and not just in the Parliament—and extending their independence for as long as and as effectively as we can.

When care is needed, the client—not recurring reorganisation—must be the core, the purpose and the reason for good health and care service delivery. The creation of some form of integrated national or community-based organisation that is centralised, bureaucratic and remote has little bearing on establishing a client-based service and determining where that service is needed and should be delivered.

The national challenge of demographic change is that we continue to eschew calls for full integration and organisation of services, and that we continue to refresh and develop further efficient local commissioning partnerships that involve equal input and responsibility on the part of councils, health boards and health and care providers—partnerships that are built on trust and strong leadership. There is a clear distinction between integrating services and budgets and integrating organisations, as some have suggested. It is clear that, in such partnerships, it is critical that whichever organisation is determined to be the lead organisation—whether the health board, the council or whatever—that is the organisation that leads and which is solely responsible for the delivery of the service that is needed. It must be local, accountable and measurable.

We face a huge ageing and demographic explosion over the next 20 years, and I am afraid to say that I am a lot closer to that explosion than most. I have mentioned the need for a national attitudinal and cultural change in promoting health improvement and independence of mind and body of the elderly, but that process must be an evolution. There must not be a rush to change or to provide a catch-all solution that may not be needed urgently or, indeed, everywhere. We need change that provides meaningful local health and care partnerships to deliver the services, at the centre of which is the elderly client. That is why I applaud the Government’s £70 million change fund, which will help to effect that change.

Given that we are dealing with the sensitive community of the elderly and their carers and health support, change must not be dramatic. As a consequence, the integrity and capability of private sector social care providers—as they, too, embrace change—must be subject to the most detailed financial scrutiny and management. There must be on-going, targeted, random—as mentioned by Jackie Baillie—regular, focused and rigorous inspection of social care providers, especially those in the private sector.

We must think of the elderly not just as the elderly but as our mums and dads, our grannies and granddads. We are here because they were there. There is a recurring debt that we owe and must pay.

Photo of Mary Fee Mary Fee Labour

I am happy to take part in the debate, because caring for the elderly is a personal issue for me, as I am sure it is for most members in the chamber. I was a carer for my aunt, who had dementia. Over several years, I dealt with her deterioration and decline daily. I therefore know how families across Scotland feel, and how services can, and should, be improved.

Dementia is a serious issue, which the Government has been working on through the dementia strategy and charter of rights. I welcome the moves that the Government has taken until now, but it must do more. It must do more on the integration of health and social care services, and it must act on the failings of CHPs that Audit Scotland pointed out.

In Scotland, 82,000 people currently have dementia, and that number is expected to rise to more than 150,000 in 20 years’ time. The increase is due to the fact that the number of people aged over 65 will sit at 50 per cent in 20 years’ time. As we see life expectancy rise, we are not seeing healthy life expectancy follow. Many social and economic factors contribute to that. The elderly will spend longer in poor health, and they will not lead the independent and fulfilling lives that they deserve to.

As I have stated, the Government has taken action on care of the elderly, but more must be done. Over the past decade, we have seen a rise in the number of people diagnosed with dementia. That is because early signs of dementia have been recognised and acted on more quickly. The stigma attached to many mental illnesses has also been removed. However, the services available to patients after diagnosis are suffering as a result of cuts to local authorities and cuts to NHS budgets—the greatest cuts since devolution.

Continuity of care must be addressed. People suffering from dementia do not react well to seeing a new face on each visit by a healthcare professional, and there is no dignity in a 15-minute visit to a patient’s home.

In the previous session of Parliament, former MSP Irene Oldfather was a well-known champion of dementia issues. In a letter to The Herald, she said:

“People with Alzheimer’s and dementia are at particular risk because of their communication difficulties. We rightly accept the importance of protecting children in our society. We have yet to place the same value on old people with dementia.”

Irene’s letter was in response to the recent exposures relating to the care of the elderly in homes, and also in response to a report by the Mental Welfare Commission for Scotland. The recent scandals over care homes in Scotland are no doubt shocking, but they are known only thanks to one doctor who had the courage to alert the authorities. What happened in the Elsie Inglis care home was not a one-off; a report by SCSWIS on the Eastleigh care centre in Aberdeen criticised the care provided as weak and less than desired. Much more must be done to protect our older population.

The care authority regulator also pointed out that, because of cuts to the inspectorate budget of around 25 per cent, the frequency of unannounced inspections has fallen to as low as one every two years. We cannot allow inspections of care homes to fall to such low levels, at the same time as we are cutting budgets to care homes. That will only leave the residents in poorer care and in a situation where untold damage can be done.

I call on the Scottish Government to work more closely with the third sector, where the vast majority of services are provided and where budgets are also being cut. We cannot expect lower-paid workers to continue to care for the elderly when they are facing wage cuts themselves, such as those affecting charities such as Quarriers.

In the Scottish Labour manifesto we promised that we would create a national care service to integrate healthcare from NHS Scotland and social care from social work departments. Unfortunately, we did not win the election, but I call on the Scottish Government to consider creating a national care service, because the SNP must do more to improve the care of the elderly in Scotland. That would provide a high quality of care to the elderly and rid us of the postcode lottery.

We face massive inequalities in how care is provided to the Scottish people, which need to be addressed urgently. The inequalities in care have only worsened since 2007, due to the failure of CHPs to have a positive impact on life quality. GPs, nurses and social workers believe CHPs to be unnecessarily bureaucratic. That is why Scotland needs a national care service to improve the integration of health and social care authorities and to provide a better level of care for our elderly.

On average, 92 per cent of our over-65s stay in their own homes. In some parts of Scotland, that figure sits at 96 per cent. If the national average sat at 96 per cent, we would see massive savings to NHS budgets. Increasing that figure would allow the elderly to improve their quality of life and their wellbeing simply by staying in the comfort of their own homes.

I congratulate the Scottish Government on its efforts in improving the care of our elderly to date, but I encourage it to do more. I am happy to work with members throughout the chamber on that.

Photo of John Scott John Scott Conservative

Mr Dornan, you have a tight six minutes.

Photo of James Dornan James Dornan Scottish National Party

Hubert Humphrey, Vice President to Lyndon B Johnson and defeated presidential candidate in 1968, once said:

“the moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; those who are in the shadows of life; the sick, the needy and the handicapped.”

The debate focuses on just one part of that moral test, but it is an incredibly important part. How we treat our elderly is a mark of what kind of society we are. High-quality and compassionate care that protects their dignity is a must if we are to call ourselves a civilised society and a progressive nation. Although I recognise the horrific recent events that have been mentioned and I share the concerns that have been raised, I am proud of the fact that the Parliament has always risen to the occasion.

When Scotland introduced free personal care for the elderly, it was something that the previous Liberal-Labour Administration could justifiably be proud of—indeed, the whole Parliament could be proud of it—while the whole country could delight in the fact that we clearly recognised the debt owed to those born before us. However, the introduction of free personal care was not just about doing the right thing and ensuring that older people received the care that they deserve; it was about demonstrating to others the values that we hold dear. A decade on, more than 77,000 older people across Scotland are benefiting from receiving personal care services free of charge.

As has been said, one of the biggest challenges that we face as a nation is planning for the increase in our older population over the coming years. Clearly, doing nothing is not an option. Given that, as many members have said, there will be a 38 per cent increase in the over-65 population in the next 20 years, and given that at present we spend £4.5 billion on services for the elderly, it is clear that new ways have to be found to deliver such services.

As a councillor on Glasgow City Council, I was a member of a community health and care partnership before the sad demise of such partnerships, which, in my view, was brought about by the unwillingness of senior personnel at the council—both politicians and officers—and the NHS to devolve responsibilities to the local level, to share accountability for and control of services and, sometimes, to hand over control to the other partner of what they perceived to be their service.

Photo of Richard Simpson Richard Simpson Labour

One of the reasons why we proposed a national care service was that attempts to form CHPs have repeatedly led to situations similar to that in Glasgow, to which the member quite rightly referred. Because partnerships are voluntary, they fall apart when the personnel do not agree.

Photo of James Dornan James Dornan Scottish National Party

As I will go on to say, the principle is sound. There is no reason to do things at a national level; they could quite easily be done at a local level. The partnerships could have worked at a Glasgow level, but that did not happen because of the intransigence of people within the organisations involved.

Those on the ground did a magnificent job in ensuring that the number of delayed discharges was drastically reduced, that adequate care packages were in place when required and that the elderly who were treated by social work and health board staff were given the respect, care and attention that they deserved. I was extremely sorry to see the demise of Glasgow’s CHCPs and I whole-heartedly support the proposal by the Government to integrate health and social care. It was never the principle that was wrong, just the inability of some to let go of control. I hope that councillors of all parties in Glasgow and managers in the NHS will engage with the process positively and constructively to put in place a fit-for-purpose care system to replace the one that was sadly lost.

The Government’s plan to integrate health and social care for adults will give people quicker access to care as well as continuing to reduce the number of delayed discharges, and it was backed by Lord Sutherland in his report. I am delighted to see the establishment of a new lead commissioning integration fund that is backed by £2 million of funding to support integration. It is right that the focus should shift to the needs of people and away from the basis of who used to do it traditionally. Cutting through red tape and improving joined-up working can only be a good thing. The pilot work that has been taking place across the country has been making progress over the past 18 months and I look forward to its extension nationwide.

Labour’s proposal to introduce a national care service may have some merit but, as George Adam has said, the truth is that we just do not know. It is unclear where the idea has come from other than from the UK Labour Party, as there appears to be limited, if any, public support for it.

Photo of James Dornan James Dornan Scottish National Party

I do not have time. I am sorry.

The idea that creating a new nationwide bureaucracy will address the poor integration of health boards does not add up at this stage.

I am pleased that the Scottish Government has announced a £70 million change fund in the draft budget to support better integration of older people’s services that are delivered by health boards, councils and the third and independent sectors. That money will act as a catalyst for more radical design of services for our older people.

Like others, I want to mention the unsung heroes of our health service—Scotland’s army of carers—about whom Fiona McLeod spoke eloquently. As we know, without Scotland’s carers our national health service would be crippled and the quality of life of many of our elderly people would be greatly reduced. The care that the carers provide often comes at great cost to themselves financially, physically and emotionally, and they themselves are often elderly. I know of 70-odd-year-olds who are looking after their 90-odd-year-old parents, which is some achievement.

It is clear that the Government recognises and is ready to take on the serious challenge that we all face. That challenge is not one that can be shirked by any of us, and I welcome the recognition across the chamber that change is required. I hope that, on this occasion, we can put party differences aside and unite behind the common cause of protecting and looking after those who are in the twilight of life, who deserve our respect and our care when required. I am confident that, once again, the Scottish Parliament will rise to the occasion and pass Hubert Humphrey’s moral test.

Photo of Malcolm Chisholm Malcolm Chisholm Labour

I will raise the issue of the regulation of care homes, specifically in the context of our older people in Scotland. The failures that have been identified from the recent case of the Elsie Inglis nursing home, in addition to the fact that one in 10 care homes in Edinburgh is now identified as being weak, raise serious wider questions over the regulation of care homes in this country and about how we provide the right standard of care for our older people.

First, there is the issue of inspection frequency. Under the new SCSWIS inspection rules, if a care home has previously received good ratings and a regulatory support assessment has deemed it low risk, the maximum frequency of inspection is 24 months. However, 24 months is simply too long. As members will agree, a great deal can change in any establishment in a 24-month period. In October 2010, the Elsie Inglis nursing home received a good rating in the category of quality of care and support so, without complaints, the home might not have been inspected again until October 2012.

More fundamentally, questions must be asked about why it took the death of a 59-year-old woman as a consequence of the care that she received to close the home. Three complaints were made after October, the details of which, plus the details of action that was subsequently taken, I should obtain in due course following a freedom of information request. The First Minister was certainly not right at First Minister’s questions to mention only a complaint that was made on 25 March and not two complaints that were made in November. Although action has now been taken regarding the Elsie Inglis nursing home, concerns remain about how a care home could plummet from being rated as good to being the worst in the country in so short a time.

The case raises serious questions about the inspection regime and the dangers of leaving a home that has been labelled good to its own devices. I question how a care home could be rated good in October 2010 yet be rated unsatisfactory across the board six months later, in April 2011. That clearly brings into question the inspection procedures that are employed by SCSWIS.

There are four quality themes according to which each care home is assessed. An inspection of a service with a low risk assessment score and grades of 4 or more may examine only one theme, so a holistic picture of the care home is not delivered on each inspection. If we look back at the Elsie Inglis reports of last year, we see that several themes were described as not assessed. It seems that, if inspectors do not know that it is bad, they are unable to look, and if they do not look, they do not know that it is bad.

It is imperative that we query the detail of the themes that are being used for inspection. It is wrong that SCSWIS inspections state:

“typically we ... talk to people who use the service”.

It should not be typical; it must be mandatory that inspectors talk to residents. Residents’ views on how they feel about living in a care home must be compiled if actionable lessons are to be learned. Their emotional care and stimulation, and not just their physical care, should be explored. That was a fundamental part of the care standards of which we were all so proud when they were first compiled in the early years of the Parliament. SCSWIS stated that, from April 2011, there would be

“Even greater emphasis on user focus.”

How that is to be implemented needs to be set out in detail.

In the October 2010 inspection of the Elsie Inglis care home, SCSWIS reported that it spoke to three service users, all with communication difficulties. Some information was therefore gained through non-verbal responses such as nodding the head. Moreover, the report states that conversations were to confirm that service users had a care file and were involved in its compilation. That is clearly not evidence of user focus. It is not even evidence of consultation.

There must be transparency in how inspections are conducted. SCSWIS states:

“Unannounced inspections will be the norm. We will announce inspections only when it is necessary to do so for practical reasons.”

What constitutes “practical reasons”? Announced inspections were acceptable when all care homes received two inspections a year, but I believe that all inspections should now be unannounced to ensure a more accurate assessment of the home.

SCSWIS, through its inspections, should be a driving force for change. The challenge is to change the image and culture of care homes so that they focus on holistic quality of life rather than simple physical care.

Another key issue to be raised specifically regarding the Elsie Inglis care home is that it was defined as providing care for older people who fell into the categories of Alzheimer’s or frail elderly. Why, then, was a 59-year-old woman with learning difficulties residing in that care home? I have asked, in a written question, how many of the residents had learning difficulties and how many were under 60 years of age.

The cuts to the funding of SCSWIS raise questions about the future quality of inspections. Forcing it to make cuts of 7.6 per cent in 2011-12 and a total of 25 per cent in the next four years is putting care home residents at further risk. I hope that the Government will look at that again.

Finally, we must challenge wider societal attitudes towards older people. The voices of older people are generally ignored, and care homes are largely detached from society. Older people are important citizens, though, and it is of fundamental importance that their voices are heard. I therefore urge the Parliament to take rapid action to improve and protect the quality of life of care home residents throughout Scotland and to set an example for the rest of the UK to follow.

Photo of Mark McDonald Mark McDonald Scottish National Party

I begin by declaring a number of interests. First, I am a member of Aberdeen City Council and, secondly, my grandmother is a dementia sufferer and my mother is her carer.

I welcome the focus on this vital issue, which has had a great deal of prominence in the media lately due to the high-profile cases that have been mentioned in previous speeches. I want to mention the Mrs V case because Dundee falls within my region, North East Scotland. My colleague Joe FitzPatrick rightly said in yesterday afternoon’s debate that it was a situation that should never have occurred and should never happen again. Every member would echo that.

With that in mind, I very much welcome the publication last year of the national dementia strategy, which addressed many of the points that that case raised, although the case took place a couple of years before the strategy was introduced. I know that many people working in the care sector as unpaid carers and indeed as professionals very much welcome the emphasis that is contained in the strategy.

Aberdeen City Council, on which I serve, has recognised the changing demography and the need to align budget provision accordingly. That is why, at its most recent budget meeting, the council took the decision to put an additional £7 million into the social care budget.

In future years, the council will focus on elderly care, because we recognise that pressures will come from that as a result of the demographic statistics, which Jackie Baillie and my colleague George Adam highlighted. The point of putting such money into social care services is to transform them early so that they are prepared not only for the demographic challenges but for the financial challenges that will follow. I am sure that members appreciate that what matters is not always the money that is put in but what the service that is in place delivers for people.

I invite members with a keen interest in the integration of health and social care to visit the Rosewell house care home in Aberdeen, which Aberdeen City Council and Grampian NHS Board operate and fund jointly. The home provides respite and rehabilitation beds and is an example of good practice in working together between the health board and the council. Perhaps that could be considered as a model for elsewhere in Scotland.

Several members have touched on unpaid carers, on which I will focus for the remainder of my speech. Next week is carers week, and it is important to recognise the invaluable role that carers play in society. I very much welcome the support for carers in Scotland that the Government, the cabinet secretary and her team have provided in recent times. Much carer support is being provided and that is very much welcomed.

I also welcome the sharing of personal experiences today by my colleague Fiona McLeod and by Mary Fee. That brings it home to us that, across the chamber, we have much personal as well as professional experience of the situations that are faced in our communities.

Fiona McLeod was right to highlight the iniquity of the carers allowance that Westminster provides. It is less than £60 per week, and many carers who receive it do not have the benefit—which my mother has—of having a working partner who can support them beyond that £60 per week. When James Purnell was the Secretary of State for Work and Pensions, my colleague Brian Adam wrote to ask him to look at the allowance with a view to uplifting it. Unfortunately, the response was that the carers allowance is not a wage. I do not dispute that but, to qualify for the allowance, a person’s working hours and the amount that they can earn per annum are restricted.

My mother cared for my grandfather when he was alive, so she cared for two elderly people. I know that a number of people care for multiple relatives rather than just one relative. However, such carers are eligible for only one carers allowance payment. With only that payment, it is difficult for many people who have no supplementary income from another family member to provide acceptable care and to deliver other services when caring for more than one relative.

As a Parliament and as the Government, we must lobby Westminster hard to ensure that the carers allowance does not become a Cinderella benefit that is left out of the overall welfare reforms that are being considered. I welcome the fact that the allowance is not being absorbed into the universal credit, but radical and urgent reform is needed to ensure that it provides the assistance that carers require it to provide. Unfortunately, carers in Scotland and across the UK ask for little, which is exactly what Westminster gives them.

Photo of Murdo Fraser Murdo Fraser Conservative

I congratulate the members who made their maiden speeches in the debate—John Finnie, Bill Walker and Mary Fee. I also thank Fiona McLeod for her speech. I am not sure whether one can be a maiden the second time round so, to avoid discussion of that issue, I will just say that I congratulate her on her return to Parliament.

I also thank the Labour Party for bringing to the chamber a timely debate that has allowed us to discuss various issues with regard to reports that have arisen lately in the media: the future of Southern Cross; the case of Mrs V at Ninewells hospital; the horrendous cases at the Elsie Inglis home in Edinburgh; the change in the inspection regime; the future of community health partnerships as examined in Audit Scotland’s recent report; and the proposed integration of health and social care. The debate has been largely consensual; of course, that is only right, given that we are dealing with serious issues on which more joins, than divides us.

Much of the debate has been taken up with discussing current issues that have arisen in care homes. However, in recognising that some of these issues have made the headlines, we should also acknowledge that most care provision, either in care homes or in people’s own homes, is excellent and that the cases that have been cited are striking precisely because they are individual occurrences and do not represent the norm. Not recognising that point creates the potential for scaremongering and causing distress both to elderly and perhaps vulnerable people and to their relatives.

We have heard in one or two speeches a slight undercurrent that all the problems are in the private sector and all the blame lies with the profit motive. Mary Scanlon was quite right to make it clear that there is no evidence to support the “public good, private bad” mantra; indeed, if we need proof of that, we have only to look at the Mrs V case in Ninewells. One can only imagine the voices that would have been raised in protest had that happened in a private care home. The point is that we need to get this matter into perspective. I say as gently as I can to John Finnie that his comments in that respect were perhaps ill advised and stood in marked contrast to the measured remarks made by his new SNP colleague Bill Walker.

Claire Baker rightly referred to the importance of mixed social care provision and made a fair point about the situation in Fife, where the SNP-run council is looking to move the four local authority-run homes into the private or independent sector. I fully understand why it is making that move—after all, many other councils have done the same—but Claire Baker was right to contrast the approach in Fife with the rather unfortunate comments about private sector provision that the First Minister made just a week ago in the chamber. As Alex Johnstone pointed out, the key is an effective regulatory regime with regular inspections across the public, private and voluntary sectors; indeed, Malcolm Chisholm made the same fair point in his excellent speech.

As Mary Scanlon made clear, we are not comfortable with the part of the Labour motion that calls for an immediate reversal of the cut in SCSWIS’s funding. In combining organisations, one is right to look for efficiency savings, as is the case across the whole of government. However, although we cannot agree with that element of the motion, it is nevertheless right to keep the matter under review and to revisit it if with time it appears that the budget reduction is impacting adversely on inspections.

Photo of Jackie Baillie Jackie Baillie Labour

I welcome that comment, because the point is critically important. SCSWIS has already lost something like 55 staff and is due by the end of the year to lose another amount, the majority of which will be inspectors.

Photo of Murdo Fraser Murdo Fraser Conservative

I do not disagree with Jackie Baillie that we need to keep the matter under close review.

As time is getting on, I want to focus on the Southern Cross situation. There is serious concern about the company’s financial situation and, given yesterday’s announcement of 3,000 job losses across the UK and the fact that it runs 98 homes in Scotland, all this uncertainty about the future will undoubtedly be causing distress to residents and their families. I very much welcome the cabinet secretary’s offer to meet us later today and to keep us updated. It is also important that there is co-operation with the Department of Health. After all, given that Southern Cross is UK-based, the matter affects not only Scotland but the rest of the UK.

As the key to helping in this situation is to avoid any disruption to the residents of these homes, any solution should focus not on finding alternative settings for people but on trying to keep them in their current situation, where they are familiar with things and feel settled. We should therefore look closely at the offers that I know other independent providers have made to come in and, if necessary, take over the running of the homes.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

I rise simply to agree with Murdo Fraser’s point, as I did earlier. There should be absolute determination to keep people in their own homes. It should be remembered that the care homes that older people are in are their own homes. I wanted to give that reassurance.

Photo of Murdo Fraser Murdo Fraser Conservative

I am grateful to the cabinet secretary for that reassurance and look forward to meeting her later to discuss these matters in more detail.

Everybody agrees that delayed discharges are wasteful and inefficient and that they often cause concern and distress to those involved. Good progress has been made in the past but, as Audit Scotland has just pointed out, the trend in delayed discharge numbers is now upwards. The figure for January 2011 that it quoted in a recent report was 30 per cent higher than that for January 2010, and older people’s emergency admissions to hospitals are now rising. We need to keep constant pressure on those figures.

There has been a healthy debate, but there is much more work to be done.

I support the amendments in the names of Mary Scanlon and Nicola Sturgeon.

Photo of Michael Matheson Michael Matheson Scottish National Party

I congratulate the members who have made their maiden speeches this morning. The debate has been of very good quality, and a number of contributions in it have been informed not only by purely political experience, but by personal experience, which is always a valid part of any such debate.

It is clear that events that have occurred recently—the cases with the Mental Welfare Commission, Elsie Inglis nursing home cases and the Southern Cross situation—have resulted in renewed interest, particularly in the media, in matters to do with the care of older people in Scotland. It is right that members should have an opportunity to reflect on those issues. Obviously, the events have resulted in a focus on the overall quality of care that is provided to older people in Scotland. Are they being treated with the dignity and respect that they deserve when they are being supported and assisted?

Murdo Fraser was entirely correct: the vast majority of care that is provided in institutional and community settings for older people is good quality. I would not like the debate to create the impression that there is a crisis in how we provide care to older people. The vast majority of care is of a good standard. The important thing is to ensure that all the care that is provided to older people is of a good standard.

Questions have been raised about the oversight system, how we monitor and assess the quality of care that is provided, how organisations such as SCSWIS respond to concerns that have been raised with them, and the inspection regime. It is important that we are assured that organisations such as SCSWIS act in a proportionate and thorough way when they receive complaints about standards of care.

I believe that we have a robust process for inspections of our care homes and care home providers. However, Malcolm Chisholm made an excellent speech in which he made a number of important points about that particular regime. We are happy to consider a number of those issues to see whether there are further ways in which we can enhance the existing system.

Photo of Mary Scanlon Mary Scanlon Conservative

When the Social Work Inspection Agency made recommendations to raise standards in councils, it always followed them up a year or two later. The Care Commission made recommendations, but it never followed them up. Will the minister ensure that recommendations are followed up now that those bodies are merged in SCSWIS?

Photo of Michael Matheson Michael Matheson Scottish National Party

I am happy to do that, because it is important that we have confidence in the inspection regime and that it picks up issues and follows them through to ensure that real, concrete improvements are achieved through the system.

Like Mary Scanlon, I was deeply concerned when I read the Mental Welfare Commission’s report on the nature of the care that Mrs V received in an NHS establishment. However, I also recognise that that care does not reflect the overall care that patients with dementia receive in our NHS system or the social care sector. That said, it is clear that there is more to be done to ensure that standards are improved. This week, the cabinet secretary outlined the dementia care standards that we will take forward, and we have commissioned the chief nursing officer to look closely at the type of care that is being provided in that area to people in our NHS.

A number of members have referred to the demographic challenges that the country faces in providing care to older people. Those issues carried over from yesterday’s debate. [Interruption.] It is important that we recognise the significant demographic change that will occur in the next 20 years or so. It is a good thing that old people are living longer, but the future shape of our care services, at the health and social care levels, must recognise the fact that we have an ageing population.

In the past, there has been too much focus on institutional care. The reshaping of the provision of care must recognise not only the need to move away from the acute sector into the primary sector and the social care sector, but the need to give people more flexibility and more opportunity to shape their care arrangements in a way that is appropriate to them. The Government is committed to taking forward the agenda on self-directed support, which is about giving people an opportunity to manage and direct their care in a way that is appropriate to them. Several members, including Fiona McLeod and Dennis Robertson, argued that, if people want to stay at home, they should have the right to do so and should have the opportunity to make care arrangements to allow it to occur.

Photo of Jackie Baillie Jackie Baillie Labour

I am delighted that the minister has mentioned self-directed support, which currently applies to local authority care services and budgets. Does he see a possibility of extending that into the NHS?

Photo of Michael Matheson Michael Matheson Scottish National Party

It is important that we give people as much flexibility as possible in how they manage their care arrangements. Some people have packages of care that are funded by the local authority and the health service, and we need to ensure that they have the opportunity to shape their care package in a way that is appropriate to them.

Claire Baker talked about the future shape of the way in which we provide care in the community and raised questions about whether it should be provided privately or by local authorities. In the short term, our focus might be largely on Southern Cross, but in the medium to long term we are open to considering whether other models can be utilised to provide care in the community, so there is scope for that. The Government is more than happy to work with members if they have ideas about how that provision can be shaped.

Several members mentioned that the issue of the integration of health and social care has been around for some time. Hugh Henry mentioned that we were having the same debate when he was a health minister some 10 years ago. Well, when I was a young occupational therapist setting out all those years ago in 1991, we were told that the National Health Service and Community Care Act 1990 would result in integration of care, so the debate has been going on for decades. We need momentum and pace to create the necessary change. The Government is determined to ensure that we stop talking the talk and start walking the walk to get real and proper integration of services.

Alison McInnes raised concerns that we might seek to centralise care. She might want to address that point to the Labour Party, given its proposals on a national care agency. We want to ensure that services are joined up in order to improve the quality of care that people receive. That has been required for some time, and we are determined to ensure that it is delivered.

The Government is committed to ensuring that the quality of care that older people in Scotland receive is the best that it can possibly be. We will continue to take forward measures to ensure that that is delivered.

The Deputy Presiding Officer:

Before we move to the final speech in the debate, which is from Richard Simpson, I ask all members to check that their mobile phones and BlackBerrys are switched off.

Photo of Richard Simpson Richard Simpson Labour

Notwithstanding the cabinet secretary’s initial comment, the tone of the debate has been exactly right. All members have reflected on the fact that there are excellent care homes out there and that many people are being looked after in an excellent way in the health service and the care home system. Michael Matheson is absolutely right that we do not have a crisis, but I fear that, with the demographic pressures and the austerity measures that are coming in, we could have a crisis if we do not examine the issue closely and stay on top of it. Therefore, I welcome the cabinet secretary’s determination to make care for the elderly a personal priority, as she did for healthcare-acquired infections. We will see whether she takes the issue forward and makes greater progress in meeting some of the promises that her deputy made under the previous Government.

Hugh Henry, Claire Baker and a number of other members talked about the general regime under which we provide care in our care homes and in the community. That is important. As Hugh Henry indicated, the issue is not the profit motive but how the system is managed. Southern Cross went for an asset-light approach, which is topical in the private equity sector at the moment. That approach means, first, that assets are stripped out and, secondly, that companies are at risk of breaking their covenants with the banks and getting into the trouble that Southern Cross did. Southern Cross is not alone in that respect, which is why I warn that we may face further crises. The Government’s contingency planning must therefore be robust and engage fully all local authorities so that, as the cabinet secretary and Murdo Fraser rightly said, we ensure that individuals can be kept in their own homes.

Malcolm Chisholm made an excellent intervention using his experience as health minister. He took the Community Care and Health (Scotland) Act 2002 through the Parliament, and he will remember that I was critical of a number of issues and, in fact, voted against my own party. One does not do that too often, but at the time I felt strongly about some of the issues on regulation and how the care commission would work.

It is clear to me that the care commission talks not just about risk management, which is entirely appropriate, but about reducing the level of inspection and inspecting companies only in respect of some elements, provided that they have had a previous good inspection at an individual level. I suggest that that is a highly risky procedure. As I have said, with groups such as Southern Cross, some of the homes are not well managed. A reduction in staff of 400 has been proposed in Scotland today. In my view, that cannot occur without degrading the quality of care, so we must look at the issue carefully.

The fact that there was a good report on Elsie Inglis care home, that complaints were then made that seem not to have been followed up as quickly as they should have been, and that we now find that it is one of the worst homes in Scotland does not give us confidence in the system. We will need to come back to the issue and look at it carefully.

I welcome the fact that unannounced inspections will be the predominant route, although I think that they should be the universal route. I am sure that we will get reassurances on that in due course.

We were all disturbed by the case of Mrs V, but unlike others I do not believe that such cases are uncommon. I regret to say that we have not moved forward in recognising that the 160-year division between mind and body, which is part of the health system and the whole medical approach, is a false dichotomy. In the current situation of an ageing population, with an increasing number of confused and demented elderly going into hospital care, we will face a really dangerous situation. It was entirely inappropriate that the mental hospitals could not cope with the woman and had to shift her to an acute hospital. We must look again at the issue.

We must ensure that the promise that the Government was given in the previous session of Parliament that all patients at risk would be admitted with at least some form of short questionnaire will now be fulfilled. I tell the cabinet secretary that that does not occur universally, so I ask her to look at the issue closely and to make sure that health boards ensure that it happens.

We must ensure an end to boarding out except when it is in the interests of the patient. I suggest that we look at models such as the one in a hospital that I visited recently, which has an overspill ward rather than patients boarded out all over the place. That is more efficient and means fewer moves—moves that should not occur unless they are needed.

We need a further review and we need Health Facilities Scotland to concentrate on hospital design in relation to dementia. I will shortly visit Larbert hospital. I have heard criticisms from patients that its design is not adequate. It is our newest hospital, and we must learn from it in relation to the Southern general. We received a promise from the Government that it would ensure that all new primary care premises would be dementia friendly. That is not occurring: health centres that are not dementia friendly have been built.

In order to reduce unplanned admissions, we must ensure that there are planned alternatives for all those with dementia who are currently living at home, including those in care homes. At present, a general practitioner who is faced with a patient with a relatively modest problem still has no alternative to admitting them to hospital. That is bad for patients in general and expensive for the taxpayer, but it is particularly bad for those with dementia.

Murdo Fraser referred to delayed discharges. I will not deal with that issue in detail today, but I refer back to the cabinet secretary’s statement. I will question her closely on whether some of the measures in response to the deaths of people awaiting discharge have been properly examined and are now part of the governance system. There is no doubt that those with incapacity represent a significant number of delayed discharges—207 in the last census—and many are in hospital for more than six months. It is not good for dementia patients to be in such a setting.

We have promoted the idea of having an old person’s champion, and I urge the Government to take a close look at that.

The main theme of the debate has been whether we should have much more prevention and much less emergency and acute care. We all agree with that, but in reality we are moving further towards providing care only for those who are at the most intense end. I do not have, and I will not pretend to have, a solution to reverse that, but we need to look at the situation closely.

Dennis Robertson, Mark McDonald and others have suggested that we need to look more closely at the involvement of carers and the voluntary sector. However, the voluntary sector is increasingly being squeezed by local authorities—that is moving in the wrong direction. We need to support those organisations and support carers with training, but that area has been cut back.

John Finnie, in an excellent first speech, spoke about a number of issues. I wrote down his name against 12 sections of my summing-up notes, and I am sorry that I cannot pay adequate tribute to his contribution. He made the pertinent and important point that while we need more telehealth and telecare, it should not be a substitute for social contact.

Care and repair services are also under attack. They were ring fenced by our Government, but that is not the case under the current Government. Those services are undoubtedly being reduced, but they are crucial to keeping people in their own homes.

I turn to what so many speakers have referred to as a national care agency. I stress that it is not about creating a new agency—I am sorry that we have not got that message across—it is about having national care service standards for services that are delivered locally, in the same way as in the health service. The health service sets standards at a national level and delivers services locally, and the Government is hugely engaged in that process.

We have moved from 86 local healthcare co-operatives, in which health professionals were fully engaged, to 41 and now 36 CHPs, which have fallen apart repeatedly because they are not underpinned by legislation. The Audit Scotland report is damning, because it clearly shows that CHPs are bureaucratic organisations that often duplicate integration measures from community planning partnerships and other areas. The system is simply not working, and I urge the Government to carry out an urgent review. It undertook its own report on CHPs, but it was relatively laudatory in comparison to the Audit Scotland report, which is much more damning and incisive.

We know that the system can work on a voluntary basis. In Clackmannanshire, in my constituency, there was a 35 per cent reduction in psychiatric referrals as a result of fully merged budgets rather than lead commissioning. It is crucial that the system is delivered locally, and we do not disagree with Alison McInnes in that regard. Sir John Arbuthnott’s expert group showed that local delivery is the way forward. Joint futures and CHPs have failed, and local healthcare co-operatives have been destroyed. Professionals, particularly GPs and primary care workers, have become disengaged.

We need to return to those issues and ensure that we have local, integrated services, because otherwise we will face a crisis in the delivery of elderly care in the next two years.