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Today we are to debate—not for the first time, nor, I suspect, the last—the age-old question of how we care for the elderly.
With the death of an elderly resident at the Elsie Inglis nursing home in Edinburgh under investigation by the police and following the collapse of Southern Cross Healthcare Group, the Health and Sport Committee decided to launch its inquiry into the regulation of care for older people. We wanted to ensure that the system was fit for purpose and that it was delivering the appropriate scrutiny of and improvement in all our care for the elderly.
The inquiry was the committee’s first of the parliamentary session. I thank the 51 organisations that submitted evidence to the inquiry, the clerks, the Scottish Parliament information centre and, in particular, the service users and carers whom we met on our fact-finding visits.
The committee’s report is a consensual one, and it is all the stronger for that. It enables us to provide the Government with a clear steer on areas for improvement in the regulatory system, because although we found the system to be sufficiently rigorous to identify care services for older people that are failing to deliver high-quality care, there are some areas that the Government needs to address. I will cover those that relate to inspections of care services by Social Care and Social Work Improvement Scotland—the care inspectorate—complaints, the national care standards, the workforce, and commissioning and procurement practices. I am sure that other members of the committee will pick up other subjects.
A key issue that was raised right at the start of the inquiry was the proposed reduction in the frequency of inspections of care homes conducted by the care inspectorate. That was criticised, and we were pleased that the committee’s inquiry prompted the Government to address that concern by increasing the frequency of inspections.
Inspections are conducted against four grade themes, but not all the themes are covered in each inspection. That approach was criticised by Age Scotland, which felt that each theme should be assessed as part of a “whole care service review” whenever an inspection was conducted.
There seems to be some contradiction between the Scottish Government and the care inspectorate on the issue of inspecting against the four themes. The Government states that the care inspectorate is assessing whether efficiency savings can be made and resources redirected to inspecting all four themes in all inspections. However, in its response, the care inspectorate states that that will not happen and that although all four themes will be inspected in medium to high-risk assessments, only a sample of 10 per cent of better-performing services will be inspected against all four quality themes. Therefore, the care inspectorate will not provide a blanket approach involving inspection against all the themes in all inspections.
Does the cabinet secretary believe that, to provide maximum assurance of the quality of care, all four themes should be covered in every inspection? The committee calls on the Scottish Government to ensure that the care inspectorate has all the necessary support to fulfil its role.
We heard evidence that the complaints system should be bolstered by greater support for whistleblowers. Our recommendation is that the care inspectorate should publish guidance for all care staff who wish to raise concerns confidentially. The Government’s response refers to the Scottish Social Services Council guidance on whistleblowing, but that guidance does not make specific reference to the whistleblower’s confidentiality being protected. I therefore seek the cabinet secretary’s views on confidentiality as it relates to whistleblowing.
Another key recommendation of our report called on the Government to conduct a review of the national care standards. I am pleased that the Government has accepted our recommendation by announcing that it will conduct a review of those standards, but I ask it to tell us when that review will get under way.
The committee felt that, as well as being in need of an update, the national care standards should have equality and human rights issues at their very heart. The Scottish Human Rights Commission has told me that it believes that the care inspectorate should be encouraged to develop its understanding of human rights standards as they apply in care settings.
Those are not simply dry words. They include, for instance, the right to be free from unintended or careless neglect; the right to be protected from pharmaceutical or medical abuse; the right to live as independently as possible; respect for privacy; and the right to modesty when dressing and bathing.
The Government’s response to our report made no explicit reference to human rights, and I am keen to hear an assurance from the cabinet secretary that human rights will be embedded in the national care standards. That can only help to improve people’s understanding of how those rights can be delivered in practice.
Another area that the committee considered was the care workforce. Its members are vital to ensuring that our care services are of the highest quality, but for many years, the social care workforce has been undervalued and often poorly paid, poorly treated and poorly trained. Its members must be registered, invested in and paid at least the living wage.
We heard from Lord Sutherland during our evidence sessions that there were instances in Edinburgh in which care home staff had left their jobs during the summer to take on casual jobs at the Edinburgh festival because those jobs were better paid. What does that say about the value that we place on the social care workforce?
Good commissioning and procurement practices go hand in hand in determining the quality of care that is delivered by a care service. The committee supports the view of the Coalition of Care and Support Providers in Scotland—CCPS—that the care inspectorate has “far fewer teeth” to challenge commissioning practice in comparison with its powers of intervention in service delivery.
The Government’s response is at odds with that view. The CCPS has reiterated its position on the issue, and it points to a number of issues to support its view. First, there are no national standards for commissioning and procurement against which to assess an authority’s performance. Secondly, there is no minimum frequency of inspection of those functions. Thirdly, there are no provisions under which the care inspectorate can issue improvement or condition notices for poor practice in commissioning.
In addition to the CCPS’s comments, “Commissioning social care”, which Audit Scotland published last week, states:
“Councils ... have been slow to develop strategic commissioning. Only 11 of the 32 council areas had commissioning strategies covering all social care services.”
It also notes that
“there is a risk that councils focus too much on reducing costs when procuring services and give insufficient regard to the range and quality of services and their impact on individuals.”
Given the CCPS’s position and the Audit Scotland report, will the Government explore further the merit in extending the care inspectorate’s powers in that area?
I am sure that I speak for all my colleagues on the committee when I say that I do not view this debate as the end of our work on the issue. Our current inquiry into the integration of health and social care services will doubtless raise issues about the assessment and monitoring of different services. We will also explore in further detail the provision of care-at-home services during our forthcoming scrutiny of the Social Care (Self-directed Support) (Scotland) Bill.
I believe that we all recognise that the commitment to elderly care has been promoted across Governments, across parties and across the Parliament. We must maintain that commitment and never lose sight of the fact that dignity, compassion and kindness should always be at the heart of care for the elderly. I believe that our inquiry has been about doing just that.
That the Parliament notes the conclusions and recommendations contained in the Health and Sport Committee’s 3rd Report, 2011 (Session 4): Report on Inquiry into the Regulation of Care for Older People (SP Paper 40).
I welcome the debate on the regulation of care for older people that the Health and Sport Committee has brought to the chamber following its inquiry into and report on what I consider to be a matter of fundamental importance. I compliment Duncan McNeil on a very good and passionate speech.
I believe that the way in which any society cares for its most vulnerable citizens is a mark of that society. Therefore, after the election last year and in response to some understandable concerns, I made clear my personal commitment, and that of the Government, to improving care for older people in Scotland. We have continued to reaffirm that commitment, both in our words and in our actions. I said then, and I say again today, that the care we provide for our older people is generally good, but being generally good is not good enough. Incidents such as those at the Elsie Inglis care home remind us of the need to be constantly vigilant and to constantly ask ourselves: how can we do things better?
In my evidence to the committee on 4 October, I confirmed the importance that the Government attaches to the inquiry, and gave an assurance that the committee’s analysis of the issues, and any recommendations it came up with, would form a key part of our commitment to continue to review the regulation of care. I thank the committee for its work, and for its recommendations, the majority of which the Government has accepted in full.
Over the past year, we have seen a new regulatory landscape for older people’s care taking shape. On 1 April 2011, the care inspectorate was established as the new single regulator for care services, and Healthcare Improvement Scotland as that for healthcare. The establishment of those bodies has contributed significantly to the simplification of the scrutiny landscape and the regulation of care in particular. As part of the reforms, we introduced a new duty of user focus on those bodies, building on the existing systems for involving service users. I was pleased to see that the committee’s report welcomed the steps taken to date by the care inspectorate in engaging service users in its inspection process and in its use of lay inspectors.
It is also important to put on record some of the other initiatives that the care inspectorate has been taking forward to improve involvement, including service users and carers themselves working with the inspectorate to develop a new approach to how people get involved in inspections. That comes as part of a wider programme of improvements, including changes to the inspection reports and consideration of how inspection findings are publicised. All of that, along with the recommendations and action that will flow from the committee’s report, is important in maintaining and improving public confidence in our regulation regime and in ensuring continuous improvements in care, highlighting high-performing as well as poor-performing care services.
As Duncan McNeil has said, in the autumn I announced a number of other steps that I would take to strengthen the regulatory regime and improve public confidence in regulation. That followed the tragic incidents at the Elsie Inglis nursing home and was, in part, in response to public concern arising from the BBC’s “Panorama” investigation at the Winterbourne View care home in England. Those steps included introducing regulations on an increased minimum frequency for certain older people’s services. To honour that commitment, regulations were laid in December and came into force on 8 February 2012, meeting the committee’s correct call for the increased inspection frequency to commence before April this year.
The regulations make it a statutory requirement that all care home services, including those for the elderly, be inspected at a minimum frequency of least once every 12 months. They stipulate that inspections should be carried out on an unannounced basis. The same regime will apply to care-at-home services for the elderly, which are an important aspect of care for the elderly generally.
We will continue to work with the Convention of Scottish Local Authorities and others, including the United Kingdom Government, to introduce recommendations on how greater financial robustness in the sector can be assured. Duncan McNeil mentioned procurement and commissioning, and we will also work with COSLA in response to Audit Scotland’s recent report on commissioning.
In response to the committee’s concerns about the care inspectorate having sufficient resources, we have made it clear that we will continue to ensure that appropriate funding is in place to support the inspectorate’s current and additional activity, and that efforts and resources are targeted at the areas where they are most needed. In particular, the costs of the new inspection arrangements that we have introduced will be contained in the care inspectorate’s proposed budget settlement for the next financial year.
The inspectorate is, of course, funded not only by the Government, but by the fees it charges, and I intend to launch a review of its fees regime shortly, by means of a public consultation. I intend to have a new system in place for 2013-14, meeting the committee’s request that the Government clarify its intentions regarding fees charged by the care inspectorate.
Looking ahead, as Duncan McNeil mentioned, I intend to commence a review of the national care standards through public consultation. In response to one of his direct questions, I can tell him that we intend the consultation to be under way by June. As I have previously indicated to Parliament, it is important that we consider such a review in the context of work on the integration of health and social care services, new models of care and the implementation of the dementia standards.
I also give Duncan McNeil and the Parliament an assurance that human rights will be at the centre of that review and of the national care standards, just as they are already at the centre of our dementia standards.
Finally, in addition to its work on older people’s care, the care inspectorate is currently developing a new approach to inspecting how services work together to support the most vulnerable in society. It will be testing that new approach in the coming months and implementing it for services that support vulnerable children and young people before applying it to services for adults. That demonstrates the importance that we all place on driving improvement in person-centred, accountable services in a genuinely joined-up way.
I repeat today what I said in my statement to Parliament on 15 September 2011: I fully intend to continue to listen to concerns and debate on the regulatory regime. I have not had the chance in the time available to me today to respond to all Duncan McNeil’s specific points, but I am happy to do so in writing.
I have no doubt that we will come back to debate the issue in Parliament on many occasions. It is vital—and I take the responsibility squarely—that we take whatever steps are required to ensure that there is confidence in the care system and in the regulation of that system.
I thank the Health and Sport Committee for its work. I look forward to working with the committee and other members to continue to provide the services that our older people have a right to expect.
I welcome the opportunity to debate the Health and Sport Committee’s report on its inquiry into the regulation of care for older people. Like others, I commend the members of the committee for their work.
As Duncan McNeil rightly reminded us, it was less than a year ago that we debated in the chamber the disturbing events at the Elsie Inglis nursing home, which is not a stone’s throw from the Parliament. The poor standards of care there resulted in two residents dying and six being admitted to hospital. There were distressing reports of residents sleeping on stained and ripped mattresses, of residents 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 care inspectorate inspected the home and gave it a good report. Families had confidence in and relied on such good reports when they made decisions about which care home to place their loved ones in.
It is clear that the change that happened at the home was dramatic and very quick, and was picked up only because the City of Edinburgh Council acted on a complaint and subsequently brought it to the attention of the care inspectorate. I understand from the cabinet secretary that the police investigation is still on-going.
Although it is important to acknowledge that the majority of care homes provide first-class care, there are still too many where the quality of care leaves a lot to be desired. It is incumbent on the Government to ensure that people have confidence in the quality of care for older people across Scotland.
A robust inspection regime is key to that, and the Scottish National Party has finally discovered that that cannot be done on the cheap. Members may recall that the care inspectorate was to start life with a 25 per cent budget cut and a 20 per cent reduction in staff, the majority of whom were to be inspectors. The regime was to move from twice yearly inspections to risk-based assessments, with some homes not being inspected for as much as two years. Given what we know about the speed at which the problems at Elsie Inglis mushroomed, that hands-off approach seems wholly misplaced.
I therefore welcome the SNP’s conversion to more frequent inspections and the partial restoration of the care inspectorate’s budget. However, it is disappointing that the cabinet secretary, and even the First Minister, were in denial about the budget cut in the first place. Their ostrich-like behaviour meant that a number of staff who took voluntary redundancy or early retirement this financial year have now had to be rehired at an additional cost, over and above their redundancy packages, of approximately £400,000. That money could have been spent on ensuring the best care for our older people.
Inspections are important in ensuring quality, but I think that all members agree that the quality of care staff is also key. We are talking about an area in which we know that wages are low and investment in training and upskilling the workforce is not generally a priority. The committee recommended that care staff be paid the living wage. If homes value their staff, they will be repaid in staff commitment and in the quality of the service.
The Government’s response in that regard was disappointingly timid. If it had the political will to do so, it could use procurement and commissioning of services to drive up standards and thereby drive up quality. In many cases it is the local authority and ultimately the Scottish Government that provide funding for adult residential care, so we can do more.
I will touch on the qualification standards that are expected of the workforce and on the committee’s recommendation that the Government accelerate the timetable for registration of care workers. It might be instructive for members if I outline the timetable for registration of workers in adult care homes: managers had to be registered by November 2009; workers with supervisory responsibilities have to be registered by March 2012; practitioners have to be registered by March 2013; and support workers, who make up the bulk of the workforce, have to be registered by September 2015. Support workers are expected to attain a Scottish vocational qualification at level 2, but they do not have to do that by 2015; they can take another three years, so we are really talking about 2018.
The Scottish National Party’s response to the committee’s call to accelerate the timetable was non-committal, at best. If we want to drive up standards and if we care about the quality of care for our older people, where are the urgency, the drive and the ambition? The Government cannot afford to stroll along on the issue. Progress is slow in relation to a number of recommendations—for example, on commissioning, enhanced powers for the care inspectorate and changes to the national care standards.
The Royal College of Nursing said that, given the increasingly complex care needs of older people, we require an increased number of qualified nurses in the care home sector, and called for a national approach to guaranteeing staffing levels.
On the national care standards, we have been promised a review by the First Minister and by the cabinet secretary. The question is, when? The cabinet secretary said that the review would be under way by June, but that is too long a timescale for embedding human rights in our care system.
The cabinet secretary has often talked about our sacred duty to older people, and rightly so, but she has a sacred duty to do more than just talk about the problem. Scotland’s older people want and deserve action, and that action must go at a faster pace than the SNP Government’s current glacial pace of change.
It is worth highlighting that the social services staff workforce is around 200,000 strong. There are 943 care homes for the elderly, with more than 39,000 beds, and they account for 90 per cent of care home residents. Therefore, our debate affects thousands of vulnerable people and their families, friends and carers.
I enjoyed being a member of the Health and Sport Committee while it was carrying out post-legislative scrutiny on implementation of policy on care for the elderly—to be honest, I enjoyed most of that. I enjoyed working with the new members, Richard Lyle and Mary Fee, who have a background in local government and are both enormously committed to improving care for the elderly.
I am pleased that the health secretary has accepted the committee’s main recommendations. For me, the main issues are the 70 per cent of elderly people in care homes who are being given psychoactive medication; training and support of care home and care-at-home staff; and the general feeling that the care inspectorate would bring confidence and reassurance to the sector after the dreadful events that members mentioned.
In its response to the committee’s recommendations on psychoactive medication, the Government gave a commitment to
“complete a baseline assessment on current prescribing levels in January 2012 ahead of an initial commitment on reducing such prescribing.”
The Government went on to say that the care inspectorate has confirmed that it will have discussions with the Mental Welfare Commission for Scotland on creating new guidance and improving awareness on the important area of psychoactive medication. It also said that the Royal Pharmaceutical Society is about to publish a report on pharmaceutical care in care homes, and that a review is under way, the report of which is due in the autumn.
Of course I welcome the “baseline assessment”, the discussion, the guidance and the improvement of awareness as a result of the review, but am I reassured that there will be improvements in the use of what is often described as the chemical cosh? The truth is that I do not know. If I were being generous, I might say that, if all this works, it might improve the situation and things might get better.
It is hardly surprising that I sound a bit impatient. All the same issues and more were highlighted—tragically—in “Remember, I’m still me”.
I understand that the Mental Welfare Commission is to issue new guidance. Does the member think that that should be a matter of some urgency? Secondly, I simply point out that the one recommendation that the Government has rejected is that the long-term conditions registration process be open to care home residents.
I have so many concerns about this issue; it should be the subject of a debate in its own right. If I may say so, Presiding Officer, I feel that an hour and a half is not sufficient for this topic. However, I hope that we will be able to debate it another day.
“Remember, I’m still me”, which was a joint report by the care commission and the MWC, was published in 2009. Has anything improved since then? The truth is that I am not sure—I simply do not know. On the evidence that was available to the committee and from all the reports and reviews, it seems that not much has changed in the past three years. For example, “Remember, I’m still me” said:
“very few people had a planned health check every year by their GP and there was little evidence that medication was regularly reviewed.”
Three years later, the committee heard exactly the same thing. There is still little or no evidence of annual health checks by GPs and still little, if any, evidence that medication is regularly reviewed. “Remember, I’m still me” also pointed to
“evidence of inappropriate and multiple prescribing” and the fact that
“Very few care homes had the right information or legal safeguards ... to give covert medication” and said that, despite specific warnings, certain drugs were being used.
My second concern—as I am summing up, I will finish it in my closing speech—relates to the training and support of care home and care-at-home staff. Hugh Henry, Richard Simpson and I were members of the committee that considered the Regulation of Care (Scotland) Bill, but we were never told—and indeed would never have expected—that it would take 20 years to train and register all existing staff. However, much of the training that is required for care home and care-at-home staff could be carried out through assessments in the workplace and distance learning.
I will finish there, Presiding Officer.
The Presiding Officer:
Thank you very much. We move to the open debate. I point out that, as time is tight, back-bench speakers will be entitled to four minutes. I will be most grateful if members can keep to that; if they do not, those who wish to contribute will have to fall off the end of the list.
As a member of Health and Sport Committee, I welcome the opportunity to speak in this debate on its report on the regulation of the care of older people. As a result of the demographic shift facing Scotland, the number of people aged 60 and over will increase by 50 per cent by 2033. Although more and more of us will enjoy healthy life expectancy and can expect to live longer, each of us is likely to have one or more long-term or life-limiting conditions by the time we retire.
In ensuring that older people receive high-quality care in a setting most appropriate to their needs, society will have to deal with a number of challenges. We must ensure that the system of registration, regulation and inspection is not only fit for purpose but fully funded. Care services will have to adapt and to accommodate the move towards increasing provision of care in a person’s home rather than in a hospital, institution or care home.
Given that the regulatory system was established by legislation passed in 2001, it was felt appropriate for the committee to undertake this inquiry and carry out valuable post-legislative scrutiny 10 years later. We have already heard about the issue of funding, and I was interested to note in the report that
“The Committee welcomes the assurance given by the Care Inspectorate that it will be able to find £400,000 of efficiencies which can be reinvested to supplement the current complement of inspection staff in order to meet the increased demands required of it.”
I think that we will all welcome that.
The committee asked a number of specific questions, the first of which was:
“Can we be confident that the regulatory system is picking up on care services where the quality of care is poor?”
The committee concluded that
“the current regulatory system is sufficiently rigorous to identify care services for older people which are failing to deliver high quality care.”
The committee also asked,
“Are there any particular weaknesses in the current system?” and agreed that there are areas in which the care inspectorate and the Scottish Government must continue to take action.
The committee recommended that care services should receive at least one unannounced inspection each year and expressed the view that such an increase in the number of inspections should be implemented before the expected statutory commencement date of April this year. The cabinet secretary has recognised that the previously planned rate of inspections was not sufficiently frequent to provide reassurance that standards of service were being maintained and improved. That shows exactly what the role of the committee system and the Health and Sport Committee is in Parliament. The committees bring issues before the Government that can then be addressed by the Government in a way that we all want to see.
Resources are critical. There must be sufficient resources in the system to ensure that the care inspectorate can fulfil its role and discharge the functions that the Government has given it. The care inspectorate and the cabinet secretary assured the committee that the available budget would be sufficient to allow that to happen. The care inspectorate also made it clear that, if circumstances were to change such that it no longer felt that it was sufficiently resourced, it would make the Government aware of the need for additional resources.
The report covered several other issues, such as whistleblowing so that staff can speak out on behalf of patients. That must be linked to ensuring that all healthcare professionals have a clear duty of care to report all concerns when they arise. The committee felt that that duty should be given far greater prominence in the training of all healthcare professionals.
This is an important report that can herald much-needed improvements in the regulatory system, but there must be a willingness to take action when it is required, and proper evaluation of progress over time must be done—
There is no room for complacency when it comes to improving the care of older people, but I believe that certain people should be commended. First, the Health and Sport Committee is to be commended because the report is impressive and comprehensive. When I started on Twitter at the end of September, one of my earliest tweets was from the Health and Sport Committee and was about how the committee showed Parliament at its best. The Opposition, too, should be commended for raising various issues during the past few months. Last, but by no means least, the cabinet secretary has shown herself to be very willing to respond to the concerns that the committee and Parliament were expressing.
This subject was one of the first to be debated after the election. I spoke in that debate on 9 June, partly because I had grown very interested in what was happening at the Elsie Inglis nursing home in Edinburgh. It is frustrating that neither the Health and Sport Committee nor anyone else can get any insight into that situation because of the police inquiry. I know that because I have submitted a freedom of information request yet still have not been able to get information because of the police inquiry. We might eventually know more about what happened there, but it threw up many of the issues that have been the subject of debate and inquiry since.
One of those issues is the frequency of inspections and, again, the cabinet secretary is to be commended for—I have to say this gently—going back to the original 2001 system of one unannounced inspection a year. She deserves credit for making that decision. The other issue that was raised by the case of the Elsie Inglis home was the consistency of inspections. It seemed odd to everyone that a home that had had a good grade became totally unacceptable; we still do not know all the reasons for that. We are told that there were management changes at the nursing home. That might explain it, but people are still concerned about consistency of inspection. The committee, rightly, made a recommendation about that.
Another interesting issue is the number of themes that should be inspected. The committee gave a measured recommendation on that and talked about taking a risk-based approach. The cabinet secretary is going further and saying that we need to deal with all four quality themes, so that issue is still to be resolved.
The main theme that I emphasised during the debate on 9 June 2011 was the need to involve residents in the inspections. We need to look at their emotional care and the stimulation that they receive as well as their physical condition. Although the committee highlighted that issue, it is the one area that the committee might have emphasised more in its report.
We are asking the care inspectorates to inspect more often, to deal with more quality themes and to have more user focus, so this is a difficult issue. We have to trust our front-line staff to have some discretion, which is why, on balance, I probably agree with the committee’s approach to thematic inspections and with the need for flexibility in relation to the number of themes to be explored.
We need to reduce the bureaucracy of care inspectorate staff to a minimum, so that they have as much time as possible to spend in care homes and, in particular, to engage with care users. That kind of user focus was embodied in the original 2001 care standards, of which every member at the time was proud, but the committee’s recommendation that they should be reviewed and the Government’s acceptance of that recommendation are important. We have to move forwards, particularly in relation to the dementia standards.
Finally, commissioning is the one area on which I am not entirely clear. The committee made a good recommendation about a greater role for the care inspectorate in commissioning, but the Government says that it is already possible for the inspectorate to do a lot of that work. I am a little unclear about what can and cannot be done, but it is certainly an important area. I hope that the commissioning practices of councils will be increasingly challenged, where necessary, by the care inspectorate.
As a member of the Health and Sport Committee, I welcome this debate, and I thank and congratulate all involved in securing it. I am especially grateful for the excellent contributions to the report by my good friends Mary Scanlon and Mary Fee, both of whom are, sadly, no longer on the committee.
With an ageing population, it is increasingly salient that we ensure that older people are provided with the correct care. It is important not only that the correct care is provided but that we can deal with the increased demand for care as a result of demographic change. Sadly, as the report makes clear, healthy life expectancy has not increased at the same rate as life expectancy, and men and women can expect to spend about seven and nine years respectively in poor health. That suggests not only that the demography and demands are changing but that those changes will have a detrimental effect on the health of all Scottish citizens.
The type of care that is required is changing and must adapt to accommodate the move towards provisions for care in a person’s home as well as for care in a care home. The motivation to produce the report stemmed from the increasingly high-profile cases of the past year, including the announcement in July 2011 that the Southern Cross Healthcare Group would cease to be a care home operator, a decision affecting more than 90 care homes in Scotland. Our aim was to scrutinise and investigate the relevant legislation in order to reveal any weak areas in the regulatory regime and to examine whether the safeguards were robust enough to protect the elderly.
Although the report shows that the current regulatory system is sufficiently rigorous to identify those care services for older people that are failing to deliver high-quality care, that does not mean that there are no weaknesses. I will highlight a few. There must be improved accessibility to and better dissemination of inspection reports, as well as enhanced engagement of healthcare professionals in the inspection process. There must also be research into the appropriate staffing mix for care homes and other services for older people, and all staff should be paid the living wage and trained to the highest standards.
The committee’s inquiry has received widespread support, including from the Scottish Human Rights Commission, which has welcomed this debate, because it has a number of recommendations for areas of improvement. The responses that the report has induced from bodies such as the commission on how we might further regulate our system are extremely valuable for the growth of better regulation for the care of older people.
In addition to that outside support, I welcome the cabinet secretary’s previous announcement that care homes for older people would receive at least one unannounced inspection each year, and that it was hoped that that provision would be implemented before the expected statutory commencement date of April 2012. In fact, that provision came into effect on 8 February, which is great news.
Feedback from inspections and from relatives and friends of care home residents should not be deemed as negative. We would like to encourage the process of regulation from within the care homes themselves. The report has already highlighted important areas that lacked integrity previously. It also works as a tool for knowledge for those who are unaware of the changing demographic situation, which must be addressed right away.
Quality of care for the elderly is a key priority for the SNP Government. The SNP is bringing forward inspired plans on the integration of health and social care through the Social Care (Self-directed Support) (Scotland) Bill. We aim to make the transition as quickly as possible so that we avoid any more tragic incidents. The Government has taken on board the committee’s recommendations. I welcome the debate and compliment Duncan McNeil for bringing the report to the Parliament.
It is worth noting that, when the inquiry was first proposed, the intention was to hold a one-day evidence session. Because of the serious nature of the incidents that led to the inquiry, I felt strongly that a one-day inquiry would not be adequate to investigate fully the issues surrounding care for the elderly or to do justice to those who were affected by the tragic events at the Elsie Inglis nursing home last year. The decision not to hold a one-day inquiry was criticised in the press. I leave it to the readers of our report to draw their own conclusions as to whether one day would have been enough.
I will highlight a number of issues that relate to the report. First, the prospect of having oversight of the financial viability of the multimillion pound corporations that are involved in the care home sector presents us with serious challenges. It is certainly simple that, before a licence is issued, a full and in-depth financial disclosure should be provided. However, in the world of private business—big or small—difficulties can and do arise in a short space of time. For obvious reasons, that is normally kept top secret by private companies, whether in the care home sector or in other sectors, at least in the short term. Nevertheless, the fact that the issue presents us with challenges is not a good reason not to explore how we can be better informed so that intervention can be orderly rather than alarming.
Secondly, it is clear from the evidence that we require not only a dedicated staff for the care sector but a well-trained and well-rewarded professional workforce. However, training and higher wages come at a price. It is difficult for me to imagine how both aims can be achieved without additional new moneys. In my view, those goals can be realised only by reducing the profits that the companies that own care homes enjoy, or by raising the charges to those who use the services, which means individuals or local authorities.
An indication of the urgency that is needed can be seen from all the predictions from informed commentators, including the Scottish Government, that the number of people who will be in need of such care will continue to grow, if not explode, in the next few years. The issues that are raised in the report highlight significant challenges for us to tackle in the not-too-distant future. I can say without overstating the situation that, given the cuts to our budget from Westminster, we will need to be inventive to make the difference. Not to put too fine a point on it, sooner or later, some of us will be in need of such care. Our decisions will affect the whole lot of us. Given the Parliament’s record on these matters, I am confident that we can get it right. I commend the report to the Parliament.
I am pleased to speak in the debate, as the report on the regulation of care for the elderly is the culmination of months of work by the Health and Sport Committee, which I was a member of before I moved to the Equal Opportunities Committee. I fully welcome the report. The regulation of care for the elderly has had a lot of attention in the past year. Improvements in care for the elderly need to be made quickly.
The importance of inspections and a robust and thorough inspection process has been highlighted. Another thing that can contribute to better regulation and care is a robust complaints procedure. Every care home and care service must have a fit complaints system at its heart so that service users, relatives and carers can feel confident that any issue that they raise, internally or externally, will be considered seriously and resolved. That is a must for driving improvements in our care service across Scotland and will benefit the service users as well as giving comfort to families that their loved ones are being looked after well.
Many people do not feel confident about complaining to a care provider directly, partly because of the lack of profile of the complaints process. I therefore welcome the cabinet secretary’s response, during the evidence sessions, that the Scottish Government will continue to support the care inspectorate in raising the profile of the complaints process. I was also happy to find, in the Government’s response, that it accepts the committee’s finding that there is a need for a single point of entry for integrated services. I hope that that is given full attention as the Government focuses more on the integration of health and social care services up and down Scotland.
I take the opportunity to discuss regulation of the workforce—in particular, those who provide care services to the elderly through self-directed support. Will those care providers be regulated? The registration of workers is vital to ensure the highest standard of care. What assurances can the cabinet secretary give the chamber that the Social Care (Self-directed Support) (Scotland) Bill, which will come before Parliament in the near future, will ensure that all staff who are taken on by service users are fully trained and registered, as those in care homes and the care sector are?
Members will know that, last year, I raised many concerns about cuts in the third sector, the impact of which was felt acutely by staff in organisations such as Quarriers, whose level of care is of the highest standard. In its report, the committee shares those concerns that the social care workforce has long been undervalued. The Quarriers case was a perfect example of that. Those at the bottom, who provide essential care to our elderly, bear the brunt of cost cutting at every level of government. A worker’s pay should reflect their output, and no one can doubt the excellence of the care that many care workers in Scotland provide, yet they do not receive what they should, nor do they have relevant terms and conditions or a chance of training and development.
In addressing the regulation of care for our elderly, it is essential that we assess the procurement process to guarantee that staff and service users do not suffer due to a race to the bottom in tendering services. Regulation and procurement are very much entwined in how services are run.
I welcome the cabinet secretary’s response on the living wage and hope that the Government can do more than support it in principle. I hope that it will introduce legislation to bring a living wage to everyone in Scotland, not only in the care sector. The living wage is essential to bringing people out of in-work poverty, which is the position of many workers in the care sector, particularly women who work part-time. I, too, await the outcome of the inquiry into the living wage in Scotland by the Local Government and Regeneration Committee.
Although we all welcome the report, I hope that every member will continue to work to improve the lives of our elderly, our vulnerable and our disabled, no matter what constitution is in place. We all know—
As someone who is not a member of the Health and Sport Committee, I thank the members of that committee for the report. I am also grateful to be able to speak in the debate. As the cabinet secretary said, how we care for our elderly and vulnerable people is a reflection of the society in which we live. If we cannot care for our older people, that says something about our society.
The speeches that we heard from Duncan McNeil and others were excellent and raised some very good points. Malcolm Chisholm raised issues from his constituency and talked about the Elsie Inglis nursing home. However, I was disappointed in Jackie Baillie’s speech, as she seemed to use the committee debate as a political stage instead of trying to get to the nub of the committee’s report, which I understand was supported by all the parties that are represented on the committee—I commend them for that. Committee debates are important, and I look forward to the next one, in which I will also speak. It would be great if committee debates in the chamber were a regular feature so that committees had the opportunity to put forward what they have been looking at and the inquiries that they have been pursuing.
I am the convener of the cross-party group on older people, age and ageing, and the issue of care homes—their treatment of people, their staffing and the frequency of inspections—is raised often in that group, not just by members of the group but by individuals. I go out into my constituency and try to visit care homes, not just as most MSPs do, but as the convener of the cross-party group.
I am pleased that the Scottish Government has taken on board most of the recommendations in the committee’s report, particularly the recommendation on the frequency of inspections of care homes, which is an issue that individuals have raised on many occasions. It is important that visits are unannounced and that people know exactly what to expect.
Duncan McNeil mentioned whistleblowing, and that is something that we have to look at. Many staff desperately want to tell people what is happening in some care homes and the nastier aspects of it, but they are terrified to say anything. That is an important point and we need to look into it.
The training of staff is an important issue, and Mary Fee mentioned the need for fair wages. If we want decent staff, we have to give them a decent wage. We have to look at that also.
As we all know, the percentage of older people is growing, unfortunately. Perhaps we will get more younger people in, particularly with immigration, but we know that the propensity exists for older people to form the biggest population group in Scotland, so it is incumbent on us to ensure that our older people are looked after and cared for properly. After all, we will all be old one day. That is why it is important that the care of elderly people is properly regulated, that care homes are properly inspected, and that the legislation is in place to provide what older people want. After all, they are the ones who have to live with the consequences.
It gives me no pleasure to say that members would not want to live in, or even visit, some of the care homes that I have visited. We need to ensure that the regulations are watertight so that our older people can live in dignity. That is where the human rights issues come into the debate.
I am grateful for the opportunity to speak in this debate. I look forward to the future and I thank the Scottish Government for taking on board most of the recommendations in the committee’s report.
I rise to speak as the next member on the conveyor belt.
Although I am not a member of the Health and Sport Committee, I welcome the opportunity to speak in the debate. After all, at the heart of the inquiry was the need to ensure that our older people have systems and structures that provide a safe and dignified life.
I put on record my appreciation for the hard-working, compassionate people who care for our older people. The role that they play in the lives of many of our senior members of society should not be taken for granted.
Recently, we saw the financial collapse of Southern Cross, and we all worried about the ramifications for residents and staff alike. We must ask why that situation came about. Was profit pursued ahead of care? Were residents merely customers? We must accept that the reason why our demography is changing, with people living longer lives, is massively influenced by the NHS being a public service and not a private one. We must look at ethical finance models for care services, such as mutuals and worker co-operatives, which have as their priority the care of service users, not shareholder profits. When we have an ageing population but people are not necessarily living healthy lives for longer, we need to have services for older people that we can trust. That is why it is concerning to read in the committee’s report—
That is why it is concerning to read in the committee’s report that, in some cases, residents and service users do not feel confident about contacting service providers directly to make complaints. How can we allow our older people to be cared for by businesses that they do not feel confident in speaking to?
There have been worryingly similar accounts from staff about whistleblowing in the sector. We need to see a commitment to work with trade unions and employers to ensure that staff feel supported in the event that they need to report poor practice. I was pleased to see the Royal College of Nursing call for independent care providers to keep formal registers of all concerns that are raised by staff in order to increase accountability and improve practice. However, I know from my background in social work that having better whistleblowing support and complaints procedures is not enough, because concerns about complaints and whistleblowing do not usually arise without reason. If there are issues that are being complained about, we need to tackle them and not just the complaints process.
Is it too much to expect staff to be properly trained and qualified in best practice in caring for our older people? Staff deserve that as much as service users do. Such training is vital as we try to reduce the high turnover of demotivated staff. On that point, I am glad that the committee supported Labour’s call for a living wage for care employees.
We need to ensure that a qualified and properly remunerated workforce is properly monitored and appraised through inspections and follow-ups. With such support, it can deliver and maintain the high standards of care and support that our old people deserve.
As more and more people live into extreme old age thanks to the support of modern medicines and an excellent health service, pressure is undoubtedly growing on the organisations and the people who care for the frailer members of our elderly community, many of whom have very complex physical and mental conditions. Those people increasingly depend on the staff who look after them for good-quality care.
In recent years, there have been disturbing reports of people who have been let down by the care services that were available to them. The Health and Sport Committee’s report on the regulation of care for older people is timely and makes interesting reading, even for those of us who were not directly involved in hearing the evidence or producing the report.
I was pleased to learn that guidance will be published for care staff who wish to raise concerns about a care service confidentially. I am sure that we all know just how vulnerable older people feel who depend wholly for their health and wellbeing on the care that others provide. Many are frightened to complain, or even just to speak out, in case they get picked on—I am sure that we have all heard anecdotally of examples of that.
Government support to raise the profile of the complaints process is welcome, as is the national inquiry line, which was set up in April last year. The line deals with more than 2,000 calls per month on care issues and signposts people to other relevant bodies, but I wonder whether families, carers and users of care services, as well as care staff, are all fully aware of the service. I would like it to be publicised more widely.
I welcome the commitment and the work that has been done to reduce the time between inspections and the publication of inspection reports. It is important for those who commission care—whether that is a council, the NHS or families and carers—to have access to the most recent information as soon as possible before making any decisions about placement in care homes. I would also like a system to alert councils to a very poor inspection report, so that they may consider suspending placements until they are satisfied that significant changes have been made to bring the service up to the quality standards that are expected of it.
Paragraphs 42 and 43 of the report relate to enforcement powers, which have concerned me for some time. I think that most people in Scotland would like to be sure that, following a poor report, the service will be improved to the extent that it meets quality standards, but that will happen only if rigorous enforcement procedures are implemented.
Training is another important issue that the report deals with. I have no doubt that better training will lead to higher quality standards, higher morale and, I hope, a higher rating by the care inspectorate. That win-win situation should also lead to a better wage and career structure for many care workers, as many of them are underpaid. That should result in reduced staff turnover—turnover is another significant problem that faces people who receive care, in particular care at home.
I welcome the Government’s commitment to reduce the prescribing of psychoactive drugs. Concerns about psychoactive and covert medication have been around for some time and were raised in the “Remember, I’m still me” report three years ago, which Mary Scanlon mentioned. A number of members will have met my constituent Hunter Watson, who has been a dogged campaigner on the issue for many years and still has the concerns that Mary Scanlon highlighted.
Some older people—particularly those with dementia—can be extremely difficult to handle when they become severely confused and agitated. Psychoactive and sedative medicines are the easy way to deal with them, but that is wrong and stops a number of people functioning at their best. Proper and adequate training is essential to equip staff with the skills to deal appropriately and sensitively with such people, so I welcome the recognition of the need for better training in dementia for care workers.
I would like to make four brief points. First, I thank the Health and Sport Committee for the power of work that it has done and I commend the hard work of all its members.
In addition, I welcome the cabinet secretary’s speedy response to the key issue of the frequency and nature of inspections.
I have a general point to make about the language not of this debate but that is frequently adopted in the press with respect to the issue of our population demographics. My colleague John Mason lodged motion S4M-02189 last week on that very subject, following a press report that used language such as “demographic time bomb” and “increased burden”. The motion stated that
“older people are inherently a good thing for Scotland ... Scots of all ages have much to contribute to society and ... in particular, older people can be a source of wisdom and support for their immediate families and the wider community”.
I absolutely endorse what my colleague said in his motion.
My last point is about one of the committee’s specific recommendations, which is on the important issue of monitoring financial viability. My colleague Gil Paterson alluded to the issue earlier. The committee was very concerned about the issue and it recommended that
“the Care Inspectorate should require registered service providers to submit copies of their annual accounts.”
It recommended that they should do so year on year. The committee pointed out that the information is already provided at the outset of the registration process as a set of annual accounts.
The committee’s idea is interesting, but I have questions about the efficacy of using that approach to secure on-going monitoring of financial viability, because annual accounts show the position for historical periods of time. I hope that the minister can indicate in his winding-up speech how that very important issue could be dealt with.
I welcome the fact that the cabinet secretary is undertaking work with the care inspectorate, COSLA and other relevant bodies to bring forward recommendations on how financial robustness in the sector can be assured. The aim of course would be to ensure that there was on-going risk assessment.
Within the continuing work, I wonder whether it would be helpful for the Scottish Government to consider requiring additional on-going financial reporting by service providers, which could be justified in light of the vital public interest that is involved. Of course, it may be too early to say what the direction of travel is in the discussions, which involve more than simply the Scottish Government, but it would be interesting to hear the minister’s response.
I put on record my thanks for the outstanding job that care home staff and other staff do throughout Scotland for so many individuals and, of course, their families.
I put on record my support for the points that my colleague Nanette Milne made.
I was probably the most vocal member of the committee on the issue of training and support for staff. Again, I am sorry to say that I found the response disappointing. The best that I could find was that the Scottish Social Services Council
“will continue to work with employers on the development of qualifications and products that support and delivers a competent, confident and qualified workforce.”
I am not entirely sure what the SSSC is continuing and whether it means that more care workers will be trained, supported and valued, but I hope that it does.
The fact is that care workers with little or no training are going into the homes of vulnerable elderly people. Investment in our colleges and the Scottish Social Services Council could secure training, would value and support the workforce and, most of all, could provide better-quality care to thousands of older people.
Jackie Baillie gave us earlier the timetable for registration of workers in adult care homes, but I will add one date to that. Registration for workers for care-at-home services will not start until 2017, with achievement of registration by 2020.
After reading the report again and reading the Government’s response, my conclusion is that there suddenly seem to be dozens of new plans and reviews. I totally agree with Malcolm Chisholm’s point about reducing bureaucracy and allowing the care inspectorate to focus on the job that we want it to do. He also raised the issue of the two paragraphs in the report on involving service users, friends and relatives, which is important, too.
The care inspectorate’s response to those two short paragraphs is that it has already started to build on the issue; it has another recently completed review; a care inspectorate involvement strategy is being developed; it is working on developing new methodologies; it has held a series of focus groups; further work is now required to underpin the new scrutiny model findings; it is preparing a full public reporting strategy; there will be a new proactive approach; it is undertaking an evaluation of its risk tools; it is holding a series of scrutiny, intelligence and risk events; a new assessment tool is on its way; and it is currently developing its involvement and intelligence strategies. There are 11 initiatives in response to two short paragraphs.
That is why I find things difficult. I hope that that is what is required, that this is not about building bureaucracy, and that what is being done will lead to improved standards, but the approach seems incredible. There are new plans, reviews, strategies and action plans, but the truth is that we really do not know whether things will be better. The response is typical of the Government’s response, although it is more the care inspectorate’s response.
I hope that the committee’s report will improve the health, welfare and wellbeing of older people who receive care at home or in care homes, but I am not convinced of that on the basis of what I have heard today. I hope that we will visit the issue again soon, given that much work is being done in the background. An update on the improved inspection process and regulation would be helpful.
I begin by making a declaration. A relative of mine recently went into a care home, and I am a director of Nursing Home Management Ltd, which runs a single nursing home in England.
As we have heard, the inquiry arose from a combination of serious events at the Elsie Inglis home, which recently had good assessments, and the collapse of the Southern Cross group of homes. As Malcolm Chisholm said, the report illustrates the Parliament working at its best in partnership with the Government and the Opposition. The Government responded as evidence came in. In particular, it reversed in part the cuts in the new care inspectorate budget, although that came too late to prevent significant redundancies among qualified inspectors, and it has modified the lighter-touch inspection regime to which Parliament had signed up. As Jim Eadie said, we will need to scrutinise the care inspectorate’s capacity to perform adequately.
One of the core concerns arose because of the rapidity with which the level of care declined at Elsie Inglis. Jackie Baillie and Malcolm Chisholm described that. Risk assessment that underpins the announced and unannounced inspection system is critical if public confidence is to be maintained. In England, the recent resignation of the chief executive of the Care Quality Commission demonstrated the importance of public confidence. Therefore, I welcome the continuing efforts to ensure that the risk assessment tool is subject to further iterative development, as are the triggers for additional unannounced scrutiny. Will the Government place the new tool and strategies in the Scottish Parliament information centre as soon as they become available? I hope that that will be soon.
The inspectorate’s national inquiry line and dedicated national complaints team are welcome, but independent evaluation of its credibility with residents, staff and carers is needed. As the cabinet secretary knows, I have been pressing for an independent and confidential whistleblowers telephone line for NHS staff, which should be for all care staff given the pending integration of health and social care. I hope that that will be part of the cabinet secretary’s welcome commitment to raising the profile of the complaints system generally. The complaints system should be aligned and integrated with the new complaints process for the NHS. As Mary Fee reminded us, the landscape is far too cluttered. It needs to be focused on the individual, not on service silos.
On the engagement of health professionals, the development of shared protocols between the inspectorate, the General Medical Council and the Nursing and Midwifery Council is welcome. Visiting health staff are being invited to comment as part of the pre-assessment. However, the Government’s rejection of the involvement of community pharmacists beyond their current role is a mistake, and it deprives residents of the same rights to registration for long-term conditions that others will enjoy. That really must be extended to other groups, such as optometrists and audiologists, as part of a falls prevention strategy.
I welcome the greater fulfilment of the key performance indicator on timing of publication but, as Richard Lyle and Nanette Milne said, local authorities must be alerted to that and we need to ensure that the process continues.
I also welcome, but seek some urgency on the implementation of, the powers to refuse further registration of services and, as Anne McTaggart and Annabelle Ewing said, powers to examine the financial health of care homes.
Many members mentioned the need to value the workforce, the absolute need to establish a minimum wage, the need to ensure that there is good training and the issue of registration. The length of the registration process is now more crucial than ever. We are moving to self-directed care and much more home support, so we need care workers to be registered early. I hope that discussions on that will continue.
We need the national care standards urgently, not in the future. We also need all local authorities, not just 11 out of 32, to have commissioning strategies if we are to prevent further scandals like the one that was exposed by the BBC’s “Panorama”.
The committee has published a useful report and we have had a useful debate that shows our shared concern to ensure that the regulation of care services in Scotland is proportionate and right to meet the needs of the individuals who use them.
In his opening speech, Duncan McNeil helpfully set out the catalyst for the committee’s decision to undertake the inquiry—the incident at the Elsie Inglis care home and the financial collapse of Southern Cross. From the way in which the matter played out in the media, it was clear that there was public concern about the operation of care establishments in Scotland—if not, to some extent, throughout the UK.
It is essential that there is public confidence in the regulatory regime for Scotland’s care services. That is why the Government has been prepared to consider where changes can be made to ensure that the regime is sufficiently robust and proportionate. We are open to making such changes and, to a large extent, the committee’s report recognises that.
Mary Scanlon helpfully pointed out the overall scale of social care provision in Scotland, the number of people who receive such services and the number of people who work in them. We should not underestimate the scale of that business or the need to ensure that the system is correctly balanced.
We have accepted the majority of the recommendations that the committee made. I note that some people think that we have not moved as fast as we could have on particular matters. However, when we have been able to take early action—such as on the regulations on the inspection regime—we have done so at the committee’s request.
It should be noted that the national care standards have been in place for almost 10 years. They have stood the test of time but there is no doubt that, given the changes in demographics and some of the challenges in social care, we must review them in order to get them right. However, it is not a simple case of refreshing the existing care standards; it is also about ensuring that they work in tandem with the standards on dementia care and the review of the social care contract that COSLA is undertaking. We need to ensure that that collection of standards works in partnership. It is better to take appropriate time to get that right to ensure that, if the standards are in place for another 10 years, they stand the test of time.
Duncan McNeil also mentioned whistleblowing, as did Richard Simpson and several other members. We and the care inspectorate recognise that it can be a valuable way of highlighting concerns about care standards. The care inspectorate and the Scottish Social Services Council have been working in partnership on a campaign with care providers in the health and social care sectors to ensure that they get the message out about having codes of practice for whistleblowing. We are more than happy to consider further whether there are ways in which we can continue to build on what is already happening in the workplace to assure people that the whistleblowing mechanism is robust and will activate the appropriate mechanisms should concerns be raised.
Mary Fee and Richard Simpson raised issues to do with the complaints process. They may be aware that the care inspectorate has already held a consultation on that process, which ended at the end of last year. We expect the findings of the review of the complaints process to be published this month. As a Government, we are open to looking at whether, when it comes to lodging a complaint, there should be a single point of call, so that there are no questions about where someone should go if they want to make a complaint. We should allow the care inspectorate to analyse the results of the consultation that it has undertaken.
The timeframe for training and qualifications has been mentioned. We are looking at that area to see whether we can address some of the issues, but we should not underestimate the scale of what is required, given that 95,000 members of staff might have to receive some form of training provision. We need to ensure that the staffing and training arrangements that are put in place are robust enough to allow that to happen in an effective way, while sustaining services.
Mary Scanlon mentioned the concerns that the committee raised about the use of psychoactive medication. We do not believe that the chronic medication service is the appropriate way of addressing the issue, because that service has been designed to improve the concordance of patients with a long-term condition with their medication, which is self-administered, often in the setting of their own home. Even the pharmacists’ professional body recognises that the chronic medication service is not the appropriate mechanism for dealing with the issue, which is being looked at as part of the review of the pharmaceutical care of patients in the community. It will consider what is the most effective way of ensuring that there is sufficient pharmaceutical care provision in our care homes. Once we have the findings from that review, in the autumn, we will be in a position to look at how to proceed.
The debate has been extremely useful. There is no doubt that the committee’s report will assist us in continuing to improve the care regime for care services in Scotland.
It is a privilege to sum up for the Health and Sport Committee in what, in general, has been a positive, informative and constructive debate. Indeed, that was the approach that our committee took to the inquiry into the regulation of care of older people. I thank the members of our committee for that approach. In my thanks, I would like to include the former members of the committee Mary Fee and Mary Scanlon, who served the committee well during their time on it. I also thank the clerking team, SPICe, all those who gave evidence, whether in written form or in person, and all those members who have made positive contributions to the debate, a number of which I will touch on.
However, I will start with a more general point. Our committee system can make a powerful contribution to driving positive change. That is exactly what I believe the Health and Sport Committee has achieved in relation to improving the system of regulation of care of older people.
When the committee embarked on its inquiry, we were determined to scrutinise the regulatory framework for some of our most vulnerable citizens in a rigorous, non-partisan and mature way, and that is what we did. Of course, our interest in the subject was raised by the tragedy at the Elsie Inglis home and the debacle surrounding Southern Cross, but it is worth stressing that our inquiry had at its core a significant degree of post-legislative scrutiny. There had been no rigorous review of legislation in the area since the implementation of the Regulation of Care (Scotland) Act 2001, since when it should be noted that the tragedy at the Elsie Inglis home and the Southern Cross debacle occurred.
I am sure that fellow committee members will agree that increased post-legislative scrutiny by our committees would be beneficial to the Parliament. While admitting that our inquiry was prompted by public concerns about high-profile incidents, as opposed to being a pre-planned effort on the committee’s part, I believe that the regulation of care of older people is all the better for it.
We should put on record the committee’s unanimous belief that the current system was sufficiently rigorous, but that that does not mean that there are not always various areas in which the system of regulation must be improved.
It is also worth noting that there remains cross-party support for the use of a risk-based assessment process in the regulation of care of older people, that risk assessment should be robustly evidence driven and that the frequency and type of inspection should be proportionate to that risk. Indeed, the Health and Sport Committee made several recommendations specifically on those points.
In his opening speech, Duncan McNeil rightly pointed out that there seemed to be a lack of clarity around whether inspections should judge care against two or four quality themes. It is a minimum of two and a maximum of four, based on a risk assessment. I draw to members’ attention the fact that the regulatory assessment tool—the tool by which one assesses the risk in the first place—has been reviewed by the care inspectorate and improved for the current year.
I listened with interest to Jackie Baillie’s contribution, in which she rightly identified a dramatic drop in the quality of care at the Elsie Inglis nursing home. The committee accepted in taking evidence that that could happen under any regulatory system, no matter how robust it was. What is important is how effectively we pick up on those dramatic falls in care standards. We are all working on the same agenda, which is to improve the system. I mentioned the regulatory assessment tool because that is the way in which we collect the evidence to allow us to pick up on those situations in which the quality of the care service has dramatically fallen.
Jackie Baillie also mentioned issues around procurement and the living wage. The committee was concerned about those matters, and I note that the Government has had further discussions with COSLA in that regard. It is only right that the committee will want to see where those discussions arrive at.
The complaints process has been a common theme in the debate: it was discussed by members such as Malcolm Chisholm, Sandra White, Richard Lyle, Nanette Milne and Mary Fee, to mention just a few. The committee believes that the complaints process is vital but the process should be positive. An open complaints process drives positive improvement in care homes, and those that are up for the challenge should have nothing to fear.
I note that Nanette Milne welcomed the guidance on confidential complaints that we are hoping to see in the near future, which links in with the concerns that we have heard about whistleblowing.
It is important to mention Mary Scanlon’s comments on the use of psychoactive drugs, which were a passionate display on an issue that she has been following for a number of years. The Scottish Government has said that it is in discussions with the care inspectorate and the Mental Welfare Commission for Scotland to improve those standards and link them to dementia standards. I sense Mary Scanlon’s frustration. Although that is the right thing to do, she wants tangible outcomes to show whether things have improved. I am sure that our committee will want to monitor that in future.
Jim Eadie mentioned the duty of care for the wider health professional groups. I know that undergraduate training for doctors and nurses will be bolstered to remind students of that. Perhaps we should extend it to training for other health professionals.
I will highlight one of the committee’s recommendations, which will, I hope, become common practice in a few years’ time. We identified that the inspection process for health and social care is not integrated. Ron Culley of COSLA told the committee that the current system of regulation was centred on general service provision and that we should move to a system that is more focused on individual outcomes. Geraldine Doherty of the Scottish Social Services Council agreed with that.
As we progress further down the road of closer health and social care integration, it is particularly important that the care pathway for individuals is assessed in a meaningful way. I do not want to overplay the importance of that but, given the current legislative context in respect of closer integration, it is vital that we get it right.
Joint inspections and closer working are vital if we are to make progress. When the care inspectorate—or whoever—enters a care home, it is reasonable to hope that the inspectors will examine the care journey for some of the residents and families who use the care home and how an individual came to be in that care home, whether they or their family believe that they could have been supported in their own home for longer and, if they had a stay in hospital before they arrived at the care home, what the quality of care in the hospital was like. The care pathway—the human journey—is where we must take the care system in future. Joint inspection work is one way to do that, and it is important.
I just want to mention some of the achievements that we have already made in relation to the regulation of care of the elderly.
Every care establishment will now have one unannounced visit a year, and some will have more depending on the risk. At least two quality themes will now be inspected. The system of engaging with health professionals such as GPs and pharmacists has been beefed up. The training of doctors and nurses will be beefed up. The complaints process will be made more accessible and streamlined, with a single point of contact, and we will soon be reviewing the national care standards. All of that has come from our committee’s recommendations. We are driving change. This is what the committee and the Parliament should push forward.