Family Care Givers

– in the Scottish Parliament on 30th September 2020.

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Photo of Christine Grahame Christine Grahame Scottish National Party

The next item of business is a debate on motion S5M-22860, in the name of Monica Lennon, on recognising the importance of family care givers.

I invite members who wish to speak in the debate to press their request-to-speak buttons now. I call Monica Lennon to speak to and move the motion.

Photo of Monica Lennon Monica Lennon Labour

I am grateful for the opportunity to open, on behalf of Scottish Labour, this debate on recognising the importance of family care givers.

I know that members across the chamber care deeply about the issues raised in the motion, and have been supporting their own constituents who have been affected. We need to find a strategy that keeps care givers connected with their loved ones, whether they are in a neonatal ward, supported living accommodation, a hospice or a care home. I hope that, alongside the work that the Cabinet Secretary for Health and Sport is leading, the debate will take us closer to achieving that.

This is a week of milestones, but unfortunately not all of them are happy ones. Tomorrow we will mark the international day of older persons, which will be an opportunity to celebrate our older citizens. However, it will also be a day on which to reflect how we might better respect their rights, needs and aspirations. This week also marks the passing of 200 days since most care homes went into lockdown. Thousands of people live in Scotland’s care homes, and they have been among the groups who have been hit hardest by Covid-19. Yesterday we reached the grim milestone of Covid-19 having caused a million deaths worldwide, so we know that we are still living through a global pandemic, with all the challenges that it brings.

At the start of the pandemic, in March and April, none of us—least of all care home residents, the staff who look after them, or their families—could have imagined what was to follow in the months ahead, or that, six months on, so many of them would still be living under such harmful restrictions.

This year has been a sad and difficult one, and our sympathies remain with all those who have lost loved ones due to Covid-19. Almost 2,000 deaths in Scotland’s care homes have been confirmed as having been caused by the virus. Worryingly, excess deaths are also increasing, including those from dementia, in comparison with those in previous years. The impact of isolation is awful and cannot be understated.

The First Minister has said on many occasions that mistakes would be made, and we cannot turn the clock back to January or February and change what has happened. However, we can ensure that the mistakes of the past are not repeated in the future. We must have a strategy to ensure that care givers and their loved ones can be together. We must avoid a winter of hell for families whose loved ones have so far survived the impacts of the pandemic but who are nevertheless grieving in their own ways as we near the mark of six months having passed since restrictions on them having contact were put in place.

Last week, I asked the First Minister about evaluation of the shielding strategy, and how such learning might inform our future approach to care homes and care givers. In response she said that although some scientists hold the view that vulnerable groups in our society should be sealed off and everyone else should be allowed to get on with their lives normally, she did not agree with that, either practically or ethically speaking.

The First Minister said:

“We cannot segregate our lives in that way. We live interdependently; younger people live with older people. I also do not think that it is ethically right to expect one group of the population to bear all the burden of dealing with the pandemic.”—[

Official Report

, 22 September 2020; c 30.]

I absolutely agree with the First Minister, but the fact is that, right now, thousands of people are in effect sealed off from their family care givers due to the current guidelines.

I pay tribute to Cathie Russell and other members of the care home relatives Scotland group because they have been instrumental in making me and people like me better understand the role of family care givers. They are not just visitors—I think that that phrase and the Twitter hashtag has left a strong impression on all of us.

I am grateful to the Cabinet Secretary for Health and Sport for her recent meetings with Cathie Russell and some members of that group and I know that she is meeting them again this week, with a view to making real progress. I was heartened to hear the cabinet secretary, in her evidence to the COVID-19 Committee this morning, acknowledge the harmful unintended consequences of restrictions on family care givers. She talked about her aspiration to increase not just the frequency of contact but the duration of that contact and she talked about the importance of touch. That will have given a lot of people some hope; I feel strongly that people should not have to come to the Parliament and hold a rally to get a response from their MSPs. Apart from the rally, we have had petitions, and I pay tribute to Natasha Hamilton and Pauline Rodger for their respective petitions on this important issue. Pauline’s petition has been running since May and it is really sad that, as we enter the autumn, there are still many issues to resolve.

One woman emailed me yesterday to tell me about her mum, who lives in a care home and is frail and elderly. Her mum does not have dementia but, even though she is fully aware of what is going on, she does not fully understand why she is being deprived of family contact and, importantly, trips outside the care home. I feel that I must give a suicide trigger warning here because her mum’s mental health deteriorated badly and, in June, she tried to take her own life—she is 92.

These individual stories are absolutely heartbreaking. Of course we need to do everything possible to stop the virus getting into care homes, but there is a hidden catastrophe in relation to mental health and we must do something about that too, so we must make access to family care givers a priority.

I want to stress that not everyone who relies on family care givers is elderly. Gary’s adult sister, who has learning disabilities, and his elderly mother live in separate care homes in South Lanarkshire and they have not seen each other for the past six months. Gary said that their care homes are just 8 miles apart, but they may as well be 8,000 miles apart.

There are other stories, such as that of Sylvia Watson, whose mother Mary just recently turned 104 years old, but can see only one of her daughters right now, due to the one visitor per household rule. Why can we not change that rule so that Sylvia and her sister can both be recognised as designated care givers? There are thousands of stories like that, so we must do better.

What is the solution? The current approach in the guidelines is leading to hundreds of different scenarios—possibly more than a thousand—with some families not knowing from one day to the next what they are able to do or when they are able to provide care. As we head into the winter, we know that the opportunity for outdoor contact will not be reliable, so a care giver strategy needs to be put in place rapidly, to restore contact between families and their loved ones.

We know that lots of testing capacity is unused every single day, so why can we not be more innovative and use that testing capacity for the benefit of family care givers? I know that colleagues such as Alison Johnstone, who is in the chamber, have been consistent in calling for regular and routine access to testing. That is really important and it is addressed in the motion. No one is suggesting that testing negates the need for other safety measures, including personal protective equipment, but it would be a step in the right direction.

I have a constituent who is a carer for his wife. Due to a serious brain injury, she is in a care home, despite being only in her 50s. Because she lost so much weight during lockdown, my constituent was granted access to come in every day at lunch time and dinner time to help to feed her. He was given regular access to testing, and he wore PPE. Thankfully, her weight stabilised. However, when the Lanarkshire lockdown was brought in, his contact was stopped immediately. He has nothing but praise for the care home staff but, as my constituent says, why is it more dangerous for him to be a care giver than it is for the staff to be there? We have to recognise that there should be equal status between family care givers and those who are employed to provide care, and I hope that the motion achieves that. None of us really feels that we have the balance right at the moment.

In a global pandemic, we can learn a lot from other countries and exchange information with them. For me, the approach in Ontario stands out. A bill has been lodged by Lisa Gretzky, who is a member of the legislative assembly, to address the issues that we are talking about. The bill’s aim is to recognise the important role and status of family care givers.

In the UK, including in Scotland, there have been really good examples of care home staff moving into care homes. In one care home in England—I think that it is in Oxford—when new residents move in, the family care giver is allowed to move in for the two-week isolation period. We have seen other examples that look quite quirky, such as people hugging through plastic sheets and jackets. People are trying to do a lot.

Of course, recognising family care givers does not take away from the professionalism and unique skills of people who provide care. The vast majority of those who have spoken to me do not have a bad word to say about the amazing staff who look after their loved ones. We know that, on an individual level, there are people of great dedication and skill who do an incredible job.

I welcome the clarification in the Scottish Government’s amendment that it will set out its winter plans really soon. That is important. I do not disagree with the content of the Conservative amendment, which was lodged by Donald Cameron. I fully agree that there is a need for a public inquiry. Many of us feel uncomfortable about the fact that we do not know when the inquiry will be, and we do not want it to be kicked into the long grass. A public inquiry has to be about much wider issues than simply what is happening in care homes.

I am not sure whether this is deliberate, but Donald Cameron’s amendment would take out the important reference in the motion to testing and it would kick out the reference to the principles in the Ontario bill. I am not trying to bind the Government’s hands on that, but we should all sign up to those principles, which go beyond people living in care homes and are about ensuring that people of all ages and in all circumstances have that important connection with family care givers.

Our care sector has been and continues to be terribly affected by the Covid-19 lockdown. Tomorrow, as we begin a new month and mark the international day of older persons, it is absolutely vital that we agree a way forward that avoids another 200 days of isolation for our care home population. I welcome the new funding that was announced yesterday for health and social care services. We need urgent investment in PPE and testing, and a clear winter plan that will get us through the difficult months to come. We need an end to the unintended consequences of lockdown, which has kept families apart for half a year, and we need to move forward with a strategy that recognises that family care givers are more than just visitors, and that they deserve equal rights.

For the past decade, it has been Scottish Labour policy to have a national care service. That is rooted in a deeply held belief that we should put people before profit. As we move forward into the 2020s, we want a national care system that puts people at the centre and gives them choice and freedom to live with dignity. We see the review as progress, but we need swift action, and we need change to happen now, starting with important family contact.

I am sorry, Presiding Officer, I thought that I had 13 minutes, but I have got that wrong, so I will finish now.

As we look round the world to our neighbours, we must learn every lesson possible. I want us all to act now to reunite families across the country.

I move,

That the Parliament observes that 1 October is International Day of Older Persons; notes that more than 200 days have passed since care homes began locking down in March 2020 in response to the COVID-19 pandemic; further notes with great sadness the scale of the pandemic in Scotland’s care homes and the tragic loss of life that has occurred; believes quality social care to be essential to the health and wellbeing of people across Scotland and concludes that it is time for a National Care Service, which will deliver pay for social care workers that reflects their value and professionalism; is concerned that limited or no contact with family caregivers is having a negative impact not only on the health and wellbeing of care home residents, including those with Alzheimer’s disease and dementia, but also on children, young people and other adults affected by restrictions on their caregivers; agrees that receiving care and support from one or more designated caregivers is important for the health and wellbeing of individuals, and that testing should be available to everyone involved in providing care; commends Bill 203: More Than A Visitor Act (Caregiving in Congregate Care Settings), 2020, which is currently progressing through the Legislative Assembly of Ontario; calls on Ministers to adopt a similar approach, and further calls on the Scottish Government to set out its plans for how social care services will be properly protected during winter.

The Deputy Presiding Officer:

If you had had 13 minutes, I would have given you 13 minutes. I had better tell members how much time they have.

I call Jeane Freeman to speak to and move amendment S5M-22860.2. You have eight minutes, Ms Freeman.

Photo of Jeane Freeman Jeane Freeman Scottish National Party

As members across the chamber well know, we are in the middle of a global pandemic. To give some context to what I am about to say, it is perhaps worth reminding ourselves of some important statistics. As Ms Lennon said, yesterday was a particularly grave milestone. In nine months, just over 1 million people have died from Covid-19 worldwide, and there have been at least 33.5 million cases. Global mortality tells us that one in 10,000 people under the age of 20 will die from the virus but that, for the over-85s, the number is one in six.

We know much more about the virus than we did nine months ago, but we do not know everything yet, even though the world’s scientific and clinical community is working faster than it has ever done to understand the virus and its impacts, and is searching hard for a vaccine that works and treatment that is effective. However, we know what harm the virus can do to sections of the population, including those of us who are older and people with individual or multiple health conditions. Increasingly, we are understanding the long-term health impacts for those who survive serious cases of the virus. We know, too, that the virus spreads.

Today, we have had the tragic duty to report that there have been a further seven deaths of people with Covid-19 in Scotland. Today, we have also had to report that there are 137 people in hospital with the virus, whereas on the same day last week there were 83 cases. That is an increase of 65 per cent in a week. The virus is still with us.

Mr Cameron’s amendment calls for an urgent public inquiry into the discharge of hospital patients into care homes. I make it clear that we are absolutely committed to holding a full public inquiry into all aspects of Covid-19 and its impact on all aspects of our nation. I hope that the United Kingdom Government will also hold a public inquiry into the handling and impact of Covid-19, at the right time.

Photo of Jeane Freeman Jeane Freeman Scottish National Party

I will do, in a moment.

Given that, I hope that Mr Cameron will understand that I cannot support his call for a separate public inquiry into only one aspect of the pandemic. I want Scotland’s inquiry to start at the appropriate time, when the impact of Covid-19 has been substantially reduced. In the light of the numbers, which I have just reminded all members of, I hope that Mr Cameron understands that, at the moment, my focus and that of our expert advisers must be on our continued efforts to control and suppress the virus and thereby save lives.

Photo of Neil Findlay Neil Findlay Labour

We know that a public inquiry will come, but the cabinet secretary has been asked on many occasions when she first knew that people were being discharged to care homes without being tested. We need only a few short words from the cabinet secretary in response to that question. We just need a date—nothing else. The cabinet secretary has been asked the question umpteen times. Why can she not give a straight answer to a simple question? On which date did she first know that that was happening?

Photo of Jeane Freeman Jeane Freeman Scottish National Party

We were initially alerted to the situation by reports in the national press on what was happening south of the border. That was when we began to investigate what was happening in our care homes. In May, June and July, there were a number of such reports. That is why we commissioned the specific piece of work that Public Health Scotland is undertaking. It is looking at the dates of discharge from hospital into care homes, whether the individuals were infectious at the point at which they were discharged and what the rationale was for the discharge of patients who were infectious.

It is in the context of the global pandemic and its presence in Scotland that we sought to introduce measures to protect those who are most vulnerable to being harmed by it. Among others, those measures included what were undoubtedly severe restrictions on visiting care homes. Those restrictions lasted for a long time, except in the case of essential visits. Since 3 July, we have been steadily trying to ease those restrictions, initially with outdoor visits, and then by increasing the number of outdoor visitors and preparing care homes for the return of indoor visits from early August, with each resident having one designated visitor. Care homes have had to be free from Covid for 28 days and to be participating fully in the staff testing programme. Most recently, we have worked to restore some of the normal communal activities and health and wellbeing services that residents previously had access to. However, none of that is normal when physical distancing remains necessary, staff are wearing additional PPE and enhanced cleaning is in place.

None of those decisions to restrict visiting or then to open it up in a limited way has been taken without strong and clear clinical advice on risk levels and mitigation, particularly from those with considerable experience in older people’s physical, neurological and mental health care. We have worked closely on this and other issues with groups such as the dementia in care homes group and Scottish Care, and we have listened to others and looked at approaches elsewhere.

Of all the decisions that we have had to make this year and all the decisions that I have had to make this year, those have to have been the hardest, because I know so very well their impact and the harms that can be caused as we try to prevent harm.

Listening to those views, I am acutely conscious that what is probably missed the most is time and touch—time with the loved one to talk, have a cup of tea and catch up on news, and the chance to touch, holding their hands and giving them a hug. When I spoke to members of the care home relatives Scotland group a few days ago, that came across very strongly, but as strong were their recognition and understanding of the need to protect their loved ones from the virus.

The work that we now have under way, on which I intend that we will reach a conclusion, in part, very shortly, is to open up visiting to designated visitors so that they can visit more often and for longer, with all the appropriate PPE and other measures being in place, and also eat with their loved ones if they wish, bring in gifts and personal possessions, and have a named back-up visitor for times when they cannot visit.

I want us to reach a better balance in the measures that we take, bearing in mind, of course, that where there are increased numbers of cases in the locality of a care home, the local director of public health has a responsibility to act to increase protective measures if that is what their professional judgment tells them is the right thing to do.

All those steps and the many views and propositions that are on offer about the future of adult social care are well within the scope of the independent review that was announced in the programme for government. The review is well under way and it is on track to produce recommendations in the very early part of next year. It has the expertise and experience of both its chair, Derek Feeley, and its advisory panel, and its work at pace includes listening to unions that represent staff, to providers, to local government, to families, to carers and, most important, to those who receive care.

In adult social care as in the NHS, the most important resource that we have are the staff who work there. Be it in care homes or in care at home, they bring compassion, skill and expertise to the job. In creating a national approach to this vital service, be it a national care service or any other option that this Parliament chooses, there are important decisions to come on valuing those staff and offering jobs that not only are worth while and rewarding in themselves, but offer future progression, training and learning in a coherent and consistent way.

Those will be vital questions for all of us in the coming months, but for the residents of our care homes and their families right now, there is, I am sure, a better balance that we can strike. That work is under way and I intend to be able to update Parliament and, most important, relatives and care home residents shortly on the first steps towards that better balance.

I am pleased to support Ms Lennon’s motion. I move amendment S5M-22860.2, to leave out from “, and further calls” to end and insert:

“; notes that the Scottish Government will soon be setting out winter plans for the NHS and social care to ensure that they are as protected as possible during the winter; welcomes that the independent review of social care is examining how adult social care can be most effectively reformed to deliver a national approach to care and support services, including a National Care Service; recognises that everyone has a part to play in ensuring that transmission of COVID-19 is curtailed in order to protect the most vulnerable people in society, and further recognises that, while some restrictions on care home visiting may be required to prevent the spread of COVID-19 to and within care homes, these should be removed, mitigated and amended as soon as it is clinically safe to do so in order that care home residents can safely see their loved ones.”

Photo of Donald Cameron Donald Cameron Conservative

I am grateful to Labour for bringing the issue to the chamber. There is much in its motion and in the Scottish Government’s amendment with which we agree in principle, in terms of both the main issue, the spirit of which is that we must recognise the importance of family care givers, and many of the more specific, practical aspects that arise.

I acknowledge the consensual tone of this debate, and for the most part I will try to replicate it in my speech. It is very hard to dispute much of what has been said by both Monica Lennon and the cabinet secretary.

I pay tribute to every care worker in Scotland for all their efforts during this unpredictable and unprecedented moment in our history and for all that they did before Covid-19. The role in society of those who work in care was hugely important long before the pandemic struck us. Whether someone works in a care home, delivers residential care in the community or cares for a family member or friend, we value immensely what they do and appreciate their commitment to that vital role, especially at this juncture. Many across the chamber will express such sentiments today; they need to be repeated, but no one should think that such repetition in any way diminishes the import of our words or our sincerity in saying them.

We acknowledge that Thursday is the United Nations international day of older persons. We recognise the aims of this year’s campaign, which include the need to increase understanding of the impact of Covid-19 on older people and on healthcare policy, planning and attitudes. The crisis has been a challenging period for many—not least those who provide care, as clear dangers exist for care givers and care receivers. Whether it is through the increased likelihood of transmission of the virus or the heightened risk of complications for those who are older or who have underlying health conditions, it is clear that the risks are greater, but the care sector has adapted to many of the challenges, and care providers should be commended for all their efforts.

The care sector has faced issues during the crisis, which have been touched on—by Monica Lennon in her motion and by other MSPs in the chamber and in the media. There have been almost 2,000 deaths in our care homes because of Covid-19, which is almost half of all such deaths in Scotland. Testing of care home staff has been inadequate, and hundreds of untested patients were moved to care homes between 1 March and 21 April. It was unacceptable to allow into our care homes at least 37 patients who tested positive for Covid-19, which exposed staff and the most vulnerable residents to the virus.

Yesterday, we learned that Public Health Scotland intends to delay until the end of October the publication of a crucial report on the true number of Covid-19 positive patients who were moved to care homes, although the First Minister confirmed that the Scottish Government asked for that report to be completed by the end of September—today.

Photo of Jeane Freeman Jeane Freeman Scottish National Party

I am sure that Mr Cameron will appreciate that Public Health Scotland’s reason for not publishing at the end of September, as it and we had hoped, is that it wants to be absolutely sure, when bringing together the number of data sets that are required to produce the report, that the data is robust and analytically sound. That is exactly the responsibility that it has and the job that it should do.

Although I, too, am disappointed that the report is not available, I am sure that we can all agree that Public Health Scotland has sound and correct professional reasons for reaching the position that it has. It has given us as much notice of that as it could do.

Photo of Donald Cameron Donald Cameron Conservative

I acknowledge that those were the reasons that were given, but the cabinet secretary can be under no illusions: the delay represents more heartache and distress for the affected families who lost loved ones in care homes. We need to know the full number of Covid-19 positive patients who entered care homes, and Neil Findlay is right: we need to know when the First Minister and the cabinet secretary first learned that that was happening. We also need to know what guidance, if any, clinicians were following when the transfers were made. That is why our amendment repeats our call for an urgent public inquiry, so that families can get those urgent answers.

I would like to move on to other areas of the debate. We recognise the immense worry and concern of family care givers who have had limited or no contact with their loved ones, particularly those who have conditions such as Alzheimer’s and dementia. We acknowledge that some work has been done to ensure that care home residents can meet people outdoors, although that will clearly become less practical as winter approaches. I take at face value what the cabinet secretary has said, in both her amendment and her public statements, about the issue, and I do not doubt her sincerity for a moment. However, as Jason Leitch said to the COVID-19 Committee this morning, it is one of the most difficult issues that has to be addressed by any Government dealing with Covid-19 anywhere in the world.

I note what the cabinet secretary said about allowing one designated visitor to meet a resident indoors, but, from my inbox—I am sure that this is the same for many MSPs—I know that family members, in particular, are increasingly distressed about not being able to see their loved ones. For instance, I have read about people being separated by Perspex screens. It is heartbreaking to read some of those stories.

The care home relatives Scotland group has called for more access for relatives in care homes to improve people’s quality of life. Members may have seen the message from Mary Fowler, who is a 104-year-old care home resident who took to social media with an emotional plea to see her family. The existing restrictions made her feel like she was in prison. That is a stark example of the people who have made significant sacrifices and a reminder that we should keep looking for ways to safely return to some kind of normality for those who are most vulnerable.

Labour referred to the national care service in its motion. We welcome the review to investigate that, which was announced in the programme for government, and we await with great interest its findings in January. We believe that that review should happen first and that its conclusions should be digested before we come to a final view.

There are undoubtedly wider issues across the whole sector—in both the public and private sectors—and we must do all that we can to remedy them by working with care workers, care providers, residents in care and bodies such as Scottish Care and the Care Inspectorate.

It seems obvious that reform of some sort is coming. As things stand, we cannot support a blanket commitment to a national care service, as in Labour’s motion, but that should not be read as Conservative members being resistant to change in the sector.

In conclusion, we are sympathetic to much of the motion. We need an urgent inquiry, and we believe that the national care service review should be carried out before we come to a final view. I hope that other members support our amendment.

I move amendment S5M-22860.1, to leave out from “concludes that it is time” to “similar approach” and insert:

“welcomes the review into a National Care Service; acknowledges the very significant contribution of social care workers, both in general and in terms of the COVID-19 pandemic; shares the concerns of families calling for better care home visiting arrangements, given that limited or no contact with family caregivers is having a negative impact, not only on the health and wellbeing of care home residents, including those with Alzheimer’s disease and dementia, but also on children, young people and other adults affected by restrictions on their caregivers, and believes that this policy should be reviewed; calls for an urgent public inquiry into the unacceptable transfer of COVID-19-positive patients to care homes”.

The Deputy Presiding Officer:

We now have no time in hand, so members must absorb interventions. I am sorry.

Photo of Alison Johnstone Alison Johnstone Green

I thank our wonderful care staff, who have done incredible work in often extremely difficult conditions throughout the pandemic. They have been a source of care—obviously—support and comfort to many care home residents during a distressing and frightening time.

The issue is an important one that we cannot debate too often, and I thank the Labour Party for bringing it to the chamber.

It is clear that errors have been made during the pandemic. Although it is essential that a public inquiry provides more detailed answers, we are in the second wave, and learning must take place now.

The Scottish Greens have been calling for regular Covid-19 testing of front-line health and care workers since April. Participation in a Covid care staff testing scheme is one of the conditions that care homes have to meet before they can resume visiting, so robust and regular testing is vital to ensure that those who have been isolated in care homes can once again see their loved ones.

As the motion states:

“more than 200 days have passed since care homes began locking down in March”.

During the lockdown, families have been unable to grieve, to celebrate or to share words of comfort together. The psychological toll that that has taken on residents of care homes and their families is immense. The motion also rightly notes the significant impact of isolation on

“those with Alzheimer’s disease and dementia”.

Although care home residents undoubtedly need to be protected from the potentially fatal harm of Covid, we have to strive to lessen the psychological harm and to maintain dignity and quality of life.

Regular testing of care workers has now been delivered, but there have been reports of long waits for test results. Only two weeks ago, a Unison poll indicated that half of care home workers had not been tested for the coronavirus.

Care-at-home workers also provide vital care to people who are often very vulnerable, and they must not be overlooked. Labour’s motion states:

“testing should be available to everyone involved in providing care”.

I could not agree more.

Scottish Care has described support for care at home as

“the Achilles heel of our pandemic response” and has said that it has been

“insufficiently planned for nationally and locally.”

We cannot afford to neglect that area of the care sector. That is evidenced by the stark warning that Scottish Care issued about a potential link between excess deaths in the community and

“the removal or reduction of homecare supports as a pandemic response”.

A report that the Care Inspectorate published this month detailed the impact that the removal of such support has had on service users. It said:

“reduced community access, due to lockdown, resulted in a loss of daily routines and predictability” and an inevitable rise in stress levels.

More widely, Inclusion Scotland conducted a survey in July that showed that 79 per cent of respondents who were in receipt of social care support prior to lockdown had lost some or all of their social care support during March and that just over a third of respondents who had had their support reduced or stopped were still being asked to pay care charges to their local authority.

Covid-19 has exposed the fundamental flaws in the care system and the devastating consequences for disabled people and unpaid carers. Engender says that

“As many as 39% of unpaid carers are providing more care due to local services reducing or closing as a result of Covid-19” and that

“Survey data published for Carers Week 2020 suggests that there are now as many as 1.1 million unpaid carers in Scotland, of which 61% are women.”

Any reintroduction of care packages will have to take into account the significant damage that may have been inflicted on people’s physical and mental health as a result of the pandemic as well as the disproportionate effect on women, who continue to take on the majority of care work.

Action is also needed on staff wellbeing. Many of our care workers will be exhausted after the trials of the past six months, and workforce issues are exacerbating that. In Scotland,

“20% of registered care services report having nursing vacancies and the level is significantly higher in care homes for older people, with 46% of these services reporting nursing vacancies.”

The Royal College of Nursing tells us that

“registered nurses working on the frontline in care homes are feeling the impact of these nursing shortages daily and this strain has been amplified during the COVID 19 pandemic” and that urgent

“Action is needed to deliver fair pay, terms and conditions for registered nurses and other nursing staff employed within care homes.

We have often discussed the on-going undervaluing of care workers in the chamber, but it bears frequent repetition. Care work is essential for our society and economy, but it remains unappreciated and underpaid. There is a vast mismatch between the value of care and the support that carers receive. Much social care in this country is still done by volunteers: partners, children, parents, friends and neighbours all contribute to helping those who are in need of care. Three out of five of us in the chamber will become carers at some point in our lives, yet the value of the work that carers do is not fully recognised. Carers’ benefits do not recognise the immense contribution that is made by unpaid carers. Better conditions are needed for both professional care workers and unpaid carers who are attending to family and friends. Social care workers do hard and vital work in people’s homes and care homes in every community, but it remains one of the lowest paid sectors, fuelling the gender pay gap.

The Scottish Green Party stood on a manifesto commitment to pay all care and support workers significantly above the living wage, financed by progressive taxation, not by care charges. We have also long called for improved working conditions for social care workers such as paid travel time, sick leave, skills training and an end to zero-hours contracts. More than half of working age carers juggle paid employment—

The Deputy Presiding Officer:

I am sorry, but you must conclude.

Photo of Alison Johnstone Alison Johnstone Green

I will conclude my remarks there.

The Deputy Presiding Officer:

I am very sorry. I was trying to signal to you.

I now call Alex Cole-Hamilton. Please watch the pen, Mr Cole-Hamilton, and I will not have to interrupt you.

Photo of Alex Cole-Hamilton Alex Cole-Hamilton Liberal Democrat

I will never ignore the pen, Presiding Officer.

I thank Monica Lennon and the Labour Party for lodging this important motion. Monica Lennon and I attended a demonstration outside the Parliament last week, which involved the care home relatives Scotland let us visit campaign. It was one of the most compelling demonstrations that I have attended outside the Parliament building. We heard real human stories about anxiety and loss.

Since those weeks of high infection rates, in early March and April, when we had to pass emergency Covid-19 legislation, I have been deeply concerned about the psychological impact on constituents. Whoever you are, these are days of high anxiety. At a time when all of us most need a hug, we are denied it.

Nowhere are the privations of human contact that have been caused by lockdown more keenly felt than in those care settings that are at both ends of life’s journey: our neonatal wards and care homes. Among all the angst, people have been told that they cannot do the most natural thing—hold the hand of a premature baby or an elderly parent. They have been denied that for over 200 days. That is a dark situation.

It does not have to be like that. I believe that we can harness what we know about the virus to better inform our public health policy so that we can allow care home residents to receive family care as well as keep everyone safe. The motion mentions Canada, and we have heard a lot about it. In Ontario, family carers are treated in a similar way to agency care staff. They undertake the same hygiene measures and are allowed to safely continue to provide the care that they provided before the outbreak, which is a vital part of the care package. I want to see that happen in Scotland.

We know that family members will stick to the rules because they do not want to jeopardise the safety of their loved ones. We also know that allowing family carers to come in can improve outcomes in homes. They are informal carers and will pick up on corners that are being cut or changes in their family members that might have otherwise been missed.

I am sure that we can all agree that it is distressing to have a sudden change in your care package, but that distress is especially acute for those who are in the early stages of dementia. I find unsettling the sight of everybody around me in masks; I cannot imagine what that must be like for people who are struggling with dementia.

Often, friends and relatives have been caring for a resident for many years, so they can pick up on early signs of deterioration. The people whom we met last week are witnessing those during the Zoom calls and the conversations through windows that they are having to make do with.

Even if care is top rated in the home and it is run very well, anxiety and separation can only exacerbate conditions and reduce life outcomes. A few months ago, we all enjoyed seeing photographs on social media of drive-by hellos at care homes, where residents sat outside in gardens and waved. It was lovely, and it meant so much to so many of them, but it is not summer any more. Autumn will soon turn to winter, and—after all, we live in Scotland—those outdoor meet-ups will just not be practical. Behind those images, as we heard at the demonstration, was also the reality of residents with dementia clawing at the screens between them and their loved ones, trying to touch or even hear their families, because it was so difficult.

We can do a lot of this through testing, and it is very important that we expand our testing operations. While we are seeing local spikes, we can box clever with adequate testing. Applying the same rules to family carers as we apply to bank and agency staff will ensure that we can allow family carers in. Willie Rennie has repeatedly called for a test for everyone who can make care homes a safer and controlled environment. We have staff tests up and running; why can we not expand that to family members?

I will come on to the Government’s amendment briefly, before I close.

One positive outcome is that people who are fortunate enough never to have been in a hospital, to have been carers or to have needed care are, for the first time, properly valuing what the social care sector means for this country. I echo Alison Johnstone’s thanks to our social care workers. They deserve the claps that we all came out and delivered to them on Thursday afternoons as much as anybody else in our health and social care system. We are relieved to know that they are there when we need them. As a country, we have been taking them for granted for far too long. I welcome a review of pay structures. Careers in social care are not only vital but in high demand, and that is only going to become more true. The number of carers needs to rise exponentially with our ageing population, so we need to make social care a profession of choice.

I will close by covering the national care service. Liberal Democrats absolutely support the national review on the formation of a care service. The sector fundamentally needs reform; however, we have grave concerns about controlling that entirely from the centre. Accountability for the delivery of social care should always have a link to the communities in which it is rooted and be responsive to regional variation.

However, that is not what today’s debate is about. Therefore, although we have some difficulty with the wording of the Government’s amendment, we want to embrace the spirit of consensus that is being forged across the majority of the Parliament today. We want to recognise that the motion and the amendments around it speak to the very needs of the families that Monica Lennon and I met on a cold day outside the Parliament last week. It is their love that keeps them going, and they want to keep their relatives going by extending that love and extending the care. They will do that not by visiting—they are not just there to hold a hand—but by being there to provide care and to be those informal inspectors who can pick up on problems. Above all those things, first and foremost, they want to provide the human contact that has been denied to so many of our most vulnerable constituents and residents of this country since the start of the pandemic.

The Deputy Presiding Officer:

I remind members that, if you wish to speak, you must press your request-to-speak button. I call Anas Sarwar, to be followed by Angela Constance.

Photo of Anas Sarwar Anas Sarwar Labour

I welcome the debate and all the contributions that have been made so far. I say, too, that it is important to acknowledge context. Covid has changed not just Scotland and the United Kingdom; it has changed the world. It is important to recognise that the people who are in positions of power have had to make difficult decisions. The science goes only so far—it cannot provide the answer to every situation, and ministers will have, largely, to make judgment calls. Sometimes those judgment calls will be correct and sometimes, in hindsight, they will be wrong. We should not forget that ministers are working round the clock to try to make the right judgment calls. I want everyone to know that any criticisms—perceived or otherwise—that I might make in my contribution are made in that context.

The past couple of weeks have emphasised that it is important to recognise that an effective communication strategy is not the same as a virus elimination strategy. I fully accept that the Scottish Government is better at communicating about the virus than the UK Government, but their decisions on the big calls have been largely the same. Six months into the pandemic, I believe that we should, despite some recent progress, be further down the road, whether that be in testing in care homes or in visits to care homes.

Care homes have faced the greatest burden of the pandemic so far. There have been almost 2,000 deaths in care home settings. Almost half—46 per cent—of all deaths have been in care homes, despite residents representing just a fraction of the wider population.

Patients were discharged from hospital without being tested. Testing them did not require scientific advice; it is just common sense that no one should have been transferred into a care home without being tested first, and that no one who tested positive should have been transferred into a care home. At the appropriate time, an enquiry will have to look into that.

I can only begin to imagine the emotional toll that this has all taken on people. I feel blessed, in a sense, that I do not have any direct family members in a care home. However, having had to visit my granny and look through the window to give her a wave, and seeing my children cry as we drive away while I hold back tears in front of them, I have an idea of how difficult the situation has been for so many of our fellow citizens.

I can only begin to imagine how difficult it must have been to have seen and to have read the reports about what has been happening in our care homes. For thousands of our fellow citizens not to be able to have direct contact with their loved ones must be simply heartbreaking.

I will talk about more that in a moment, but first, as Alison Johnstone, Alex Cole-Hamilton and Monica Lennon have done, I pay tribute to our care home staff. The pandemic has been extremely difficult for them. They should not feel as though they are to blame for the spread of the virus in their workplaces. They went to their workplaces and risked their own lives and the lives of their families. If the pandemic has taught us anything, it is who really keeps our country going in times of crisis. That should be recognised in how those people are regarded—not just through applause, but by how they are paid and how they are treated in the workplace and by wider society.

I will go back to wider issues around care homes. We are talking fundamentally about human rights and the right to life, not about the presumption that a person who lives in a care home has a certain healthcare need or certain mental capacity. I find it really frustrating that we have, at times during the pandemic, treated care homes as palliative care centres rather than as care homes. Good quality of life matters, but too many of our fellow citizens are feeling as though they are imprisoned in their care homes, and are suffering from loneliness, isolation, and emotional, psychological and physical trauma, as a result. We will see their scars, and the crises that are being caused by the mental health scars, in the following generation for years to come.

Last week, the First Minister said that it would be ethically wrong to single out a community. She is right, but we have singled out one community—care home residents. We have heard the heartbreaking personal stories of individuals feeling disorientated, their health deteriorating and many sadly giving up on life altogether and presuming that these are their final moments in this world. It is simply heartbreaking, so I want to pay tribute to all the people with relatives in care homes, particularly care home relatives Scotland, who have been sharing their stories.

Eliminating the virus matters, but human relationships also matter. I fear that how we have responded to the virus will cost more lives and cause more long-term morbidity than the virus itself. After six months, we can do better than this—we should be doing better, and we must do better. We need rapid testing and efficient and equal personal protective equipment in care homes.

We need to recognise that human interactions are a key part of our lives and that they have to happen so that we can give justice to all the people who live in care homes and those who care for people who live in care homes. I hope that through this debate we can do better for all those citizens, and respect the human rights of all those in our care homes.

Photo of Angela Constance Angela Constance Scottish National Party

I very much welcome the debate, because the pandemic and the national response have reminded us that, often in life, the hardest decisions are those that we do not want to make—but make them we must. Even life-saving and necessary decisions come at a cost and with consequences. It is apposite and correct that we talk about that and mitigate it, where we can safely do so.

I was grateful to the cabinet secretary for outlining the work that she is overseeing on how to make visits to care homes more humane where possible, including some creative ways to approach that. That was certainly important to my family before my grandmother passed: my family knows what it is like not to see a loved one.

I also welcome the debate because we should recognise the United Nations international day of older persons. It should be a springboard to increasing our resolve. The debate also gives us a great opportunity to solidify and build on the growing consensus for a national care service, given that the debate is shifting from whether we should establish one to how we do it.

Like me, the cabinet secretary will remember well our journey in building a social security system for Scotland. Although devolution of powers was only partial, it was nonetheless a mammoth task. Within and outwith Parliament, there was much debate, negotiation and argument, and votes were won and lost on all sides. However, our starting point was to build on a foundation of consensus about purpose and principles. We need to do likewise with a national care service.

Given that the Scottish Government has kick-started a comprehensive but short review of adult health and social care, now is the time for all parliamentarians to start building consensus, and to make sure that it is based on firm foundations by testing and debating not just the aspirations and vision, but the “How?”—the plan and the next steps. I know that many of us are already doing that, as individuals and as members of our political parties and other organisations that we are involved in. As others are, I am carrying out a consultation that is specific to the experience of residents, staff and people who have had a loved one in a care home.

Given the spectrum of care services and the desire for services to be delivered locally—in people’s homes, where possible—and to have national standards that provide a national safety net, members should make no mistake: building a national care service is a much bigger and more complex task than delivering a new social security service, or any other previous or existing government reform programme. However, I know that the prize is greater, because care touches, directly or indirectly, every aspect of our society and lives, and every public service.

Yesterday, we heard from the Reverend Dr Nanda Groenewald at time for reflection. I hope that everyone was listening, because Nanda is a minister in my constituency. She quoted Nelson Mandela and said that things may seem impossible until the next time. The pandemic remains the biggest public health crisis of our lifetimes, but even with the virus on the march again, I and others remain of the view that now is also the biggest opportunity in our lifetimes to rewrite the rules and to put right things that have never been right.

First and foremost, we need to take a human rights approach to care, but we need to find the right language to explain why it is essential to real daily life. Now is the time to put it beyond a shadow of doubt that, as a nation, we really value care work and care workers. Care workers might be low paid, but care work is never low skilled. They deserve so much more than our thanks.

Investment in social care must also be seen as an investment in wellbeing and in our economy, in the same way that the debate on childcare was transformed a few years ago with the recognition that it was key to getting women into work.

We know that the care sector employs more than 200,000 people. If we were to increase the number of people who work in care and increase pay for the work, that would increase employment rates by five percentage points and decrease the gender employment gap by four percentage points. Of course, we cannot talk about care—paid or unpaid—without talking about women.

As I have said before, we need to follow the money forensically in order to know exactly what public money is extracted from the private care sector and to the benefit of whom. Perhaps an early examination of the national care home contract would be helpful in our quest for care before profit.

I see that the Presiding Officer is giving me the nod. As usual, like other members, I feel as though I have just skated over the surface of the issues. All I will say is that we need to grasp that everything has changed—it must change and we must all play a part in that change.

The Deputy Presiding Officer:

I can tell members that interrupting all these wonderful speeches is not a happy task, but I have to do it.

Photo of Jeremy Balfour Jeremy Balfour Conservative

Along with other members, I thank Monica Lennon and the Labour group for bringing the debate to the chamber. There is a consensual feel to the debate, and I would echo many of the remarks from fellow members.

We have heard a lot about those who have dementia or who are in homes because of old age, but—with the Presiding Officer’s permission—I would like to move the debate on to talk about other people who are in residential homes. I have spoken about this issue in previous debates. Those who have learning disabilities or physical disabilities have been excluded from being able to see their parents, siblings and other loved ones in their family. Again, I congratulate PAMIS and other third sector organisations on keeping the campaign alive over the past few weeks.

A few weeks ago, I spoke in the chamber about a lady whom I had spoken to who has not seen her son since February this year. She has not physically been able to see him. He is bedridden so he could not come out into the garden for a visit over the summer, and she has had no physical contact with him. Because of his learning difficulties, he is unable to use Zoom or any other social media, and yet he is aware that he has had no contact with his mother for more than six months.

He and others in his position, and their mums and dads and their siblings, are looking for some kind of contact with their loved ones, not just to be able to touch them—although, as the cabinet secretary said, that is important—but for their mental welfare. I think that most of us would find it very hard to have no contact with the chief person in our life. If we add in disability on top of that, it makes it even harder.

I ask the Government, can we not make at least one member of a person’s family part of their caring team? As we regularly test carers who are looking after people, can we not add at least one individual per family to that testing regime so that they can go in and have regular contact with their son, daughter, brother or sister? That would not seem to go too far, and it would not seem to be beyond us to put testing in place. It would complement what the carers are doing for those individuals. The carers are doing a fantastic job, and I echo the remarks from almost every member in the chamber about what we owe to them and the work that they do.

However, we need to go a step further and add a family member who can go in on a regular basis with the appropriate testing. As Alex Cole-Hamilton said in his speech, they will look after them, they will obey the rules and they will do the cleaning, because they know that those things affect their loved ones and other people in the home. I hope that we can make progress on that sooner rather than later.

I will now expand these points slightly to consider those carers who are caring in individual homes, as well as in institutions, and the testing that they require. I have a carer who comes in and helps me in the morning. She then goes on to see probably five or six other people in her day. That is vital work, which allows me to be here to entertain you all on a regular basis. However, I am concerned that she and her colleagues, not just throughout Lothian but throughout Scotland, are not getting the appropriate testing. As we see an increase in the prevalence of the virus, we must consider what we are doing to protect carers, individuals and staff, so that they, too, will get the appropriate testing in the appropriate way.

All of us want the same thing; we just need to move forward as quickly as possible. I ask the cabinet secretary again if she could address the issue around those who are in homes: could one of their mums, dads, brothers or sisters not be made part of the caring team?

Photo of Stuart McMillan Stuart McMillan Scottish National Party

I welcome the debate, and I note the importance of 1 October as the international day of older persons.

There will be a vast amount on which we will agree today across the chamber—that has certainly been the case thus far—but I will touch on one point that every politician in the chamber might find a wee bit uncomfortable. We have to be honest with ourselves. I read the helpful briefing from Inclusion Scotland, and one section of it was headed “Postcode Lottery”. I know that the phrase “postcode lottery” is not used in the motion or any of the amendments, but it struck me that, when we as politicians use the phrase “postcode lottery”—it has been used thousands of times before, and it will be used thousands of times in the future—we sometimes fail to do so properly; it can just be a soundbite that is used to attack or challenge somebody from a different party without any attention being paid to the various factors affecting the subject concerned.

Alex Cole-Hamilton touched on regional variations, and I agree with him on that point. There will be occasions when, from a national perspective, a postcode lottery is very much the right thing: the regional variation that will happen with service delivery, whatever that service may be, is extremely important.

I move on to my second point. On 15 September, when the Parliament debated migration and care workers, I quoted a National Records of Scotland demographic and census publication from 2017 that referred to Inverclyde. The report stated:

“Inverclyde is projected to have an ageing population over the next 25 years, with a projected increase of 38% for those aged 65 or over. In contrast, the working age population (aged 16-64 years) is projected to fall by 26% between 2014 and 2039.”

Comparing Inverclyde with Midlothian in terms of the number of households between 2001 and 2019, the figure for my area has decreased by 0.6 per cent, while the figure for Midlothian has increased by 23.9 per cent. Most of those people will be younger and of working age.

I will explain why I am touching on that again. I welcome the fact that the Migration Advisory Committee appears to have done a U-turn yesterday on the issue of the shortage occupation list. When the Migration Advisory Committee spoke to the Culture, Tourism, Europe and External Affairs Committee on 1 November 2018, it had no concept whatsoever of how important social care is to Scotland. I have two quotes from that meeting. Professor Alan Manning, the committee’s chair, said then that the MAC’s view was that

“there are plenty of domestic workers—current residents—who are capable of working in the social care sector.”

Secondly, he said that

“Social care faces some very serious problems, and the MAC is not convinced that migration is the solution.”—[

Official Report, Culture, Tourism, Europe and External Affairs Committee,

1 November 2018; c 7.]

I wanted to get that on the record again, because of the MAC’s U-turn, and because the chamber is debating the issue again today in a serious way. Whatever happens and no matter what the review recommends, the Parliament must, in the short term, ensure that enough people are working in the social care sector to look after our older population.

Members have spoken about the independent review of adult social care, and I welcome the fact that that is happening. Those facilities are not just a care facility, but somebody’s home—somebody lives there—so it is important that they are well run, well staffed and well funded, because that will reassure family members.

My community is well served by care homes and I rarely receive any complaints about service provision. As other members have done, I pay tribute to all care workers across Scotland and particularly to those in my constituency. It is important, however, that we always strive to improve any service delivery for our older citizens, who deserve it.

The review will be wide ranging and consider whole aspects of the issue, particularly about how the highest standards of support can be achieved for the independence and wellbeing of people who use adult social care support. Its aim is to build on our long-standing commitments to improving adult social care provision and to ensuring that social care is effectively integrated with health services—I could go on, but I am conscious of time.

Since the start of the pandemic, the priority has been to save people’s lives, wherever they are. The scientific advice that was available at the time guided all decisions on the Covid-19 response. The discussion about the future of care homes is crucial and can help to set the example of the ambition that we have for the country and of the type of country that we want to have for our older citizens.

Photo of Pauline McNeill Pauline McNeill Labour

For me, the biggest tragedy of the Covid pandemic—an outrage, in fact, for which we must all account—was the treatment of older people, particularly in the early days of the crisis. In my opinion, in the early days we lost our basic humanity. Do not resuscitate notices were hastily issued; families were so distressed. In the early days, doctors told me personally that over-65s would not be admitted to hospital.

I asked the Minister for Older People and Equalities in committee whether she knew who made those decisions; she said that the honest answer was that she did not know. The guidance did not change.

The minister said that, at the beginning, many thought that the NHS would be overwhelmed. Perhaps she is right, but I hope that we would all agree in looking back that we must account for those decisions and, even if that was the case, we cannot justify having a policy—or any suggestion of a policy—that operates on the basis of the arbitrary age of 65 ever again. We must know how those decisions were made in the early days.

Photo of Jeane Freeman Jeane Freeman Scottish National Party

I am grateful to the member for taking an intervention because it allows me to clarify again for the record that there was no policy to issue do not resuscitate notices.

Those decisions were taken by some individual general practitioner practices and others. When we were advised of that, we made sure, through the chief medical officer at the time, the chief nursing officer, the Royal College of General Practitioners and others, that conversations were had, so that people understood the proper way in which decisions on such matters are reached and which decisions have to involve the individual patient and their family. There was no national policy decision whatsoever, and there will be no such national policy decision for as long as I am the Cabinet Secretary for Health and Sport.

Photo of Lewis Macdonald Lewis Macdonald Labour

Ms McNeill, you will get your time back.

Photo of Pauline McNeill Pauline McNeill Labour

Thank you.

It is a really important point. I accept everything that the cabinet secretary says, but I spoke to doctors who believed that they got guidance from somewhere. They did not make those decisions on their own. If the cabinet secretary is saying that the guidance did not change, which I accept, I ask her to tell Parliament at some point whether GPs made those decisions completely on their own. There were too many GPs out there saying that they were advised that the NHS could not cope.

I make the point because I want to make sure that any future Parliament, in any future scenario in which we face making hard decisions—I do not underestimate how difficult that was, particularly in the early days of the pandemic—never allows such a policy from any GP or organisation. If GPs made that decision on their own, that cannot be allowed to happen again. I do not say that for argument’s sake; I want to make sure that, looking back, we all agree that that can never be allowed to happen again.

There has been a loss of human and family contact, and families have been shut out due to their necessary removal from healthcare settings. Even at the best of times, when someone is ill, it is important that they have someone advocating for them with doctors and nurses. For many people, by necessity, that could not happen.

From looking on social media, it struck me that a generation of people have lost their parents prematurely, some people have lost both their parents in a short space of time, and many have lost their parents in care homes. Between the start of March and 21 April, nearly 1,500 untested patients were discharged into care homes from hospital, despite concerns that doing so might aid the spread of the virus. Other members have called for an inquiry into that matter, which I think is important.

More than six months on from care homes having to close their facilities to visitors, we examine what can be done at this point to make sure that families can have contact with their loved ones. As we move to the autumn and winter, the continuation of outdoor visiting is not suitable, and alternative solutions need to be found. I whole-heartedly support the Labour motion, and the call of the care home relatives Scotland campaign group that family members be treated as essential carers with the necessary access to PPE and testing, to allow more frequent and closer contact.

As we approach winter, and a potential second wave of Covid-19, it is essential that care homes are protected, and that we learn all the lessons that we can. The Royal College of Nursing has raised particular concerns around access to PPE for staff who are working outside the hospital environment, including in care homes. A report found that social care workers are more than twice as likely to die from Covid-19 than colleagues on the NHS front line.

Care workers need to be given not only better protection but better pay. The 3.3 per cent rise that was offered by the Government in April is not enough to recognise the key work that they do. My union, the GMB, is at the forefront of highlighting poor levels of pay in a predominantly women-run service.

As Angela Constance and Alison Johnstone have highlighted, women are most likely to be the providers of care, both paid and unpaid. Women comprise 85 per cent of the social care workforce in Scotland, and the Covid-19 pandemic underscores society’s reliance on women on the front line and at home. Jamie Livingstone, who is head of Oxfam Scotland, pointed out that

“Many carers, and particularly women who deliver most care, were already trapped in poverty before coronavirus and they are telling us that they’re facing rising bills for things like food and other essentials.”

The pandemic has had a disproportionate impact on women. We need to make sure that dealing with Covid does not have the unintended consequence of rolling back women’s rights.

Photo of James Dornan James Dornan Scottish National Party

I welcome the international day for older persons, purely for personal reasons, because my younger brother is elderly.

Many of the stories that we have heard today evidence the profound impact that the coronavirus has had on those who are involved in care, whether that is the carers—paid or unpaid—those who visit their loved ones in care homes or other settings, or those who require care. The staff in care homes and sheltered accommodation around my community and the country deserve immense credit for looking after our society’s most vulnerable people at the most challenging of times.

In April, I met—outdoors, of course—staff in care homes and sheltered accommodation in my constituency to provide them with top-up pieces of PPE that were kindly donated by local businesses. I was hugely impressed by the users and staff who I met and by the steps that all the homes had taken to adapt to the unprecedented situation. Just this week, my office heard back from some of the care homes that I had visited, and I was delighted to be informed that, to date, they have reported zero Covid cases. I thank them for all their hard work and dedication and for the care that they have shown throughout the pandemic.

Some of the measures that have already been introduced to prevent outbreaks in care homes—such as weekly staff testing, enhanced infection prevention and control and the provision of PPE—have undoubtedly saved lives, but, sadly, many facilities and families have faced, and continue to face, some of the most heartbreaking situations that we can imagine.

The most recent comprehensive National Records of Scotland Covid-19 report showed that the percentage of coronavirus deaths in care homes was the same as the percentage of Covid deaths in hospital: 46 per cent. Every week of the pandemic until the NRS report on 9 September, care homes have reported Covid deaths. Just as in other countries, the weekly number of deaths in our care homes has begun to increase again.

Worldwide, the death toll of this horrendous virus has reached a milestone that no one wanted to see. Officially, the death toll has now surpassed 1 million people. That figure starkly highlights why we must tread cautiously with any changes to existing guidance and make changes only when it is deemed clinically safe to do so.

I recognise how immensely difficult it is for anybody to see or hear the distress that relatives, families and those working in care homes are experiencing. I have an 86-year-old mother and my partner has a 76-year-old mother, who contracted Covid while receiving treatment for a stroke and was not allowed any visitors while recovering. Thankfully, our mothers are both now at home and living with the restrictions that are in place in Glasgow, but that experience gave us a flavour of what it must be like for those who have loved ones in care.

It is important for care home residents and their loved ones to see each other, and it is obvious that having visitors is fundamental to the health and wellbeing of those who live in such settings. Nonetheless, as we have heard, it is difficult to balance safe visiting with the risks that are posed by this awful virus.

Unfortunately, NHS Greater Glasgow and Clyde and a number of other health boards in the west of Scotland are under more stringent rules than those in the rest of the country and, as part of that, care home visits have been further restricted. They are limited to outdoor visits with a maximum of three people from no more than two households or essential indoor visits.

I am in touch with a constituent whose mother is in a care home. Due to the current rules, she has been visiting her mother outdoors, which the home has been using marquees to facilitate. Earlier this month during a visit, harsh winds made the marquee structures feel unsafe, causing my constituent and her mother alarm. My constituent is fearful that, should those restrictions remain in place over the winter months, it could become virtually impossible to see her mother, which we all want to avoid happening. However, we should not be under any illusion about the complexity of balancing the need to allow visits to take place safely for everyone with the risk of causing harm through this awful virus. The home in question specialises in the care of those with dementia and Alzheimer’s disease, which brings further challenges in itself.

The Scottish Government has worked hard with Scottish Care to find as good a balance as possible between its responsibilities to keep people safe and protect lives and its sincere recognition of the positive benefits of family connection for care home residents. Since the start of the pandemic, the priority has been to save people’s lives, wherever they live, and, as part of that priority, the Government has taken firm action to protect care home staff and residents.

The First Minister has said—and I do not for a second doubt her—that

“no decisions” taken by the Government

“have been more difficult and at times more genuinely upsetting than the range of decisions” that have been taken

“around care homes”.—[

Official Report

, 17 September 2020; c 12.]

I am grateful that the Cabinet Secretary for Health and Sport is ensuring that care home visiting guidance is kept under review, and I appreciate the work that is being undertaken to develop proposals for the next stage of the visiting plan.

I fully support the principle of a national care service. It feels like an idea whose time has come. If there is to be any silver lining from this horrendous virus, it must be that we use the space that it has created to rebuild some of the parts of society that needed change. A national care service sounds like a good place to start.

I hope that my constituents, and others across the country, will be reassured by today’s debate, and that the Government will look to open up further visiting options for families, including increased frequency of visits, while continuing to work tirelessly towards keeping people safe and protected during this public health crisis.

Photo of Edward Mountain Edward Mountain Conservative

This is going to be a hard winter for families and their loved ones who live in care homes. Like many MSPs, I have been asked by a constituent to try to imagine what it would be like to meet your mother, who was suffering from dementia, through a closed window, and then for her to wail and bang on the window as she does not understand why you will not come in; Covid-19 means nothing to her, but she cannot understand why you will not hold her as she wants to hold you.

Many families across Scotland are struggling with that situation. It feels—and is—heartless. That is why some families are questioning whether we have got the balance right. Although positive cases of Covid-19 are on the rise, so is the poor mental health of our elderly and most vulnerable, who feel confused, lonely, unloved and ignored. Worse still, in many cases they feel deserted by their families.

We have a duty to protect people from the threat of the pandemic, but we must not lose sight of what makes us human. We all crave the contact and, often, the physical reassurance of connection that is achieved by visits from family and friends. That is especially important when a loved one is coming to the end of their life and wants nothing more than to reach out and hold hands for the last time.

Family visits are vital to the health of long-term in-patients who also have complex needs, and it is far from ideal that designated family members are so limited in their visits. We need to find a safer way to show that we care. We are all aware of the risks that our care homes face from the threat of Covid-19. That is why we have to take the threat seriously.

However, I want to go back to what happened some time ago and, briefly in passing, to say that transferring Covid-positive patients into care homes was wrong. It must never be allowed to happen again. That is why I say to the Cabinet Secretary for Health and Sport that we need to see the report as soon as possible—not only for us as MSPs to see and understand it but for grieving families, who deserve answers, as do the people who gave the care in those care homes.

As winter approaches and the second wave begins, the Government must do more to protect and support care homes. However, we should not forget home carers. They play a vital role in caring for our elderly and vulnerable, and they need more support from the Scottish Government. Back in April, I was in regular contact with Highland Home Carers, which was in desperate need of PPE for its hard-working staff to carry out home visits. They had been let down. The situation was critical. Thankfully, I was contacted by a local estate, which donated 100,000 face masks to the Highlands. We got those to where they were needed—to Highland Home Carers, so that the staff could continue their visits. It should not have come to that. The Scottish Government should have reacted far more quickly to the challenge of PPE shortages across Scotland.

Looking to the future, I think that the way in which we?care?for our elderly population needs to be reviewed. We need to look at the structure of?care?homes, and at how we pay for them, to ensure that our ageing populations receive the best possible?care and that carers can secure jobs with long-term?career paths.

It should not be a heated debate about whether public or private care is better. Both models bring value and have a huge role to play in our future care system. There is no doubt that privately run care homes provide great services. When I visited the Parklands care home in Grantown-on-Spey, the Castlehill and Barchester care homes in Inverness, and others too numerous to mention, I saw just how much they do. I want to take a moment to say well done to Parklands Care Homes, which has just been named as the best smaller care group in the national care home awards.

However, that is not the only model of care that we should look to. As I have mentioned, we must also consider care that is provided in people’s own homes. Earlier, I mentioned Highland Home Carers, in whose philosophy I have become embedded. It is the second-largest employee-owned company in Scotland. It provides a great level of home care and offers good career options, too. That is important, because the whole care sector is facing huge recruitment challenges, so we need to ensure that such work is made more attractive to people.

Unless we provide carers with a career path, people will not be attracted to that vocation. If there are not enough home carers, more people will have to choose the care home option, which is expensive and can mean that people have to live further away from their loved ones. That is a key issue in remote areas such as the Highlands, where there is a need for more home carers and more rural care homes. Work must begin today on reforming Scotland’s care sector. Difficult choices lie ahead if we are to ensure that it is fit for the future.

The Scottish Government also has hard choices to make when it comes to family visits to care homes during the pandemic. Many families are seriously questioning whether the right balance has been found on that. Disease transmission must be prevented, but so must isolation. No one wants to lose a loved one to the pandemic, but neither do they want their mother, father or grandparent to feel so isolated that they lose the very will to live. That balance is a difficult and delicate one. It is up to the Government to listen to all members who have spoken in the debate, to address the issue and to make a judgment. Frankly, Presiding Officer, I do not believe that it has got that balance right at the moment.

Photo of George Adam George Adam Scottish National Party

I welcome the opportunity to speak in the debate, because health and social care has long been my focus both in my time as a councillor and now in my time as a member of the Scottish Parliament.

I would go so far as to say that it is my duty as Paisley’s MSP to ensure that my fellow buddies have access to the best possible health and social care system. That has become even more apparent during the past seven months. It goes without saying that we owe a mammoth amount to all those who have worked tirelessly in the care sector during the biggest global challenge that we have faced since wartime.

Monica Lennon’s motion is an important one. Tomorrow will be the international day of older persons, so it is important that we highlight, tackle and deal with the issues that our older constituents face and the additional worries and complications that the past few months have brought them. It is also important that we place people at the top of all our agendas, and the debate has been a perfect example of that approach. We must ensure that elderly members of our community are treated with dignity and respect.

With that in mind, I stress my belief that the Scottish Government does not underestimate the profound impact that the coronavirus has had on so many people. That includes those who want to visit their loved ones in care homes as well as the residents themselves, who are undoubtedly missing visits from their families and friends.

There are a good number of care homes in my constituency and, over the years, I have become close to quite a few constituents who are now struggling with having been separated from their husbands, wives, siblings, parents and friends. It has been difficult for me to see and hear the distress that they face, and I know that all members across the chamber will also find that extremely difficult. However, we must remember that decisions affecting care homes have not been taken lightly and that the restrictions have been put in place to help us to protect their residents and, ultimately, to save lives.

We must continue to recognise the additional risks that communal living presents for people who are more vulnerable to the effects of exposure to Covid-19, and to continue to mitigate such risks as best we can while the prevalence of the virus across all our communities is increasing again.

As the First Minister has said on numerous occasions,

“no decisions have been more difficult” or

”genuinely upsetting than the ... decisions that we have had to take around care homes”,—[

Official Repor t, 17 September 2020; c 12.], but the Government continues to make such decisions with the best of intentions.

As is the case for Anas Sarwar, whose contribution I heard earlier, my older family members do not live in care homes, but I feel his pain about being unable to meet family members. My in-laws live in their own home, close to me and my wife Stacey, but because of restrictions, we cannot see them either. I understand the need for that but it is not easy for anyone—do not tell them, Presiding Officer, but I kind of miss them as well; I will never hear the end of it once they get hold of that.

Although these decisions are necessary in the here and now, they are constantly under review. We must continue to remember the human aspect in this whole debate. If Anas Sarwar and I are upset about not being able to meet and spend quality time with our family members, how do those people who have family members in a care home feel?

As I said earlier, constituents have told me their stories and they are difficult to listen to. It is difficult for me, as a parliamentarian, to have to say to my local community, “You have to stop seeing each other for your own safety, and the safety of your family and your community.” That is difficult for us all.

Can the cabinet secretary say in summing up whether she has the power to ask private care homes to change their visiting arrangements? I know that she can give advice, but can she ask them to make those changes? It is a genuine question, as that has been one of the major points of the debate.

Keeping our care homes safe and functioning at optimum levels has been a key priority since the beginning of the pandemic. Alongside keeping carers safe and secure in their workplaces, it is just as important that we continue to value those working in health and social care. They do a remarkable job.

That brings me to the idea of the national care service. This year’s programme for government has a commitment to an independent review of the idea of a national care service in Scotland, which will aim to ensure consistently excellent support for people who use those services as well as their carers and their families, with care being accessible and provided to all. The review is set to consider previous and on-going work, including the programme for social care reform that is currently being taken forward by the Scottish Government and the Convention of Scottish Local Authorities. Work is being undertaken by the Care Inspectorate to consider opportunities for improving adult social care provision and work is being undertaken by wider partners, including the third sector, to understand people’s experience of care and how support could be improved.

I, for one, see that we have an opportunity here to change things for the better. We need to look at the positives all the time and at what we can do to further improve on the care that we provide to everyone in Scotland—that is extremely important.

There is no denying that this year has been incredibly hard, but now is the time for us all to come together, as we have done today, to ensure that our front-line workers, along with residents and their families, are heard. I look forward to seeing what we can achieve with everyone’s voices coming together in collaboration, both in and out of the chamber, as that is when the magic happens and positive change can become a reality.

Photo of Neil Findlay Neil Findlay Labour

I declare an interest, as my mum is a care home resident.

What I am about to say is no criticism of any social care or health staff; I have nothing but admiration and support for them and will do all that I can to help to deliver their call for fair pay and conditions and dignity at work. What is needed is a fundamental change in how the sector operates. Now that the clapping has fallen silent, they need politicians to deliver—no more warm words, please.

Many of the things that have happened and the decisions that have been made during the Covid crisis have been right, but many have left me and many of my constituents depressed, sad, frustrated and, at times, angry. I think of the lack of preparation and planning when we were warned of the impending crisis; the failure to follow World Health Organization advice; the wholly inadequate testing regime—which is still wholly inadequate; the mixed messages on school closures and the wearing of masks; PPE shortages; the exams fiasco; and the current universities situation. However, it is the treatment of our older people—our mums and dads, grandparents, neighbours and friends—that, for me, is the low point to date.

Let us reflect on what has happened over the past seven months before we look at the current situation. Prior to lockdown, we had record numbers of delayed discharges. Professor David Bell says that 78 per cent of those cases involved people who were stuck in hospital waiting for assessments, the setting up of care arrangements, the arrangement of funding or the availability of places. Around 47,500 bed days were lost, which was up 8 per cent in a year. That is 47,500 days and nights of people stuck in hospital unnecessarily, at a cost of £4,000 a week. Those patients and their families were told that the delay was because they were waiting for an assessment, a place or a care package.

Then, miraculously, in April, 53 per cent of the number disappeared. We have been told repeatedly that that was down to sharing of best practice and joint working. What on earth was going on if people were not sharing best practice and joint working prior to that date? That is a cover, and it is utter rubbish. We all know that the reality is that those places became available due to money being released. All those excuses for the delays and the stays in hospital were a convenient smokescreen, and they were accepted by families whose respect for and deference to the medical profession led most of them, including me, not to question it.

Then we had the mass exodus overnight to care homes. Residents were shipped out and tested, and we know that some were discharged while Covid positive, which endangered their lives and the lives of staff and their fellow residents. To me, that was negligence, because those actions were taken knowingly—those people were knowingly discharged. Then, when those residents became ill, many were not admitted to hospital, and others were pressured into agreeing to do not resuscitate notices, or had those completed without their family’s knowledge. It is completely and utterly wrong to say that that was done by a few general practitioners or practices, because it happened across the country. I am absolutely certain that it happened in the constituencies of almost every member who is in the chamber. In my village, it happened via text message. People were texted about DNR notices.

Ministers’ standard defence is, “Those were clinical decisions, so it was nowt to do with us.” Alternatively, they say, “If only we knew then what we know now, we might have acted differently.” That is no defence for bad or wrong policy decisions that in my view have contributed to the deaths of far too many of our citizens.

Given all that, is it any wonder that the virus has caused so much misery in our care home sector? The situation now for our loved ones is one of frustration, isolation, loneliness and declining health and wellbeing. We are heading towards 200 days of no or limited access to family, friends and loved ones, which means 200 days with little contact and limited stimulation.

When visits started, they were with one member of the family for half an hour outside each week. Then, the First Minister announced that three people from two households could visit from the following Monday, only for that to fall through, as risk assessments had not been done. In NHS Lothian’s case, care homes would not even receive the paperwork for another five days.

We now have one half-hour visit a week by three people from two households, which is an improvement, but it is very unsatisfactory. It is dispiriting and frustrating for everyone involved, including the staff. The visits take place outside, and often in makeshift shelters. It is regularly cold and windy, and older people need piles of clothes and blankets around them to keep warm. It is not credible, humane or dignified for that to continue into the winter. We need safe, warm, sheltered and comforting space where people can share intimate moments, chat, discuss family matters and laugh, cry and hug. We need a place to reconnect and rebuild weakened relationships, to meet children and grandchildren, friends and former colleagues—the social circle of people who care and love one another the most.

I hear a lot of earnest talk about co-production, patient-centred care and human and patient rights. The Covid crisis has exposed those words as often vacuous buzzwords that have no bearing on the reality of the life that people live at the moment. Where was the patient-centred care when thousands were kept in hospital unnecessarily and misled about the reason? What about the human rights of those who were denied hospitalisation or who were pressured into agreeing to DNR notices? Where was the co-production when the mass exodus from hospital to care homes took place? Where is the residents’ right to choose to meet those whom they love and who love them in a safe setting?

I have to say that we need a revolution—I use the word advisedly—in social care. We cannot claim to be a civilised society when we tolerate some of the most vulnerable people and those who look after them being treated in that way. The Covid crisis must result in our ending a system that is based on a privatised model in which profit generation comes on the back of low pay and exploitation.

Photo of Fulton MacGregor Fulton MacGregor Scottish National Party

The point has already been made that visiting is a fundamental part of the health and wellbeing of those who live in care homes, particularly in the case of people who are living with dementia, but it is also fundamental for their loved ones, who, in normal circumstances, would be used to spending time with their families. It is such an important conversation that we are having today, the day before the international day of older persons. Many families from my constituency have got in contact with me over the past few months to highlight the impact that coronavirus and the visiting restrictions are having on them. Therefore, I thank the Labour Party for bringing the subject to the chamber for debate and allowing such concerns to be raised.

One family, who have given me permission to talk of their situation, have been unable to comfort their 80-year-old relative for six months, as she resides in a care home. She lives with severe dementia and has a hearing impairment. Although her care in the home is satisfactory and she is safe, I cannot begin to imagine how difficult it is not to be able to hold your mother’s hand or give her a hug when she is in distress.

Just this week, I have had contact with another family, who tell me that they were refused more extensive and flexible indoor visiting with their mother during her end-of-life care. They reported that she was in her own room and that they had all the appropriate PPE. Only after some robust discussions with the manager did they manage to secure some additional visiting for their mother’s final days. My thoughts are with all the family, but, to make matters worse, the lady, who sadly died, had a sister in the care home, and I have been told today that she has not had any indoor visits at a time when she and her family are still grieving.

We can all agree that that is an immensely tough situation for anyone to be in. As those families and many others have pointed out, garden visits were more suitable in the summer months when the Scottish weather can be a lot kinder, but we have now entered the months when the temperature drops and rain, hail or snow can come at any given minute. I am sure that we all agree that visiting the elderly outside in such conditions is unsuitable and that the restrictions should be reviewed in the light of the coming winter months.

We all know that care home residents and loved ones must be able to see one another. Visiting is a fundamental part of the health and wellbeing of those who live in care homes; as I said, it is particularly important for people who are living with dementia. Our Government has already done so much to tackle loneliness. That is a policy that we can be proud of, and we need to keep it front and centre as we move into what will, it seems, be a difficult winter and a second wave of Covid.

On the other side of the horrendous dilemma that we face is the fact that care homes have been hit particularly hard by this ruthless virus, and it is immensely difficult to strike the balance between protecting those who live in care homes and ensuring that they can be supported by family and friends at a time that is isolating for all of us, but particularly for our elderly relatives.

I am pleased to learn that the clinical and professional advisory group is looking again at what more can be done as we enter winter to strike a balance between, on the one hand, allowing family and visitor contact to take place, activities to be run and healthcare services to be provided for residents and, on the other, protecting residents from the virus being introduced into their homes. I was also reassured to hear that the health secretary met representatives from the care home relatives Scotland group on 18 September and discussed a range of proposals by the group. I am eager to hear about the results of that meeting so that I can get back to my constituents on that.

I also welcome the independent review of adult social care, which is due to report in January. I feel assured that it will work towards ensuring that Scotland provides unfailingly outstanding support for people who use adult social care services, as well as their carers and families. We know that the review will consider changes that are required to achieve the highest standards of support for the independence and wellbeing of people who use adult social care services, and I believe that it will ensure that social care is effectively integrated with health services.

Turning to a point that Angela Constance touched on, I believe that, as elected representatives and leaders in our communities, we need to do what we can. I know that many colleagues will—as I do—have a good working relationship with many of our care homes. That is why, several months ago, I took the decision to write an open letter to all those who use care homes in my constituency—residents, families, staff and owners. It was not a blaming letter but one in which I offered help and support with any queries. It has been very well received, and I would encourage any colleagues who have not taken such an approach to consider doing so, because it is incumbent on us all to work together collaboratively.

Like George Adam and Anas Sarwar, I do not have any family members in a care home, and I can only begin to appreciate how hard it is for people to be separated from family and loved ones for such long periods. We have all had to make sacrifices to ensure the safety of the wider population in the past six months. However, as we have heard today, we are still—sadly—living with the pandemic and we need to do all that we can to keep our loved ones safe.

I have faith that, as we move into the winter, the Government will continue to take stock, reassess and find more balanced judgments to keep people safe while preserving quality of life and relationships. I thank all residents, families and care givers across the country, but particularly those in my Coatbridge and Chryston constituency, for sticking with it. I know that, together, we will get there.

Photo of Annie Wells Annie Wells Conservative

I am pleased to contribute to the debate. I t is always right to mark the international day of older persons, but this year, in particular, it takes on extra poignancy. This has been a year like no other for our older people and those who care for them. It has illustrated the fundamental importance of the role of those who give up their own time to look after a loved one in the face of incredibly challenging circumstances.

Most of our older people have, at best, been confined to their homes for most of the year. Some, in care homes, have been at heightened risk of infection, with many having lost their lives. During the early stages of lockdown, the role of family members in providing care was essential. We will all know of people who were unable to get slots for shopping to be delivered, which prompted children and grandchildren to pick up that burden on their behalf.

In severe circumstances, relatives have taken on more responsibilities—attending to health and wellbeing needs as well as providing crucial social contact for elderly relatives who might not have spoken to another person for days. When we think of family care givers, it should be to value the contributions of those who have stepped in to do whatever is necessary for a loved one, regardless of whether that has been easy for them.

However, for families with relatives in care homes, the story is vastly different. It is a matter of record that 1,500 untested patients were, irrespective of the risk at the time, transferred from hospitals to care homes before testing for Covid was mandatory. In March and April, at least 37 patients who tested positive were not kept in hospital as they should have been, but were sent to care homes. It is not difficult to see how that could have contributed to the 2,000 deaths in care homes up and down the country, which represents almost half the national total.

Now, Public Health Scotland tells us that the report that ministers promised for today at the latest will be delayed for another month because of concerns about data quality. Care home staff have put themselves at great risk over the past few months, and have shown dedication that makes us all proud. If we want to show care staff our gratitude, it is vital that we take the necessary steps to make their workplaces safer. The report is key to doing that; the delay is not good enough.

We must remember that at the heart of this are the people whom we serve and those whom they hold dearest. Recently, I received a really difficult email from a Glasgow student, Lucy Challoner, who is desperately concerned about the situation in care homes. Her mother and grandmother have been in separate homes on either side of the country since March. Lucy told me:

“I’m not sure when or if they will ever see each other again in person. That’s a mum and a daughter being kept away from each other. They miss each other dearly. Visits for half an hour are simply not long enough. The time goes by so fast and my mum and Grandma get very upset when I have to leave at the end of the visit and so do I. I feel very guilty for leaving them. My Grandma has had to be wheeled away in her wheelchair while crying her eyes out at the end of the visit. It is very distressing for both of us.”

Lucy asked me to raise that today because she has emailed the health secretary but has not yet received a response.

I understand that there is an obvious need to suppress the virus, especially in places where older people are present, but it does not take a genius to figure out that the right balance has not yet been struck. In order to know how to improve care home access for families as safely as possible, we must know the underlying reasons why the Scottish Government got its strategy so wrong in the first place. That is why it is so important that we get the best information and data in short order. It is unacceptable that its vital publication has been delayed because the work cannot be completed on time.

The ordeal that care homes have gone through has been one of the most significant failings during the crisis. Families such as Lucy’s have pleaded for the problems to be fixed, so I hope that ministers will, as winter approaches, act to resolve them at a quicker pace than we have seen from them so far.

The Deputy Presiding Officer:

Emma Harper will be the last speaker in the open debate.

Photo of Emma Harper Emma Harper Scottish National Party

At the outset of my speech, I acknowledge, as my colleagues have done, the profound impact that Covid-19 has had on so many people across Scotland and the world. Covid has affected young people, including those in education; it has affected the working-age population, including people who are now working from home; and it has affected people who have been shielding. It has also, of course, affected those whom we have been discussing today: our older people—both in care homes and in their own homes.

We have all had to adapt to a new normal and to make difficult sacrifices in the interests of promoting and protecting the public health of people in Scotland. Obviously, we must remember that we want to keep all our loved ones safe.

I thank everyone across Scotland for their commitment to following the route map: we are all doing our bit to protect Scotland from Covid-19 and to reduce the spread of this virulent virus.

We have learned a lot in the past eight months and we will continue to learn and adapt—sometimes more rapidly than we want to. I know that more debates will take place. Clinicians are now learning from Covid care. Hydrocortisone, dexamethasone and cytokine storm are all words with which clinicians are now familiar. We are now discussing post-Covid exposure complications, which has been termed “long Covid”. It is important that we acknowledge that everything is moving and evolving as we learn about this virulent and deadly virus.

I turn to the Labour motion. Of course, I acknowledge the impact that Covid-19 has had on care homes, people who wish to visit family members in care homes, carers and those who receive care. After I left school, my first job was in a care home, and it prepared me for my career in nursing. For people in care homes, particularly those with dementia, visits from family members are a fundamental part of their health and wellbeing. I know from my casework the difficulty that many families are facing at this time, and I absolutely agree with Alex Cole-Hamilton’s comment that it must be very disconcerting for people in care to be met with face-mask wearers in their homes or care homes.

The issues that we face are really difficult. It is important to note the complexity in striking a balance between allowing people to continue life as normal—for example, through undertaking care home and family visits—and protecting people from the real and serious implications of the virus. The mortality figures that the cabinet secretary described—one in six older people who is exposed to the virus succumbs—are really quite sobering. I welcome the Scottish Government’s work on trying to strike a good balance between its responsibility to keep people as safe as possible and the positive benefits, which it sincerely recognises, of family visits and allowing people, as far as possible, to continue as normal.

The Scottish Government has, with care home owners and providers, supported care home visits going ahead, where they are appropriate. Indeed, the Government’s aim is to allow people to visit their loved ones, but visiting must be done safely and must be based on the best available scientific evidence and medical advice.

Limited outdoor and indoor visiting may now take place, provided that strict criteria are considered and met and plans are signed off by local directors of public health. Other members have noted that winter is coming. Outdoor visits may therefore be a real challenge, as we move forward. The guidance has been, and will continue to be, developed by the care homes clinical and professional advisory group, which is made up of clinicians and family members.

Labour’s motion refers to the need for a national care service. The Scottish Government is already looking at that. There is, absolutely, a need for a rethink of social care in Scotland—how we value it, how we deliver it, and how our citizens who need it most should be looked after.

I agree with the Labour motion that all our carers deserve to be treated as professionals and to be paid fairly for the invaluable work that they do day in and day out. To that end, I welcome the independent review of adult social care, which aims to ensure that Scotland provides consistently excellent support for people who use those services, as well as for their carers and their families. The review, which is a programme for government commitment, will consider what changes are required in order to achieve the highest standards of support for the independence and wellbeing of people who use adult social care support. It is important that it will take a human-rights-based approach, with a focus on the views of people with lived experience. The independent review will report by January 2021. I look forward to its recommendations.

Concurrently, the Health and Sport Committee, which I am a member of, is about to commence a social care inquiry. I also look forward to the evidence that we will hear in that.

The safety, protection and wellbeing of residents and staff in our care home sector have always been top priorities for the Scottish Government, and that will continue to be its approach. I hope that all members will welcome that. Since March, more than 124 million items of PPE from the national stock have been delivered to social care providers in more than 1,000 locations, including care homes. That provision is over and above the social care providers’ normal supply chains. I welcome the fact that the Scottish Government has supported the PPE producer Alpha Solway, in Annan. That has helped to protect the PPE supplies that we might need this winter.

In conclusion, I welcome the Scottish Government’s work to best protect and help Scotland’s carers and those who are cared for in care homes and their own homes during the pandemic. I urge members across the chamber and the country to continue to follow the advice that aims to protect the population and reduce the spread of Covid—to protect Scotland’s people.

Photo of Brian Whittle Brian Whittle Conservative

I thank the Labour Party for bringing the debate to the chamber and for allowing us the time to debate what is obviously an extremely important and on-going issue. That has been brought home to me—as I am sure it has to all members—by members of the public who have spoken to us, written to us and emailed us to ask us for help in gaining some sort of access to their loved ones. Such access was taken for granted prior to Covid, but it has been and still is being rationed or even denied in some cases. Who would have thought that we would have to deal with a Government-imposed limitation on access to our families?

Edward Mountain powerfully told his constituent’s story about their mother. The same issue was starkly highlighted to me when a friend of mine approached me and told me about his mother passing away and the family being unable to gain access to the father, who resided in a care home, to tell him the sad news. The situation was further complicated because his father has dementia. I am grateful to the cabinet secretary for her intervention after I raised that case at First Minister’s question time and for facilitating a meeting. Subsequently, the family have been able to visit the father for 30 minutes a week. That is outside, however, and it will become increasingly difficult as the weather turns, so even those 30 minutes are becoming increasingly unlikely. My friend says that he is watching his father disappear week by week. That begs the question: do we really understand fully what exactly we are protecting that elderly gentleman from?

Jeremy Balfour made a powerful speech calling for at least one family member to be part of an individuals’ caring community and to be given regular access to them, which is a very good call.

Anas Sarwar mentioned the potential breaching of human rights by isolating care home residents for an extended period of time without access to their families. That is really what we must consider.

We are six months into the pandemic. Surely, it is not outwith the wit of the Scottish Government to have care homes and carers supported to develop Covid-secure visiting inside care homes. Some are managing that very well, whereas others have made little progress. The truth is that, by now, we should be able to protect the vulnerable, whether that be from Covid or from the effects of lockdown. The rest of us should be behaving with a bit of common sense and following the simple rules around cleanliness, social distancing and wearing masks where appropriate.

The effects of lockdown have been felt the most by those in care homes and those who are most vulnerable. However, care givers and family members have somehow been forgotten, although their anxieties and grief are just as real.

Looking at decisions that are made and making comments in hindsight is a favourite pastime of politicians. In this case, decisions have been thrust on Governments the world over that none of us would relish. We will, no doubt, get to rake over the coals of the Covid crisis at our leisure when, I hope, we are at the other side of it. We would prefer that to be sooner rather than later, so that, as we are asked to continue to support the Government’s approach, we understand the scientific reasons for those decisions.

One thing that has constantly nagged at me is how the Scottish Government watched the virus spread from the far east across Europe, seeing the devastation in countries such as Italy and Spain and how it attacked the most vulnerable, the elderly and those with other medical conditions, and did not make different choices. The cabinet secretary replied to the question on that issue that I put to her in the chamber a few weeks ago with the answer that we did the same as every other country. I think that that is kind of the point.

Alison Johnstone and Monica Lennon mentioned that mistakes will be made—but, although wise people learn from their mistakes, wiser people learn from the mistakes of others. Time will tell whether the Scottish Government has managed to do either, which is why we urgently need a public inquiry.

Donald Cameron highlighted that, although Covid may have shone a light on how we look after the most vulnerable in our society, the issue has been there for far longer than Covid. I would hope that every person in the chamber recognises that those in our public services who care for our most vulnerable are not supported in the way that they should be.

The Labour Party’s motion calls for the delivery of pay that reflects the value and professionalism of our care workers. How could anybody disagree with that? I would add that we should look not only at how our care workers are remunerated but at the conditions in which they are being asked to work. The Conservative Party has long called for a system that looks after those who look after us.

As we look at the process, we must also deliver a long-term, sustainable solution and not just a hike in value that cannot be maintained. It is clear to me that the direction of travel that we are on with our health and social care delivery is unsustainable. We must always invest what we can invest—of course we should. However, if the percentage of spend on health and social care continues to rise, it must eventually reach a top line. We often talk about saving money in our health services, but what actually happens is that any saving in one area is distributed to another—the same money just gets moved around.

The impact that health has on our economy is undeniable. I have said before that we are an unhealthy nation. We need to accept that and actively pursue policies that reverse that trend. To date, the Scottish Government has been tinkering around the edges. We need a fundamental change in how we look at health and social care and all the elements that make up our health and wellbeing. The long-term reward is a reduction in the cost to the public purse of preventable conditions. That is where long-term investment in how we care for the most vulnerable and those who care for them will come from.

I said in my first speech in Parliament that we must be prepared to pursue long-term policies that we will not get the credit for. One of the fundamental flaws of this place is that politicians cannot see past the next election. The Labour Party’s motion calls for the establishment of a national care service. Is that the right way to go? I do not know, but I definitely think that it is worth considering. If we can learn anything from the crisis that we are navigating and from its impact on our care homes and care services, it is the conclusion that it is time for change.

Photo of Clare Haughey Clare Haughey Scottish National Party

I add my thanks to members across the chamber for their contributions to this extremely important debate. I also thank those who have been in touch with us ahead of today. That includes Inclusion Scotland, Engender and Close the Gap, but, most importantly, it includes the families and friends of loved ones who have shared their experiences with me, as a Scottish minister and as a constituency MSP.

It is clear from the debate that we all agree that visiting is a fundamental part of the health and wellbeing of those who live in care homes. As has been illustrated by members today and by others, the lack of connection with loved ones has had a profound impact on people—those in our care homes as well as their friends and families. I am sure that each of us has heard accounts like the ones that have been shared in the debate from our constituents and families who have loved ones in care homes. Those accounts have been heartfelt, like the personal experiences that we have now heard about from across the chamber.

Being able to pop in on a daily basis to see your mum or dad, or your husband or wife, has not been possible. When visits do take place, they are often outside, for a short period, with distancing taking place. That is not what any of us is used to, and I recognise that, for those with dementia, who might have limited ability to understand the restrictions that are in place, it must be particularly hard.

We know that, when restrictions have been put in place, they have been necessary to safeguard people. The virus has had devastating consequences across the world. We also know that the pandemic is still with us, so we need to do all that we can to continue to protect people. However, we need to balance that with the need to protect people from the harms of a lack of connection with loved ones.

The guidance that we have published sets a staged approach to reintroducing visiting. As the health secretary has confirmed, we are looking at what more we can do to strike a better balance between family and visitor contact and protecting people. We recognise the need for proportionality in how we do that, but we are committed to opening up further opportunities for people to see their loved ones.

That calls for collaboration, but it is achievable. Supporting safe visiting requires the efforts of all partners. We cannot ignore the harms that are posed by not supporting connection with loved ones. Every day counts, and we need to work together to promote visiting where it is safe to do so.

The health secretary has valued the opportunity to meet families from care home relatives Scotland—which we have heard about in several speeches—and to hear their experiences and views. She has committed to meet them again this week and to continue that very important dialogue. The experiences and views that they have expressed have illustrated that families and carers are essential partners in providing care and supporting the wellbeing of people in care homes. As we have heard in the debate, they are not just visitors. Families and friends play an essential role in a person’s care, whether it is in supporting eating and drinking, in communicating wishes or in providing emotional care and connection with the outside world.

The Scottish Government is working with partners to develop a national Covid-19 dementia transition and resilience plan, and we will work with national and local partners across all sectors to support its implementation. Key to the transition plan will be how we support those with dementia and their carers in a world with Covid-19.

The debate has also focused on the provision of care and support. We all recognise that care and support services have had to adapt during the Covid-19 pandemic. I want to make clear our commitment to do all that we can to support the provision of high-quality care and support for people.

I turn to some of the points that members have raised. Monica Lennon talked about the additional investment that the cabinet secretary announced yesterday. That money is additional to the money that was already provided to integration joint boards and local authorities for PPE and testing.

George Adam talked about the Scottish Government providing guidance, and he asked whether we can ensure its implementation. We can provide guidance and promote its implementation, but it must be remembered that a huge part of the care home sector is predominantly in private ownership. We will, however, continue to work with partners as best we can.

Photo of Brian Whittle Brian Whittle Conservative

The fact that the care home sector is private has been discussed quite a lot. Does the cabinet secretary recognise that, just as the NHS and the Government were not prepared for the pandemic, neither was the care home sector, so we must work together to get through it just the same?

Photo of Clare Haughey Clare Haughey Scottish National Party

Of course, we will continue to work with all partners who provide care across the country. Mr Whittle needs to remember that the virus emerged in January this year, and none of us could have predicted what would happen in the months following that. We will continue to work with care home providers, but it must be remembered that we cannot instruct them in the way that some people seem to think we should be able to do. We can provide guidance and we can promote its implementation.

Mr Balfour talked about also testing in other care settings. As testing capacity increases in the NHS and regional hubs, we will look at the issue while following clinical advice, and we will do that where it is appropriate.

Pauline McNeill talked about “do not attempt CPR” guidance, and I reiterate the fact that there was no national guidance on that. When the issue was raised, the chief medical officer and the chief nursing officer intervened to clarify the situation that appeared to be emerging. The cabinet secretary has committed to writing to Pauline McNeill about the issue after the debate.

I would like to talk about one other point that came up in the debate. Angela Constance said that care work is never low skilled. We have heard that many times in the Parliament, including during contributions from the Tory members. Perhaps they could take that message back to the immigration minister at Westminster when they are looking at who they think is skilled enough to migrate to the UK.

The Scottish Government will provide the necessary funding across health and care services to meet the additional costs of responding to Covid-19 and to support service remobilisation. Yesterday, the health secretary announced funding of £1.1 billion across NHS boards and integration authorities to meet costs arising from the response to the Covid-19 pandemic. That will provide NHS boards and integration authorities with funding to meet expenditure to date, as well as providing for future months. We will continue to work closely with boards and integration authorities during the coming months to review and further revise financial assessments. We will shortly publish an adult social care winter plan for 2020-21.

We can all agree that we need work as safely as possible to open up care home visiting and return to normal care home life so that family and loved ones can visit as they did previously, and so that care homes can continue to flourish as part of their local communities. The Government will work with the care home community and families to do just that.

Photo of Jackie Baillie Jackie Baillie Labour

I join with other members by thanking all those in caring roles, whether paid or unpaid. They have faced the toughest of times this year and, as Anas Sarwar said, much has changed. We should all recognise that the work that they do is vital in keeping vulnerable people safe and supported during uncertain times.

Our care homes have been at the centre of the pandemic and staff and residents have suffered as a consequence. It has been nothing short of a tragedy and scandal. From removing older people from hospitals and putting them into care homes without testing them, to the denial by care homes such as HCI in Dumbarton that there was even a problem, the shortage of personal protective equipment in the early critical weeks, with reports of supplies being rationed and locked in cupboards, the “Do not resuscitate” notices that Pauline McNeill raised, the delays in testing, and now the delays in getting results, it has been one thing after another.

As we approach a second wave of Covid-19, we need to be so much smarter about what we do, so I welcome the new-found support for a national care service. Forgive me for pointing out that I suggested one 10 years ago, but Nicola Sturgeon, who was health minister at the time, rejected it. However, I welcome all converts, no matter how late.

That suggestion was a direct result of the experience with Clostridium difficile that took the lives of people in the Vale of Leven hospital and across Scotland. It was not simply confined to hospitals but affected care homes too. It was a different disease from Covid, but it had the same issues of hospital to care home transfer and the need for barrier nursing, PPE and testing. Had a national care service been put in place then, we might have avoided the scale of deaths that we have witnessed during the Covid pandemic. I wish the review group every success and hope that it will make progress, offering any help that it wishes, because we have had reviews before and nothing has happened. We need to get that right.

I welcome the cabinet secretary’s praise for social care staff and note the GMB union’s campaign to value those staff not just with applause but with a £2 per hour pay rise. I hope that she will deliver on that and provide more than warm words.

We have now had more than 200 days of lockdown and isolation for all those people in residential facilities in the social care sector, from young adults with additional needs in supported accommodation to older people in care homes. Their mental health and wellbeing are at breaking point. We have heard numerous examples from members across the chamber about the suffering of care home residents and their families who have been unable to visit. Let me offer two illustrations of my own.

First, there was a survey of people with Alzheimer’s and dementia and their carers during the pandemic. Of those with dementia, 82 per cent were reported to have had a deterioration in their condition and there was a profound impact on 95 per cent of carers, who experienced a negative impact on their mental health. In part, that was due to a lack of visiting allowed in care homes, but it was also due to the closure of day centres that provided families with so much important support. Those people are feeling abandoned during the pandemic and their mental health and wellbeing are suffering. I am grateful to the minister for recognising that.

My second example concerns people with complex learning disabilities. I have been working with organisations such as PAMIS and individual families, who have told me about the nightmare that they are going through in trying to maintain contact with their adult children who are living in supported accommodation or care homes. Family members are central to the care that those adults receive—they are part of the care team—but they are fighting to be allowed to continue to provide the care that they provided pre-Covid. That care is central to ensuring the wellbeing and protecting the physical and mental health of their loved ones with severe learning disabilities. Anyone who has a family member or loved one with complex needs will tell you how important structure and continuity are to help those people to stay calm and functioning. They will tell you how the smallest changes to daily routine can result in huge distress and trauma. Just imagine the effect that removing family carers from the care of those adults for six months is having on them.

Since March, the essential contribution that parents make as part of the care team has been completely disregarded. All they have been allowed to do is visit their loved one through a window, unable to hug, care for or even touch their family member. The same is true of older people in care homes. The removal of much-needed social interaction is having a negative impact on their mental and physical health.

We need to find a way to encourage safe contact that balances the concerns about increasing the spread of the virus. Let me make some positive suggestions to the Scottish Government. I sense from the minister’s comments that we may be pushing at an open door and hope that that is the case.

First, let us recognise family care givers as front-line care staff. As Jeremy Balfour said, make them part of the care team, test them, give them PPE and, under controlled conditions, let them help with the care and wellbeing of their loved one. I am struck by just how much we rely on unpaid carers. As Alison Johnstone pointed out, 61 per cent of the more than 1 million unpaid carers in Scotland are women. We need to pay them much more than lip service.

Secondly, we must ensure that the guidance that is issued is specific to the group. Those with complex learning disabilities who are living in supported accommodation are different from older people in care homes. Grouping them together makes as much sense as issuing the same guidance for nurseries and universities.

Photo of Clare Haughey Clare Haughey Scottish National Party

Jackie Baillie may well be aware of the guidance that the cabinet secretary issued on 4 September, which recognises that the needs of older adults in care homes are different from the needs of younger adults who are living in care, and which allows for the safe reopening of communal activities and areas and for community and social outings.

Photo of Jackie Baillie Jackie Baillie Labour

That guidance is very welcome, but it is not currently being implemented on the ground. People are being quite risk averse with regard to ensuring that the guidance that the cabinet secretary has provided can actually work.

Thirdly, I suggest that providers make more use of risk assessments. The guidance provides for that but, again, social care organisations would rather not follow it, defaulting instead to no-contact restrictions. That is the experience of people on the ground. We are pleading with the cabinet secretary to ensure that the guidance is followed and that those risk assessments are shared with families.

Photo of Jeane Freeman Jeane Freeman Scottish National Party

I would plead with myself to do that, but I cannot make private or third sector providers do what I want them to do. Trust me—I so wish that I could, but I cannot. I can give guidance and support, ensure that the proper training is there and give providers wraparound care from primary care. There are many things that I can do, and I do them, but I cannot force private providers, in whatever residential facility they are providing care in, to do what I am asking them to do. Indeed, some providers have become so risk averse that they are withdrawing outdoor visiting, far less enabling indoor visiting. I will do my very best, but I cannot make that happen.

Photo of Jackie Baillie Jackie Baillie Labour

Thank you, Presiding Officer—I have great faith in the Scottish Government, and in the cabinet secretary in particular, to make that happen. The cabinet secretary can use monitoring, and she can use the Care Inspectorate and local authorities on the ground. All those things can be done, and I think that she can do it. There is the challenge.

I know that the Scottish Government plans to address that issue, and I am grateful to Clare Haughey for her support. However, before any plan is published, it is vital that input is given by family care givers, who are most acutely aware of the changes that need to be made. Those family care givers are in fact front-line workers, and it is vital, both for them and for those whom they care for, that they are officially recognised as such.

I will close by mentioning the Ontario bill. Bill 203, the More Than a Visitor Act, sums up the situation perfectly. Family care givers are more than simply visitors, and it is now more important than ever that that is recognised. The Ontario bill seeks to support and promote the rights of those in care settings, and I strongly encourage the Scottish Government to learn from that approach. It does not necessarily need to introduce legislation, but it needs to do something now to address the mental health and wellbeing of carers and those who are cared for.