The next item of business is a debate on motion S4M-15561, in the name of Jamie Hepburn, on the Carers (Scotland) Bill. I invite members who wish to speak in the debate to press their request-to-speak button now or as soon as possible. I further invite members who are leaving the chamber to do so quickly and quietly, please.
I am delighted to open the stage 3 debate on the Carers (Scotland) Bill. If the Parliament agrees to pass the bill, as I hope it will after the debate, today will mark a key change in our recognition of the contribution of carers across Scotland. The bill will also extend carers’ rights in order to improve their health and wellbeing, so that they can continue to care, if they so wish, and to have a life alongside caring. I am sure that we can all agree that those outcomes are worth achieving.
I am sure that colleagues in the chamber will join me in acknowledging what is done every day by Scotland’s 745,000 adult carers and the 44,000 young carers who are under the age of 18—almost 800,000 carers in all.
I thank colleagues on the Health and Sport Committee, the Finance Committee and the Delegated Powers and Law Reform Committee for their diligent and expert scrutiny of the bill. I extend my thanks to members who have discussed the bill with me and those who lodged a range of amendments, both at stage 2 and for today’s stage 3.
I thank the many key interests with whom I have engaged during the bill’s passage through Parliament, who generously gave of their time and experience to enhance it. I include in that the national carer organisations: Carers Scotland, the Coalition of Carers in Scotland, the Carers Trust Scotland, Shared Care Scotland, the Minority Ethnic Carers of People Project—MECOPP—the Scottish young carers service alliance and Crossroads Caring Scotland. I also thank Marie Curie, Enable Scotland, local authorities, health boards and the Convention of Scottish Local Authorities.
I believe that the process of engagement and parliamentary scrutiny has improved the bill as introduced. It was a good piece of legislation, and I believe that it was enhanced at stage 2. The bill that we are debating at the final parliamentary stage is even better, having been amended during stage 3.
Above all, I thank the hundreds of thousands of carers across Scotland—those who have engaged with and helped to improve the bill and the many others who play an important role for their loved ones, their communities and our society. I am sure that the Parliament will wish to record its collective thanks to Scotland’s carers, some of whom care in very challenging circumstances.
The bill does not sit in isolation from the world in which it will operate. Although many of the key drivers for change to support carers on a much more sustainable basis are provided for in the bill, the wider economic, social and educational context in which it will operate is also important.
Scotland has a growing population of older people who are successfully living longer, although often with multiple and complex physical and mental healthcare needs. We need to support Scotland’s carers so that they, in turn, can support, if they so wish, the many people who have illnesses and disabilities or who are frail, many of whom have dementia.
Health and social care integration is one of Scotland’s major reform programmes. At its heart, health and social care integration is about ensuring that those who use services get the right care and support at every point in the care journey, whatever their needs. That includes carers, whether as service users themselves or as providers of care.
We want the health and social care workforce to fully recognise and value carers. That applies to schools, colleges and universities, too, where young carers can be fully encouraged and supported if we value their caring role and ensure that they are children and young people first and foremost. The implementation of the Children and Young People (Scotland) Act 2014 also has a key role in ensuring that that happens. The Social Care (Self-directed Support) (Scotland) Act 2013 has an important role, too, as it forms the basis of good support, providing people with flexibility, choice and control. Like everyone in our society, carers will benefit from the range of actions that the Government is taking to encourage a flourishing economy and a healthier nation.
We are continuing to support both adults and young carers in 2016-17, subject to the Parliament’s final approval of the budget. We are providing more than £8 million in 2016-17 for the voluntary sector short breaks fund, health board carer information strategies and other initiatives. Those include a grant to Shared Care Scotland for the innovative respitality pilot, which links the hospitality industry to the provision of short breaks; a grant to the Coalition of Carers in Scotland to work with carers on the integration joint boards and on other strategic partnerships; continued workforce development; a record ninth annual young carers festival; the carer positive scheme, which recognises employers who support carers in the workforce; and another carers parliament.
The bill extends the rights of carers in law. The right to an adult carer support plan or a young carer statement is open to all who fall within the now much wider definition of “carer” that we are legislating for. Many more carers than ever before can request or be offered a plan or statement and an assessment of their need for support. The bill is based on the principle of prevention. Providing small interventions at an early stage or at the right time can prevent a crisis and the consequent breakdown in care. Enabling people to request an adult carer support plan or a young carer statement as soon as they become a carer can result in an early assessment of their need for support and thereby reduce the risk of any need for crisis intervention at a later stage.
Carers have said to me how important it is that they are involved as individuals in discussions about support for them as a carer and for the person they care for. I recognise that. The principle of carer involvement is a theme that runs through many of the bill’s provisions. Carers are to be consulted on an individual basis and also at a strategic level, such as in the preparation of the local carer strategy and the carers charter, and in carer services.
An important amendment by Nanette Milne at stage 2, which was further finessed today at stage 3, provides carers with the right to be involved with the process of discharging from hospital the person they care for.
Short breaks are a key form of support to help carers recharge their batteries, as they often say themselves. With my support, Nanette Milne lodged important amendments for stage 3 regarding short breaks.
The bill requires local authorities to set local eligibility criteria, a matter that we debated earlier. Those eligibility criteria will allow the local authority to determine whether it is required to provide support to a carer. There is a view that eligibility criteria should be set nationally. Again, I refer to the debate that we have just had. I understand that view, but I have concluded that individual local authorities, as bodies that are democratically accountable to their electorate, should be able to make decisions that are based on the needs of their caring population.
I am afraid that I do not agree with that. Given that we are talking about care today, I might reflect on the fact that we are providing a substantial package of support—some £250 million—half of which will go towards ensuring that those who work in the care sector are paid the living wage. I would have thought that Ms Lamont would welcome that, but I have heard scant welcome for it from the Labour benches. I regret that intervention, because I want to try to move forward on the basis of the broad consensus with which we have approached the subject today.
Local eligibility criteria will enable each local authority to determine whether carers’ identified needs call for the provision of support, taking into account the total resource that is available to meet local demand for support. However, I want to ensure consistency of approach across Scotland. I believe that that can be achieved through the national matters that will be set out in regulations and which will underpin local eligibility criteria. As I made clear in my response to the Health and Sport Committee’s stage 1 report, the national carer organisations’ work on nationally set criteria will help to influence the regulations relating to those national matters. I set that out again today.
I am committed to continuing to work with key stakeholders to share ideas and views about how local eligibility criteria should work in practice. That will inform development of regulations and guidance under the bill.
To be clear, we will look closely at the efficacy of the approach that is taken. I have retained a power in the bill so that ministers can, by way of regulations, introduce national eligibility criteria, if that is felt to be necessary down the line. I described that power earlier as one that we are holding in reserve. Let me be clear that the Government will not hesitate to use it should it find that it has to.
Finally, I will say a word about implementation. Resources to support implementation of the bill are set out in the financial memorandum. I have confirmed to the Finance Committee that the Scottish Government expects to use the maximum costs that are set out in the financial memorandum for planning purposes. Those costs are £19.4 million in 2017-18; they rise to £88.52 million in 2021-22 and on a recurring basis thereafter. I believe that that represents a substantial commitment to the bill.
The passage of the bill is only part of the journey. We have done much to support Scotland’s carers outwith the bill, and we will continue to do that. In the weeks and months ahead, a significant effort will be required to ensure that we, along with key interests, including carers and their representative organisations, pave the way for commencement of the bill in 2017-18.
There will be challenges ahead. I am committed to working collaboratively with stakeholders to undertake the necessary planning and to co-produce a significant number of regulations and guidance. I extend that offer to members—if they want to speak to me about any of these matters, I will always be willing to hear from them. I know that all parties have a genuine desire for the bill to be implemented successfully and to achieve the positive outcomes for carers that it aspires to achieve, to which we all collectively aspire.
That the Parliament agrees that the Carers (Scotland) Bill be passed.
There are a large number of people whom I need to thank for their work on the bill over the past weeks and months. I thank our committee clerks and the legislation team for all their help and support. I thank the minister for his constructive approach—I believe that the bill will be better because all parties have worked together to get the best bill that we can for carers. I also thank the minister’s officials for their role in making the process work. Most of all, I thank carers groups and representatives. The many groups and individuals in the Highlands and Islands who contacted me and took the time to share their experiences with me gave me a real insight into what was needed in the bill.
In addition, I thank the national carer organisations, the members of which the minister listed, which worked closely with all parties during the process, thereby informing the debate. On a personal level, I would also like to thank Clare Lally for all her help and advice to me. She has been a star and has made the process much easier for me.
There are many aspects of the bill that we agree on, but there are still areas of disagreement, the greatest of which is the funding that is to be allocated to it, which is woefully inadequate. We are really concerned that, although the bill offers hope, it will not deliver because of the lack of funding. This year, councils are facing a cut of £0.5 billion to their budgets, and they are being forced to cut support rather than increase it. Carers tell us continually that they want more than warm words; I really hope that the bill will not be just warm words.
We need to make it clear that more funding is required to make the bill work for carers. More funding is needed for assessments, for support, for breaks and for replacement care. We are told that the estimates that have been used are wrong. The position needs to be kept under review and, when it is required, funding must be allocated to make sure that the bill works.
The bill allows local authorities to set their own criteria for who will be supported under the bill and to decide on the kind of support that will be offered. We tried to have included in the bill some national criteria for who should be given priority for support in order to ensure a minimum level of support for carers, but COSLA did not support that approach. It was clear that it wanted to support carers, whose role it really values; its concern was that funding increased services for carers would lead to cuts in service for those who are cared for because the bill is not properly funded. If support were to be cut for cared-for clients, that would simply increase the burden on carers.
Carers fear that the lack of national eligibility criteria will mean that they will experience a postcode lottery. That is the case with support for cared-for clients. Different local authorities offer different levels of service and levy different charges for those services. A care package depends on where someone lives and not on the level of support that they need. The national criteria that we tried to set were very modest. They would have guaranteed support for those in greatest need of urgent support: carers whose role is going to end or is at risk of ending because they can no longer continue without support. We all want to support carers long before they reach that stage, but surely they must be given support when they reach it. If they are not, the likelihood is that the carer and their loved one will require to be cared for by the state, and that is simply a false economy.
With the right funding, the bill could make a real difference to and change the lives of carers who look after their loved ones and who often give up their own careers and social lives to support family and friends.
Elderly parents who care for their adult children are worried sick about who will look after their children when they no longer can. We also know that there are carers as young as three years old whose lives revolve around caring for parents and siblings.
One teacher told me about a pupil in her school who was usually sleepy and unkempt. One day, he seemed a bit animated and was watching the clock with a sense of anticipation. Seeing that interest, the teacher made the most of the situation and asked him whether he was doing something nice after school. He said that he knew that there would be a delivery waiting for him when he got home. She asked what it was, expecting him to say that it was a gift from somebody who lived at a distance. He told her that it was a hoover—their hoover had broken some weeks earlier, and he had just managed to save enough money from the family budget to buy a new one. He was hoping that it would be there when he got home that night. That was the first indication that the teacher had that he was a young carer—it was the first that she knew of his caring role.
We know that carers neglect their own health because their loved one cannot be left to look after themselves in their absence. We know of carers who are abandoned in situations without any help. I have a constituent who was sent home in the middle of the night with the person he was then going to have to care for, who very suddenly could no longer walk or talk. All that he was given on discharge was a post-it note with a phone number on it—a phone number that did not lead to anybody who could provide him with any information or help at all. That was an absolutely shocking situation, and things must change. I hope that the bill will be the start of a change that will support carers.
Many of us have spoken about the role of the voluntary sector, which must be protected. Volunteers are often the only people who support carers, and their role has grown in our communities. That work is often led by carers themselves or by people who were previously carers and who have seen the gap in support—when their caring role has ended, they have come forward to provide that support to others. Carers really value those services, as they are local and the people who run them understand the situations that carers are in. Although it falls on local authorities to put the provisions of the bill in place—I am sure that it will also be up to joint boards and lead agencies in time—I very much hope that they will use the expertise in the voluntary sector and in carers groups to deliver services and support.
I conclude simply by paying tribute to the work that has been carried out by carers. They save the public purse £10.3 billion every year. What they are asking for in return is a drop in the ocean in comparison. Let us not disappoint them.
I endorse the thanks that have already been given to all those who have helped with the progress of the bill through its parliamentary stages.
When I first entered Parliament nearly 13 years ago, I knew almost nothing about carers, even though I and other family members had been involved in looking after loved ones following serious illness or in the terminal stages of life. We did not recognise ourselves as carers; we just wanted to give support to our relatives. Outside agencies were rarely involved.
My grannie, who had severe dementia, lived with us for the last two years of her life This was many years ago, but I remember that, after she died, my mother was a physical and emotional wreck, having been with her day and night, coping with soiled clothes and bedding without even a washing machine.
Thankfully, things are not like that nowadays, although many carers still do not recognise themselves as carers. Help is available, but many carers still do not receive the support that they deserve in carrying out their caring role.
As we know, there are an estimated 745,000 adult carers and 44,000 young carers in Scotland today. The value of the care that they provide is reckoned to be around £10.3 billion per year. Clearly, they are invaluable and indispensable. However, caring can have a detrimental effect on a carer’s health and wellbeing, which can ultimately have an adverse impact on the person being cared for.
At present, local authorities have a duty to assess a carer’s ability to care, and they have the power to provide support where necessary. Health boards can be required to publish a carer information strategy, setting out how carers will be informed of their right to request an assessment. It is accepted, however, that that is not enough, and many carers are still not identified.
The Carers (Scotland) Bill aims to provide better and more consistent support to all carers, both young and adult, by enshrining their rights in law so that they can continue to care, if they so wish, in good health and able to have a life besides caring—and, in the case of young carers, to have a childhood similar to that of their non-carer peers.
Carers and carer organisations warmly welcomed the bill at stage 1, although it was accepted that it would require significant amendment if it was to achieve its laudable aim of improving the lives of the many carers who make such a valuable contribution to our society. Financial provision was at the fore of the concerns that were expressed, because legislation such as the bill cannot be successful unless the entitlements and promises are properly and adequately funded. I am not convinced that that has been fully resolved yet. It could be a hurdle to overcome in providing proper support and services to people who are entitled to them, particularly at a time of significant constraints on council funding. The Parliament and the Government should monitor that extremely carefully in the next parliamentary session.
The amendments that we have approved at stages 2 and 3 have strengthened the bill significantly and I am pleased that they are to the satisfaction of people who are at the coal face of caring.
I will focus briefly on my stage 3 amendments, because they should make a real difference to carers. I have felt strongly for some time that, in many instances, hospital discharge could be better planned if the main carer was identified and discharge planning started as early as possible in the patient’s journey through hospital care. There are many examples of good practice in that respect, but the opposite is all too common and legislation should ensure that good practice is the case everywhere. To illustrate my point, I will give two examples, one of which I mentioned at stage 2 and which shocked me.
At a meeting that I attended—as did Rhoda Grant—to discuss the bill, a carer told us about getting just two hours’ warning of her husband’s discharge from hospital on oxygen, which is a flammable substance. The home was heated by an open gas fire and they had a gas cooker, both of which had to be quickly disconnected before her husband’s arrival home. It took several days until alternative heating and cooking facilities could be installed. That is clearly no way to treat a carer or a cared-for person.
My other example concerns a friend of mine with dementia, who is cared for by her husband. Following admission and treatment for an acute illness, she would have been discharged home without discussion or planning had not their daughter, who lives in another town, refused it because she felt that her father could no longer cope without support. It took considerable time to get a care package in place, which resulted in a classic case of delayed discharge because no thought had been given early on in my friend’s stay in hospital to what might be needed when she went home.
I am pleased to say that there is a happy ending because my friend’s husband is delighted with the support that he now gets at home. Moreover, a few days of care home respite is provided regularly, which allows him to plan to have a couple of days away from his caring role when he needs them. He now feels that he can cope much better and his own health is no longer being put at risk because he can look forward to regular short breaks when he can resume a more normal life.
Those are only two examples but they are replicated throughout the country. The bill that I hope we will pass today could make for a better life for many people who might otherwise suffer adverse effects from being carers and, indeed, who might have to curtail their caring roles because of the impact on their health and wellbeing. Time will tell whether the Carers (Scotland) Bill has the desired effect of improving the lives of young and adult carers. I hope that it will do so. It might not yet be perfect but, by and large, it has the approval of carer organisations. I also hope that continuing work between them and the minister in preparing regulations and guidance will refine its provisions further.
The Scottish Conservatives appreciate the help and co-operation that we have received from the minister and his officials. We will be happy to vote for the Carers (Scotland) Bill at decision time.
It gives me great pleasure to speak in the debate. Just before the debate, I met a group of carers who came to the Parliament with Enable Scotland to celebrate the inclusion in the bill of emergency planning and future planning, for which Enable had campaigned. We cannot exaggerate the sense of achievement that people feel, not only about succeeding in that but about the bill overall, which gives them proper rights for the first time. The psychological shift that is involved in that is important. Many people, particularly a certain generation, do not like asking for help, but there is a shift when the rights are enshrined in law. The fact that emergency planning will now be part of those rights has made a big difference.
A year ago, Enable came to the cross-party group on carers, which I co-convene, and presented a piece of work called “Picking up the pieces: Supporting Carers with Emergency Planning”, which surveyed the extent of emergency and long-term planning for carers throughout the country. It also identified the difficulties faced by carers when an emergency prevents them from caring. Such emergencies can be long or short term. They are usually unexpected and could be as simple as a car breaking down or a bus not turning up so that the cared-for person does not get the help that they need. Obviously, they can also be something much more serious: a hospital admission, an accident or sudden illness can result in the cared-for person being separated from essential support.
The problem is particularly acute if there is no wider family support and if the cared-for person’s needs are so great that they cannot be left alone to look after themselves. Fear of such a situation occurring is a constant source of stress for the carer. Related to that, for older carers in particular, are questions of what happens if the crisis is not resolved and what happens if there is no long-term plan. Will their loved one be placed in unsuitable accommodation? For example, a young person with a learning difficulty could be put into residential accommodation for older folk. Will the cared-for person be moved away from the area and away from their friends, their routine, their support networks and their leisure activities—everything that they enjoy and that is essential to their quality of life? Putting in place a long-term plan for suitable accommodation in a place that the cared-for person knows and feels happy with is absolutely essential.
Enable’s presentation clearly struck a chord with all the carers present at the cross-party group, not just those who care for someone with a learning disability. “Picking up the pieces” was not just about carers looking after someone with a learning disability. Enable found that emergency planning varied across the country. There were some very good examples and some bad examples. After that presentation the cross-party group identified emergency planning as a priority for the bill.
Initially there was disappointment that emergency planning would be covered by regulations, but the minister listened carefully to representations from Enable, other carers groups and MSPs such as me. I am pleased that he took on board our arguments and put emergency and long-term planning in the bill. It is difficult to exaggerate the sense of achievement that that brought to campaigners. The minister emphasised emergency and long-term planning in his speech and comments today; the fact that he sees it as so important is very welcome.
Jen Savage, Enable’s director of campaigns and external affairs, said:
“Enable Scotland is absolutely delighted with the announcement. We congratulate the First Minister”— who of course first announced the change regarding emergency planning—
“for listening to the voices of carers of people who have learning disabilities about their worries about the future, and deciding to change the Carers Bill to make things better.”
Enable is already very much on the ball. It has prepared a toolkit to take forward the emergency planning provisions. I have it here—I know that I am not really supposed to show it to members, but it is very well worth looking at. There is an emergency plan that goes with the toolkit, which encourages people to answer the questions that they have in their heads about the needs of the people for whom they care, but which they do not necessarily always articulate. It is really important that the plan is not just in the carer’s head but written down. I recommend the toolkit to everyone in the chamber.
It is a privilege for me to be involved in the debate and, over the years, to have met and worked with carers, whether those in my family, those whom I knew during my time as a schoolteacher or those whom I know now. Carers are determined to change the lives of those for whom they care and to ensure that their needs are fully addressed. I recognise the importance for them of this stage in their campaign.
Of course, there is a blunt truth: carers’ work saves the state a fortune. The level of impact on carers’ lives, their ability to work, their ability to have time for themselves and the resulting sense of isolation that they suffer is hard to fully appreciate. Across the Parliament there is recognition of the role of carers in supporting their loved ones and in shaping a proper understanding of the needs of those who are being cared for and the needs of carers themselves. Carers have been at the forefront of creating better understanding of the needs of those with disability or illness who need help, and how that support should be delivered.
We have seen great change, from the recognition of the right of people with learning disabilities to live as independently as possible, to the recognition of the rights of siblings and the families of a child with disabilities, to the needs of those living with dementia. That has been driven by carers and campaigning organisations themselves. Joan McAlpine is absolutely right to highlight Enable’s campaign, because it speaks to an issue that is not really about resources but about understanding how the simple things can make a huge difference to people. We recognise carers’ determination to ensure that the voices of those who are being cared for are fully heard and understood.
As someone who meets carers regularly, I know—as they know—that there is a long way to go. Carers still talk of battle and struggle; of being overstretched, with insufficient respite and anxieties about quality of care. We should understand the financial and emotional impact on them and their families. Nobody here would wish to oppose carers’ rights, and I recognise what Joan McAlpine said about the breadth of support to ensure that we do the right thing. However, as I said in the stage 1 debate, carers’ rights must be enforceable if they are to be rights at all. Anything else would be a cruel deceit. The challenge for all of us is to ensure that those rights are enforceable. Over the last wee while we have been exercised by the debate on taxation and the impact on local government of cuts to its funding, but there can be no doubt about the importance of that debate when we reflect on the needs of carers. The funding of local government is not knockabout. It is not an academic debating point. It is about the real world and real lives. It is about care workers losing their jobs and the remaining care workers being left to support more people with less time and fewer resources. Those carers are the people who know how much the cuts will matter.
I appreciate what Johann Lamont says about care workers and their importance. Since she raises the issue, will she tell us whether she will be encouraging Labour local authorities to support the package that gives £250 million to pay care workers the living wage?
Absolutely. There is no doubt about the Labour Party’s commitment to the living wage and to respect for care workers. The point that I would make is that care workers will lose their jobs. They will not have the living wage. The issue is about properly funding local government.
I say this as a carer: the cuts will mean that carers will be left to pick up the slack, fill the gaps in care and manage the strains on paid care support. There will also be cuts to the support that carers can receive from carers centres and other things that help to sustain them. That is how serious the cuts will be to the lives of carers.
I do not doubt the sincerity of the minister’s recognition of the importance of carers, but it is his job—more than it is the job of anyone else in the chamber—to translate that commitment into the allocation of proper resources. Of course we can support the bill’s intention, but I emphasise again the fact that the intention will only be realised if resources are made available.
I am concerned about the lack of response to COSLA’s view that the bill’s intentions are not funded, which is set in the context of a local government settlement in which COSLA has identified a £500 million cut in this year alone. I am sure that, like me, the minister would abhor an approach in which we as a Parliament confer rights but do not resource them, then denounce local government when those rights are not realised.
Members should not get me wrong. I know that local government can fall short, and it has had to understand fully that it needs to deliver services in a better way. However, we need to respond to the question of resources.
I am happy to support the bill as a recognition of the stage that carers have got to in making their case to Parliament. I welcome the bill’s aspiration. However, we need seriously to reflect on the consequences for carers and others of an aspiration that remains only that. We need to debate how we resource what we are all committed to: delivering for carers across Scotland.
I support the bill and I am pleased that it has reached and been amended at stage 3. I hope that it will provide a framework of support for the 745,000 adult carers and more than 44,000 young carers—that figure is just an estimate; the number of young carers may be double that. The implementation of the framework through the bill as amended will mean that hundreds of thousands of people will without doubt get the support that they need.
It is important to remember that caring for someone can have a mental and physical toll. Marie Curie notes the importance of providing support to carers of people with terminal illness, both during the time of their caring role and after it. A number of amendments sought to provide person-centred, specialised services. A major framework of action and support that can provide such services is of course the integration of health and social care. Integration joint boards will have the opportunity of providing those services, while avoiding duplication of work and giving carers more options. I thank the Scottish Government for its amendments and, in her absence, I thank Nanette Milne for her stage 2 amendments, which provided for far more involvement of carers in NHS procedures. The admission, care and discharge of a person can best be supported and facilitated when information on what is best for them is presented, and carers are the people who can best provide that information.
I was encouraged that a better definition for the timescales for the preparation of support plans was agreed at stage 2. The minister’s amendments set out better timescales for young and adult carers.
Other parts of the bill should be considered, such as whether eligibility criteria should be local or national. The decision was in favour of the local formulation. Should the bill be reviewed, it may be worth revisiting whether that allows for flexibility and adaptation to local needs and circumstances
Mr Hume will have heard my remarks and I hope that he accepts them in good faith. We will monitor the efficacy of the approach that we have legislated for. If we find that it is not working on the ground, we will not hesitate to use the reserved position that we have retained—in the face of COSLA’s opposition—and institute national eligibility criteria by way of regulation.
I appreciate that the minister has put that on the record. I never doubted that he would mention the commitment to review the approach, which he made in good faith. I am glad to hear the minister’s words. The goal should be to ensure that a minimum level of service is provided and that carers across Scotland are not in any way victims of a postcode lottery. I am glad that the minister will keep an eye on that.
“We would caution that amendment 38 would be difficult to implement”,
so I am glad that it was not moved.
The national carer organisations also noted that through the Public Bodies (Joint Working) (Scotland) Act 2013 there are multiple channels to monitor carers’ experiences and an extra layer of inspection is not needed. If we were to add that extra layer of inspection, we would also have to provide support and back-up for that work. I identified that issue in relation to amendment 43, which was withdrawn. We know that the budgets of councils and other public bodies are being cut, which is adding more responsibilities to already stretched resources, so it would not have been wise to pass amendment 43. Although the ability to invite every person on the register of carers for an annual health check would have been welcome in principle, we needed to be realistic. The register would exist only for those willing to self-identify and who agreed to their registration. Trying to fulfil the register’s positive purpose would risk the diversion of resources from where they are needed most.
I am glad that we have reached this stage of the Carers (Scotland) Bill and I hope that it will be passed. We will certainly support it. Its implementation will be swift and straightforward and it will benefit all those whom it seeks to help.
Legislation can take a long time to work its way on to the statute books, but it is just the tip of an iceberg. Underneath it, a host of people and organisations from all walks of life strive to improve situations that impact on them in different ways. That is especially true for the Carers (Scotland) Bill. Only a few short weeks after being elected in 2007, I was invited along to meet the South Lanarkshire Carers Network, which spoke about its aspiration for a carers bill. Just over a year ago, I joined Robert Anderson, who is the chairman of the South Lanarkshire Carers Network, and Jamie Hepburn, the minister, to officially open the network’s new headquarters. The organisation was started in 1990 by Robert.
Robert Anderson characteristically says that the MBE that was awarded to him is a testament to solid partnership working, which is something that we have seen with the bill. When he accepted his MBE last January, he said:
“Above anything else I hope receiving this MBE underlines to people in a caring role that they are not alone—and help and support is available to them.”
Robert knows what it is like to be someone’s unpaid carer. His wife, Nan, suffered two strokes. Sadly, after many years of caring for her, Robert said goodbye to Nan just a few weeks ago. He said:
“I was a full time salesman at the time but was suddenly thrust into a new world, with new responsibilities, from cleaning the house, managing finances to helping with my wife’s needs. It was then I realised that there wasn’t a lot of support or information available for people in my situation—especially when the chips are down … The caring role often feels overwhelming and can leave the person feeling very isolated, as they can soon become cut off from peers and friends because of the demands. I realised things then needed to change”.
He also said that he has been profoundly impressed by the depth and scale of commitment of everyone involved.
Unpaid carers are immensely giving and generous. For those who do get paid, the bill, along with the budget, brings the prospect of a decent pay improvement. While Westminster makes a great hue and cry about its fantastic new national wage of £7.20 an hour, the Scottish Government has taken on the guidance of the Living Wage Foundation and increased the rate to £8.25. That is a difference of £36 in an average week—a huge difference to people who take on a caring role as their profession.
As I said, for some people the origins of the bill go back almost a decade, and probably go back many more years for others. It has been two years since the formal consultation on legislation to support carers and young carers in Scotland, and a great deal of input has been taken on board. We heard that in many contributions this afternoon.
As we have heard—and as the Scottish Government has recognised—there are an estimated 745,000 adult carers, with 44,000 young carers. It is easy for us to look on and admire carers and take them for granted; they deserve better than that. They deserve to lead a fulfilling life, to be properly paid and to get professional and accessible support and advice. If my mother had had such support 30-odd years ago when she was looking after my father, who had motor neurone disease, we might have had a much easier life when we were growing up. However, we managed, which is what happens. We have grown up a lot from that outdated perception of the dutiful, stoical and unpaid carer who never reached breaking point and had no recourse to state support of any kind.
Since 2007, there have been many interventions and much investment in this area, and that work has been manifested in this bill, which sets out a very practical and important way of giving carers a better deal and proper recognition. The Scottish Government has, in the evolution of the bill, been working towards improving outcomes for carers with a range of initiatives such as the reshaping care for older people change fund; the voluntary short breaks fund, which has helped more than 32,000 carers; and the carer information strategy. With health board funding, significant progress has been achieved on carer identification and support; indeed, that was one thing that the South Lanarkshire Carers Network did very well.
I pay tribute to the South Lanarkshire Carers Network; to COVEY Befriending, which is an organisation that supports young carers in my constituency; and to all the organisations that we have heard about this afternoon. However, this is just the start of another journey. I hope that the bill gives carers the life that they need—the responsibility is on us to ensure that we deliver it.
There are almost 800,000 carers in Scotland. Although around 30,000 to 40,000 people stop caring for a loved one each year, the overall number hardly varies, because a similar number replaces them. According to Carers UK, the economic value of that unpaid care is in excess of £10 billion, which is an enormous amount of money that is saved for our public services; the emotional value of that support and care is inestimable.
Many of us here will have our own experiences of the role that carers play. If one’s friends or family were affected, few would hesitate to help. However, the responsibility of caring for a vulnerable person often goes way beyond helping; it can be more demanding and stressful and go on for much longer than carers might have predicted at the outset of their caring responsibilities.
The care that is needed and provided is vital. Too often, it is not apparent to others; it goes on behind closed doors and away from the agencies that can provide help. Indeed, many carers do not even recognise themselves as such—they simply think that they are doing what is right. As a consequence, the value of that care is not always recognised by the public or by those who provide public services. In fact, the care is often taken for granted. Too often, support service providers do not even know that someone is a carer. People often care for loved ones alone, with little or no external support or engagement with support services, and we need to identify carers at the earliest possible stage, so that they know what support is available to them.
It is common for carers with additional support needs not to be identified as such. One of the challenges that face organisations that wish to support young carers in particular is to actually identify who and where they are; after all, many young people either do not see themselves as having that role or do not want to ask for help. That is why it is so important to take a multi-agency approach to all stages of the care process and to enshrine that in law to ensure that all agencies know their roles and responsibilities in the field.
Underpinning the moves to change that situation for the better is the preparation of carer strategies by the NHS and local government. That work is important, because the NHS can provide a great deal of support for not just the person being cared for but carers themselves. Far too often, however, carers are not aware of the support that is available to them. The needs of carers must be at the forefront of all our minds and at the centre of policy in this field. Indeed, it is clear that we need a coherent, multi-agency approach for most carers.
At stage 2, my colleague Rhoda Grant was able to introduce into the bill a carers charter to ensure that carers know their rights. However, there are many gaps in the bill that still need to be addressed. I supported all the amendments in Rhoda Grant’s name, because they began the process of addressing those gaps. They sought to introduce bereavement support, requirements in relation to planning, a duty to provide advocacy, a general practitioner register of carers, an appeals mechanism, provisions on equalities and national criteria for assistance.
Many people questioned the national criteria that were the subject of an amendment at stage 2. I am pleased that Rhoda Grant considered the issue carefully and worked with local authorities and carers organisations to find a solution to the problem. Along with the Health and Social Care Alliance Scotland, I am concerned that the proposed introduction of eligibility criteria that are defined locally by local authorities will lead to a postcode lottery of support for carers across Scotland. As the alliance put it,
“Whilst local best practice and scope for local variation to satisfy varying needs and caring trends are to be fully supported, we do not believe that there is any justification for a variation in the levels of need which trigger an entitlement to carer support.”
Although the Government did not support Rhoda Grant’s amendments in that regard today, I note the minister’s willingness to address the matter should it become an issue for carers in the months and years to come.
The introduction of a duty to support carers, which is linked to eligibility criteria, is the gateway to new rights for carers. In light of that, clear rights must be available to all, rather than being left at the discretion of local criteria. Support for carers and the people to whom they provide care in considering what arrangements should be in place in an emergency is a vital preventative measure. Effective emergency and future planning is another hugely important aspect of the bill. The security that comes with knowing that a plan is in place should an unexpected event happen is hugely positive for carers.
Marie Curie raised the important issue of what happens to carers who are nearing the end of their caring role. Marie Curie said that planning for the end of the caring role should begin as soon as is appropriate and should be part of the adult carer support plan and young carer statement. The organisation is also surely correct to express concern about the lack of information and advice for people at the end of their caring role.
We should be continuously looking to improve the framework in the bill. Carers issues should be part of the policy-making process. I hope that the bill will improve carers’ lives, but we must recognise that there is much more for us to do.
In an afternoon in which we draw all the deliberations on the Carers (Scotland) Bill to a conclusion, I acknowledge the bill’s importance. Throughout its progress it has enjoyed cross-party support and engaged a great many organisations, who had high hopes and expectations of what it might achieve. Many organisations were involved in discussions with all parties as we considered amendments and moved towards this afternoon’s conclusion, and many of those organisations have been named by members during the amendment stage and this short debate.
The bill will improve the lives of some 800,000 carers and the very many people to whom they offer support and care. As Nanette Milne said, the hidden benefit to the country can be quantified; it is more than £10 billion. That is a remarkable testament to the commitment that so many people give, so willingly.
The bill has been improved by amendments, not least those that were lodged by Rhoda Grant and Nanette Milne. The success of Nanette Milne’s amendments on the important issues of carer involvement in hospital discharge and short breaks was made possible by the support of the minister, who has engaged in a consensual manner with everyone who has sought to improve the bill. We find ourselves able to commend the minister who promoted the bill as an example to his colleagues, who are sometimes more bullish in their approach. The bill is an example of what can be achieved on a cross-party basis, on a matter on which there is considerable agreement to start with.
The future funding in relation to the bill will determine its ultimate success. I will not pursue that argument this afternoon, but I acknowledge the important comments that Johann Lamont made in that regard.
Nanette Milne talked about the experiences of her mother and grandmother in times past—I will not be more specific. In the years to come, many more people will find themselves involved in the care of relatives and loved ones. The bill is designed to ensure that their experience will be very much better than that of past generations. I commend the bill, which Scottish Conservatives will be delighted to support at decision time.
This has been a good debate. Many of us can draw on our own experiences, as many of us have been carers at one point or another. However, we would not be here in this chamber if we had a long-term caring role. As Jayne Baxter said, many people have that role for a lifetime. Parents of disabled children and carers for people with long-term conditions, for example, do not see their caring role as one that will end; they see it as part of their day-to-day lives. It is hard for us to appreciate what that means, especially if that role is unsupported. People in that position face huge difficulties. I have a constituent whose own health is failing and who finds it difficult to see what the future holds, because she does not know how long she can continue to provide care and she does not know what support there will be for her.
We all agree that carers need more support, but there are dividing lines, and I want to go back to those. We are keen that the eligibility criteria be set nationally for the carers who are most in need, so that they do not face a postcode lottery and can get help when they need it. There are powers to impose national eligibility criteria, and the minister should consider using them if need be. However, the problem is that he would have to consider how to fund that approach. I sometimes think that the funding and the national eligibility criteria are very much two sides of the same coin. We need to ensure that carers get the support that they need. As Johann Lamont said, rights need to be enforceable or they are not rights at all. That is important. If the funding is not available locally to provide the support for carers, there will be no support at all.
The committee heard evidence about the cost of carrying out an assessment. That was hugely underestimated in the financial memorandum. More funding has been put into short breaks, but one carer told me that, because of the complex needs of the person she was caring for, it would cost thousands of pounds to replace her for one week. Carers save the state a fortune, as Johann Lamont said, and we need to ensure that, when they need our support, we acknowledge the amount that they save us. That carer was saving the state thousands and thousands of pounds but, because of the amount of money that is involved in replacing the care that she gives, we cannot see how she will get a break.
Nanette Milne talked about planning for discharges from hospital. We have both heard of the case in which a person was sent home on oxygen, which meant that they could not use their gas fire or their cooker—they could not eat and they were freezing cold. How on earth could someone think that they could send someone home in those circumstances? We often hear of someone being discharged and going back to a house that is not appropriate for them any more, as they can no longer access bedrooms, bathrooms or whatever. A lot more thought has to be given to how we send people home and also how the carer will cope when we do that.
Emergency and future planning are important, and I am glad that they are in the bill. I am also glad that the minister pointed out that bereavement support and planning will be part of that future planning. The way in which we support carers who are providing care in a palliative setting is difficult enough, but what happens when they lose the person they love is difficult, too, and we cannot abandon them at that point.
Short breaks really have to be for the good of the carer, not respite for the cared-for person. The cared-for person might need to get away for a change of scene and a break from their surroundings, but that does not give the carer a short break in the same way. We need to think separately and differently about breaks for the carer.
A number of people talked about the workforce, and we need to involve all the relevant bodies and voluntary organisations in the preparation of the plans and statements, not only because they have a real insight into the issues but because there are not enough social workers to do that work. That was one of the worries about the bill. Where would we find all the social workers to do the necessary work? They are already overworked. Plans and statements need to be based on the needs of the carer, rather than on budgets.
GMB told me that, when its members look at support plans for cared-for people, they often omit interventions because they know that they cannot be funded from the budget. That is really not right.
Joan McAlpine talked about the living wage for care workers. Labour members have asked the Government for that, but it has voted down our attempts to introduce it. Joan McAlpine also talked about the £200 million for community care. That money is going into the health budgets, not the local government budgets, so it will do nothing to help local government and its funding crisis.
On a point of information, that funding will go to health and social care partnerships, which are an integral partner of local government. It is important to place that on the record.
It will indeed go to health and social care partnerships, but it is going through the health budgets, not the local government budgets, so the health boards have control over that money and how it is spent. I hope that local government will have some influence, but it is not being given that money. That might be a political point so that health budgets are not cut, as the Government promised, rather than about where the funding goes at the end of the day.
We have spent hours and years discussing health and social care integration. The care packages are delivered by people in the community and the joint boards. Surely Rhoda Grant is not suggesting that the health board is directing social workers who deliver the care packages.
Many of the joint boards will not be set up until this April, and the money is going to health boards, not to local government, as the Scottish Government keeps saying. The health boards are expected to put that money into the joint partnerships. Local government has no control over that money; it depends on health boards putting it into the joint pot.
If the Scottish Government wanted to give that money to local government, why was it not in the local government budget? That is either political expediency or a way of punishing local government for saying that the Scottish Government is cutting its budgets. That takes us away from the support of carers, but it is really important that smoke and mirrors are not used for that money and that we recognise that local government will bear the cost of the bill and that it will be for it to deliver what is asked.
A number of members have talked about carers’ need to self-identify. Jayne Baxter pointed out that carers—especially young carers—often do not recognise that they are carers. Carers need to be asked what we can do to support them. They need to be referred to services, not signposted or asked to self-refer. We need to take the burden off carers for their own support.
In conclusion, we owe it to carers to ensure that the bill is not the last word. It is an important step, but we are far from there. We owe it to carers to continue to seek better ways in which we can support them in the future.
I thank all the members who have contributed to the debate; they have done so with genuine respect for Scotland’s carers. I welcome the insight that has been shown and the helpful and informative contributions that have been made. There is a clear sense of cross-party support for the bill and, more important in many ways, there is a clear sense of collective support for Scotland’s carers.
I thank all those who have been involved in the bill’s progress through Parliament. Many have spoken in debates, served on the various committees that have considered the bill and lodged amendments to the bill. That was often done on behalf of carers or carers representative groups. All those efforts and that engagement have significantly enhanced the bill. It is thanks to that interest, care and attention that the bill takes the form on which the Parliament will vote at decision time.
It would be remiss of me not to thank again all the carer interests that helped to shape the bill. I thank carers for providing their input directly or through their representative organisations. It would also be remiss of me not to pick up on a point that Christina McKelvie made. I was glad to meet Robert Anderson on two occasions to discuss not only the bill but the wider work of the South Lanarkshire Carers Network. His work is a good example of interaction with the legislative process. As Christina McKelvie said, he sadly lost his wife recently. I was aware of that and I put on record my condolences to him.
I agree totally with Rhoda Grant, Nanette Milne and Jackson Carlaw that the engagement in the Parliament has ensured that the bill is better now than it was when it was introduced. I am loth to pick out anyone in particular, but the manner in which Ms Grant and Ms Milne engaged in seeking to amend the bill was particularly co-operative. That emphasises the point that improving the lives of Scotland’s carers is a shared agenda.
It is right that we recognise that Scotland’s carers are integral to our society. They provide vital care and support to their families, friends and neighbours, often in challenging circumstances.
The current legislation, which we seek to change and widen to cover all carers today, requires that a carer must care regularly and substantially and that the person for whom they care must be eligible for a community care assessment before the carer can request a carer’s assessment. We know that few assessments are carried out compared with the number of carers. Even when a carer’s assessment is undertaken, the local authority has discretion about whether to provide the support.
I am pleased that, when the bill is passed today—as I am sure it will be—it will mean that many more people will be able to ask for or be offered an adult carer support plan or a young carer statement as a means of assessing their need for support. Furthermore, the bill widens the definition of a carer so that people who care intermittently—perhaps because the person for whom they care has an illness that does not occur regularly—can also ask for or be offered an adult carer support plan or a young carer statement.
The adult carer support plan or young carer statement will record the outcome of the discussion with the practitioner in relation to identifying the carer’s personal outcomes and needs, as well as any support that the local authority is to provide to meet those needs. The plan or statement can also be of therapeutic value in itself. Many carers feel a sense of loneliness and isolation, and an empathetic assessment can help the carer to feel more supported.
There will be circumstances in which the adult carer support plan or young carer statement needs to be prepared quickly. Many carers care for people with a terminal illness or provide end-of-life care. I was glad that Marie Curie raised that issue directly with our Administration, and we have amended the bill to provide powers for the Scottish ministers to introduce regulations to put in place an expedited process for such carers.
I was also glad to hear voices calling for emergency planning and future planning to be recognised as part of the assessment process. Joan McAlpine spoke of the role of Enable, which I acknowledge as well. It is heartening that Enable clearly expects us to pass the bill, because it has already worked on its emergency planning toolkit. I congratulate it on that endeavour. I am behind the curve a little because, unlike Ms McAlpine, I have not seen that toolkit. However, it is good that Enable is engaged in the process and I look forward to seeing it. That is the kind of creative work that needs to happen throughout Scotland. The Government will be happy to engage in that process.
The bill places a duty on local authorities to provide support if the carer’s identified needs meet the local eligibility criteria. As consideration has to be given in the first instance to whether a carer’s needs can be met by the provision of services that are available generally in the community or services that are provided to the cared-for person, even a carer who has lower-level needs may get some support. That is quite different from the current position.
One general service for which the bill provides is the information and advice service. Each local authority’s information and advice service will provide information and advice about a range of issues that are important to carers, including income maximisation, education and training, advocacy, carers’ rights and health and wellbeing. To take account of carers’ views, the bill also refers to information and advice about emergency care and future planning.
The information and advice service will be available to all. It is important to recognise that, as we have amended the bill to add advice on bereavement services, it will allow former carers who are transitioning to a life without a caring role to take advantage of the support that the service will offer.
An important amendment was made at stage 2 to clarify that local authorities do not need to set up those services from new. Many good third sector information and advice services already exist and we want to encourage local authorities to build on what is already available. They do not need to reinvent the wheel; they can use existing services.
The bill makes specific provision for young carers, in recognition of their particular needs. The definition of young carers has been extended so that young carers who reach the age of 18 and are still at school can continue with a young carer statement, which will help them with the transition to any adult carer support plan while ensuring that there is no gap in provision. The young carer statement will continue to have effect until an adult carer support plan is in place. I have already spoken today about our commitment to ensuring that good guidance is in place to further support the transition arrangements.
There is also the local carer strategy, which has to involve carers and their representative organisations. That is another important step forward.
A number of members have raised issues about resourcing for the provisions in the bill. Maybe I was not listening, but I certainly do not recall the issue having been raised before. It has been suggested that, when the attractiveness of national eligibility criteria was considered, there was some form of financial consideration, but I want to be absolutely clear that that did not factor into my determination of the way forward. That is evidenced by the fact that we have retained the provision that might subsequently allow us to institute national eligibility criteria by regulation.
I am clear that we will resource the provisions of the bill. The financial memorandum sets out £19.4 million in 2017-18, rising to £88.52 million in 2021-22 and on a recurring basis thereafter.
As welcome as it was, Ms Grant’s intervention was unnecessary. I will go on to say what I was going to say.
I still consider the financial memorandum to be our best estimate. It has been informed largely by local government and COSLA figures. During the debate, Johann Lamont said that I had not responded to COSLA’s concerns, which was a surprise to me, because I met COSLA in advance of stage 1 and heard its concerns. I asked COSLA for alternative figures and I am still waiting for them.
To take on board the further concerns that were expressed, I established the finance review group, of which COSLA is a key member. I have heard nothing from that review group that leads me to question the assumptions in the financial memorandum. Any financial memorandum is always a best estimate and I stand by this one. I have seen nothing that would cause me to question the assumptions that have been made therein.
I can, indeed.
What Johann Lamont said seems to be a case of reading between the lines. I have specifically said to COSLA that I am happy to take any figures that it provides and I am still waiting for them. I have also established the finance review group, on which COSLA sits. If it comes forward with any new information, of course I will consider it; that is my clear commitment to those who are involved in the process and to Parliament.
I introduced the bill because I want to accelerate the pace of change and build on what has been achieved. The bill is a huge step forward in helping to ensure that carers can continue to care if they so wish. People having good health and a life while they are caring are aims that we want to be achieved. I hope that tonight we will unite to back the Carers (Scotland) Bill.