- The Presiding Officer (Tricia Marwick):
The next item of business is a debate on motion S4M-04086, in the name of Alex Neil, on the Social Care (Self-directed Support) (Scotland) Bill.
- The Minister for Public Health (Michael Matheson):
I am delighted to open the debate on the general principles of the Social Care (Self-directed Support) Scotland Bill.
I will thank a number of people. I thank Duncan McNeil, his colleagues on the Health and Sport Committee and the committee’s clerking team for the careful and robust way in which they have scrutinised our proposals and for the considered conclusions in the committee’s stage 1 report. I also thank the Finance Committee and the Subordinate Legislation Committee for the part that they have played in scrutinising the bill, and I thank the many witnesses who have provided evidence to the committees.
I offer my thanks to the organisations and individuals who have helped to shape our policy on self-directed support over a number of years. Their input has helped to ensure that the bill will make a difference to the lives of people who access care and support and to the lives of their carers.
At some point in our lives, each one of us in the chamber will need to draw on care and support services for ourselves or for someone in our family. We must ensure that we plan, design and provide services in a way that best meets people’s needs now and in the future. People have told us that greater choice and control are key to better outcomes and we therefore need to empower people to play a full and active part, working in partnership with professionals, in designing their own solutions to their support needs.
That is not only a more sustainable approach to delivering and planning public services, but it is better for people, carers, families and communities as a whole. It is the kind of approach that was called for by the Christie commission. Indeed, the commission recognised the role that self-directed support can play in reshaping social care. However, it also noted the current low uptake of self-directed support and called for more action to build the capacity for and awareness of self-directed support to encourage broader participation.
I am strongly committed to self-directed support, not only as a concept that embodies the ideas of equality, human rights and independent living, but as a mechanism that across Scotland delivers practical, tangible benefits to many people, their families and their carers. It is a privilege to hear directly from people in communities across the country who receive social care services and their carers about the positive difference that self-directed support makes to their lives.
I was particularly pleased that the Health and Sport Committee had a chance at its final evidence session to hear from a variety of individuals, including Omar Haq and Margaret Cassidy, about what self-directed support means to them personally. It is clear from their experience that giving people more choice, more control and a greater say in their support—whatever they choose to do with it—leads to improved outcomes and a better overall experience for them. Such stories strengthen my resolve to ensure that the ambitions of self-directed support are realised for the benefit of all people who are eligible for social care.
I am therefore pleased that there has been significant support for the bill during the earlier consultation phases and in its parliamentary passage to date.
- Liam McArthur (Orkney Islands) (LD):
Mr Matheson has set out well the benefits of self-directed support. I am sure that he is aware that Orkney Islands Council has in some senses led the way on the number who receive self-directed support, although the amounts are smaller. Does he recognise the constraints on smaller local authorities in delivering packages? Other areas can deliver economies of scale in service provision.
- Michael Matheson:
I recognise the work that Orkney Islands Council has done. A number of local authorities have a good track record in promoting self-directed support. Rurality and the provision of some services in small communities create challenges, but I know that Orkney Islands Council always works hard to try to deliver the best range of services that it can, within the limitations that it experiences because of the challenges. Self-directed support provides an opportunity to look at other options that might not traditionally have been considered in designing care for individuals that they can develop to meet their care needs.
I hope that Health and Sport Committee members have seen my written response to their stage 1 report, but it is worth while summarising some of the main points, as I have no doubt that they will be touched on in the debate. First, I welcome the widespread support for the principles that we have placed at the forefront of the bill—informed choice, control and participation. I am always open to potential improvements, so my officials are exploring the committee’s recommendation that the bill should also refer directly to the principle of independent living.
On the allocation of budgets by local authorities, I share the committee’s view that
“self-directed support must not be, or be seen to be, a cover for cuts.”
Under the Social Work (Scotland) Act 1968, local authorities have a responsibility to meet a person’s assessed eligible needs, no matter which option that person chooses in self-directed support. We will ensure that that is made very clear in the framework of statutory and best practice guidance that will accompany the bill.
- Bob Doris (Glasgow) (SNP):
The minister touched on the idea that self-directed support should not be a cover for cuts. Would it be helpful to put it on the record that Glasgow City Council has cut its social work budget by 20 per cent in the past year, although its revenue budget was cut by only 3.4 per cent? [Bob Doris has corrected this contribution. See end of report.] What would he say to people who look for self-directed support in Glasgow and who might see the self-directed support model being used as a cover for cuts in that city?
- Michael Matheson:
The key issue is that, as I said, irrespective of someone’s choice under self-directed support, their local authority remains under a legal obligation to meet their assessed eligible needs. That stands for any local authority—Glasgow City Council and others. When individuals feel that a local authority’s system is not meeting their needs sufficiently, they should use that authority’s processes to pursue the matter further.
I agree with the Health and Sport Committee that it is important to identify and share best practice in relation to complaints and the appeals process. Following a consultation this year on how social work complaints procedures might be updated, a working group is being set up. Among other things, the group will look at whether disputes need to be separated from the complaints process. My officials will ensure that the committee’s views on that issue are passed on to that group for further consideration.
The committee asked whether the provision in the bill for support for adult carers should be a power or a duty. I am acutely aware of the contribution that unpaid carers make and I share the view that supporting their health and wellbeing is hugely important. The vital point is that we should create the right legislative and policy framework to support carers appropriately. Having a power rather than a duty will give us the necessary flexibility to meet our ambition to provide early preventative support to carers. Through investment from the change fund, the carers information strategy and the short breaks fund and through work on other issues such as dementia, autism and mental health, we are already working hard to help to support carers in Scotland. The bill provides a further important tool to enable local authorities to continue to support carers in the most flexible and appropriate way.
Self-directed support applies to children and their families as well as to adults, and I am pleased to note that the committee supports that position. It is in line with the principles of getting it right for every child, and I believe that it can be of real benefit to children and young people and their families. However, I also note concerns about the specifics of the policy’s application to children, particularly around issues relating to transition.
I assure all members that we will ensure that the guidance that is developed around the bill has specific information on support for children and on transition planning. We will draw practitioners’ and providers’ attention to that guidance through a variety of means. Although direct payments for children’s support are well established as an option, there is considerable scope for extending their availability to many more children. I am confident that, along with the work that we are pursuing at present, we can further develop that area in a positive way.
One of the great strengths of self-directed support is the flexibility that it affords individuals, and a key factor in that flexibility is the workforce. However, I appreciate that there are concerns about personal assistants, who provide some of the most flexible support. There are risks inherent in employing or being employed as a PA, but I believe that those risks are manageable and that the current safeguards are proportionate. Therefore, we have no plans to require the compulsory registration of PAs with the Scottish Social Services Council or with any other body. Nevertheless, I share the committee’s view that we need to enhance the status and value of personal assistants. In my written response, I discussed the wide range of actions that are being developed or which are already under way to support PAs and their employers. I believe that the emphasis should be on enhancing the capacity of professionals, individuals and their carers to make the right choice to best meet their needs.
Closely related to the question of personal assistants is the issue of the employment of family members. I believe that our approach should be one of flexibility and proportionality. I welcome the committee’s agreement that the current definition of “exceptional circumstances” is no longer appropriate. If the bill is enacted, I will launch a consultation on regulations that will include definitions of appropriate and inappropriate circumstances for the employment of a close relative. The aim is to move towards a culture that seeks to identify appropriate circumstances rather than one that focuses on exceptional circumstances. Safeguards will be important and I expect that to be fully explored during the consultation exercise.
I will say a brief word on costs. The financial resources accompanying the bill have been a source of concern for some. However, I am confident that the transformational funding that has been allocated to local authorities, providers and advice and support organisations will be sufficient to support a significant improvement in the provision of self-directed support options throughout Scotland. My officials have held several meetings with the Convention of Scottish Local Authorities and the Association of Directors of Social Work, and we will continue to meet them in the run-up to the implementation phase of the legislation. In addition, my officials have started a programme of visits to local authorities, which is aimed at gathering useful information about transformational processes across Scotland.
The bill raises a number of important and complex issues, and I am sure that we will hear much more about those during the debate. I remind members that, although the detail of the bill is of crucial importance, and although it is right and proper that it is thoroughly scrutinised and discussed, the overall purpose of the legislation is to make a difference to the lives of those in our society who need to access social care and support. We owe it to them to deliver real change.
That the Parliament agrees to the general principles of the Social Care (Self-directed Support) (Scotland) Bill.
- The Deputy Presiding Officer (John Scott):
I call Duncan McNeil to speak on behalf of the Health and Sport Committee.
- Duncan McNeil (Greenock and Inverclyde) (Lab):
Legislation and policy making can be an impersonal business, but I want to recount the very human story of Omar Haq, to whom the minister referred. Omar is an intelligent young man with his life and career ahead of him. He graduated a couple of years ago with a masters degree in human resources management and is currently looking for work. Employers take note.
Omar Haq has cerebral palsy and he spoke eloquently to the Health and Sport Committee during its stage 1 consideration of the bill about the positive impact that access to self-directed support has had on his life. The bill has four options for self-directed support, one of which is the use of direct payments to employ a personal assistant. That is what Omar does. He described his personal assistant as fulfilling a personal need by enabling him to go about his day-to-day activities, including travelling on a bus and filling out application forms. Ultimately, the flexibility that is offered by direct payments enables Omar to take more control over not just his care but his life. It raises his ambition to what is possible and drives him on to greater levels of independence. That striving for independent living is at the heart of the aims of the bill.
The committee received compelling evidence from Pam Duncan of the independent living in Scotland project that we should not be too focused on the process of self-directed support as an end in itself; instead, we were urged to look at its ability to empower those who use it to lead independent lives so that they may participate in society and live a full and ordinary life. As in Omar Haq’s case, it is not just the system of support that is important but what the system enables people to achieve. The committee believes that the core principle of independent living should be more explicit in the bill. I welcome the Scottish Government’s commitment to explore the possibility of such an amendment.
There are high expectations that the bill will bring greater freedom, choice, dignity and indeed control for people like Omar Haq, who require social care to maintain a quality of life and fulfil their potential. However, in the course of our scrutiny, the committee heard the changes that will be required of local authorities and independent and voluntary sector providers to ensure the success of the policy described as dramatic, wide ranging and difficult in every area. We heard evidence from practitioners about the individual, rather than collective files that will need to be kept. The changes were described as “seismic”.
Local authorities seem to be in a variety of states of readiness. Some are further down the line than others in areas such as decommissioning group services, creating individual budgets around packages and embedding the concept of self-directed support in their assessment and care management processes. Concerns were raised with the committee about the approach of some councils to implementing self-directed support, and the impact of that on service users. The issue appears to get very complex at that level, although the problems are no less for that.
We drilled down below the usual suspects as we took evidence. We found invaluable the insight that was provided by service users and carers at discussion sessions co-ordinated by the Princess Royal Trust for Carers and the independent living in Scotland project. Strong views were expressed by individuals about the implementation of self-directed support alongside reassessment processes in Glasgow. Bob Doris touched on that. That negativity was put into context by service users who had been on the receiving end of cuts to their budgets. For them, self-directed support had got off to a bad start and was not an empowering process.
Self-directed support cannot be seen as camouflage for cuts—I was pleased to hear the minister recognise that. The perception of the bill is important in terms of poisoning the process at an early stage. If things seem to be imposed on people, the bill could be seen as having a cuts agenda—that denies the opportunities that the bill would offer people.
The Scottish Government must ensure that the system is robust and that service users are offered a package that meets their needs. I understand that officials are working with COSLA to assess whether there is merit in establishing a national threshold for access to formal support. Perhaps the minister can say something about that later.
The committee believes that the statutory complaints procedure is inappropriate for dealing with disputes that arise regarding an individual’s social care assessment. As the Law Society of Scotland told the committee:
“An appeals procedure is about saying that we think that something has not gone right and asking where we want to get to and what we want to put in place. Complaints procedures tend to be backwards looking”—[Official Report, Health and Sport Committee, 15 May 2012; c 2269.]
and focused on apportioning blame.
Local authorities need to make a clear distinction between complaints and appeals. The committee urges the forthcoming Scottish Government working group on social work complaints procedures to endorse the need for such a distinction. I heard the minister’s comments earlier that that work is going on.
As well as focusing on service users, the committee’s scrutiny took into account the views of unpaid carers, because without Scotland’s army of unpaid carers our health and social care system would grind to a halt. They play a vital role in the provision of care in Scotland. We heard first hand from carers of their desire for the proposed discretionary power to become a duty on local authorities to provide support following an assessment.
Florence Burke of the Princess Royal Trust for Carers suggested:
“Potentially, a small investment for carers ... who want to take up self-directed support in their own right”
could go a long way. She told us that it could even
“help to maintain the £10 billion savings to the public purse that carers provide by giving unpaid support.”—[Official Report, Health and Sport Committee, 22 May 2012; c 2325.]
The committee recognises that it is vital that carers are given support to protect their physical and mental wellbeing. The bill should underline that most moral of imperatives.
Another key strand is the cost of the bill’s implementation, particularly at a time of reduced budgets. There is a major discrepancy in the estimates of how much the bill will cost to implement, with COSLA estimating that it could cost double the amount claimed by the Scottish Government. That difference is so great that it cannot be explained simply as the result of different methodologies. COSLA’s failure to share with the committee the details of individual cost estimates by local authorities is unacceptable—it is not acceptable for it to come to a committee and not be prepared to back up its argument, because the committee cannot determine whether the funding gap that was identified is real or imaginary.
I am keen to seek assurances that there are sufficient resources to ensure that the bill can be implemented effectively. I look forward to hearing further updates from the minister on the on-going discussions that he described. Seriously, those discussions need to be out in the open—this is not something for back rooms. The committees exist to enable such open discussion.
The bill holds challenges for service users and service providers alike. However, the committee believes that legislating on the policy of self-directed support should ensure uptake and promote greater consistency of approach across local authorities. The committee welcomes the proposed legislation.
- The Deputy Presiding Officer:
We are very tight for time today. Jackie Baillie has up to nine minutes.
- Jackie Baillie (Dumbarton) (Lab):
I welcome the opportunity to contribute to this stage 1 debate on the Social Care (Self-directed Support) (Scotland) Bill and I associate myself with the minister’s thanks to all those who were involved in shaping and scrutinising the bill.
I am sure that the minister will forgive me for saying that the bill has been a long time coming. It was promised for the previous parliamentary session, but I understand that it was sacrificed in negotiations with COSLA just before the 2011 election because there were legitimate concerns about funding. As Duncan McNeil explained, there remain legitimate concerns about funding.
The bill has returned and some would say that it is a pale imitation of its previous incarnation, but perhaps it is a more practical set of measures and therefore a greater opportunity to create some change at a local level. On the basis that the bill will extend choice and control for people who receive social care, Labour members will be pleased to support the bill’s general principles this evening.
Before I consider specific areas of the bill, I want to look at the policy context for self-directed support and, in its widest form, personalisation, which was first advanced by the previous United Kingdom Labour Government, working alongside disabled people. Personalisation is of course much wider than social care, given that it is about all the different things that contribute to the way we live our lives: our education, housing, employment, health, transport and so on. It is not intended to be a narrow focus on social care alone. It is about empowering those with additional needs to shape their lives in a way that suits them. I hope that the Scottish Government will in due course consider the wider possibilities of personalisation.
Let me look to social care for an illustration. Many of us have constituents, many of them older people, who benefit from a tuck-in service that helps them to get ready for bed every night. Nine times out of 10 that tuck-in service is delivered between 7pm and 8pm. I do not know about members, but I do not know anybody who goes to bed that early in the evening. [Interruption.] Jackson Carlaw has put up his hand to say that he does—old age is clearly advancing. Visits at such times are perhaps more about the interests of the service and lack the flexibility to respond to individuals’ needs. Self-directed support is about exercising a degree of choice and control that makes life better.
Let me outline some specific concerns that have been raised. First, the independent living movement is clear that the bill should be viewed as a mechanism to support disabled people and those who live with long-term conditions to realise independent living. In his evidence to the committee, the minister agreed with that and I was pleased to hear today that he will give further consideration to strengthening the bill with perhaps a clear statement of intent about independent living.
That statement should recognise that disabled people have a right to independent living and state that the bill will empower those who use self-directed support to have the same freedom, choice, dignity, and control as other citizens at home, at work and in the community so that they may participate in society and live an ordinary life. That approach is supported by a powerful range of organisations, including Inclusion Scotland, the Health and Social Care Alliance, Self Directed Support Scotland and the independent living in Scotland project.
Secondly, there is the question of advocacy. There is no doubt that, although the bill seeks to extend choice and control so that there is greater direction over how support is provided, there remains a need for independent advocacy. We know from experience that it can be difficult for some people to negotiate through choices that are often different and complex and that they require assistance and guidance in doing so. Including in the bill a right to advocacy will ensure that the bill’s provisions, which we all support, will become a reality for all.
Thirdly, there is the question of an appeals mechanism. As the bill is written, it seems to me that the local authority will determine need and provide what it believes are appropriate services to meet those needs but that there will be only an internal complaints procedure if things go wrong. There may be access to the Scottish Public Services Ombudsman, but it looks only at the process by which a decision was made rather than at the substance. My experience tells me that people generally need money to access a judicial review.
The provision in the bill is not as comprehensive as having an independent and impartial tribunal to ensure that appeals are robust. Indeed, I understand from Capability Scotland that the Scottish committee of the Council on Tribunals—never heard of it before—recommended this month
“the establishment of a new tribunal jurisdiction to deal with appeals against community care decisions”.
The absence of an appeals procedure ultimately has the effect of weakening rights, and I hope that the minister will take time to reflect further on that.
Fourthly, there is a concern about the postcode lottery of care and, in particular, care charging. That is not a new issue in the Parliament, as I have been raising it consistently for three, if not four, years. I am genuinely disappointed that the Government and COSLA have taken so long to resolve the issue. There is a working group but, as I have said before, if that group was on performance-related pay, it would not be earning very much. Apparently, the issue is just too difficult. Frankly, in a country of this size, it is not acceptable for a service to have wild variations in charging such as those in my area, where the charge is £30 per week for a service in West Dunbartonshire, but £300 per week for the same service in neighbouring Argyll and Bute. There are different charges and criteria, and a lack of transparency and fairness.
Wherever someone lives Scotland, they should pay broadly the same and the criteria for charging should be the same.
- Bob Doris:
Will the member give way?
- Jackie Baillie:
No—not on this point.
The postcode lottery in charging could have a negative impact on disabled people’s ability to direct their support in a meaningful way. Will the minister ensure that rapid progress is made in developing a national framework for the provision of and charging for care? We need fairness and transparency on the issue once and for all.
Fifthly, there is the matter of balance between individual and collective services. For example, day care centres are much valued by their users as a means of providing social interaction, yet their very existence could be threatened because of the withdrawal of funding. Although I absolutely acknowledge that self-directed support would not prevent an individual from continuing to use a day care centre if they chose to do so, that is not the practical experience on the ground. Therefore, more thought perhaps needs to be given to the transition for collective services. Sufficient financial support is needed to underpin the changes so that we do not have the perverse consequence of losing valuable services.
I turn briefly to carers. There is a call from carers organisations and carers that the bill should establish a duty to support unpaid carers so that they can receive direct payments in their own right following an assessment. I sympathise with the carers’ view, and with the minister’s approach, not least because the contribution that carers make is invaluable and because, by supporting carers, we spend to save. I suspect that such a duty will require additional funding and some thought. I am interested to hear whether the minister has made an assessment of that, never mind ensuring that carers have their needs assessed in the first place. Carers already have the right to an assessment, but it is difficult for them to access that. Their view is that a discretionary power is perhaps not enough. I would welcome it if the minister considered that issue.
Finally, I turn to the integration of health and social care. That developing policy, rather than an obsession with separation, should be dominating the Parliament’s discourse. We need nothing short of a transformation of people’s experiences of health and social care so that no one falls through the gaps. We might disagree about the means, but we do not disagree about the need for integration. The challenging demographics alone underline the need to act and to do so decisively. Labour believes in the creation of a national care service, which would be as radical as the creation of the national health service more than 60 years ago, with local delivery and local accountability. It would be a seamless service that joined up health and social care, with a framework of minimum standards and an end to the postcode lottery.
Self-directed support is an important step in that journey, although it is disappointing that it is focused only on social care. The Scottish Government had a pilot on self-directed support in health. I would want to explore the opportunity of taking that further in a limited number of cases in which people’s health needs overlap their social care needs.
The bill is an opportunity not to be missed, but it needs further improvement. We will work with the Government to ensure that the bill truly supports choice, control and independent living.
- Nanette Milne (North East Scotland) (Con):
In my nine years plus as a member of the Parliament, I have not been closely involved with a bill that has had such widespread support for its general principles. The bill will become legislation that, if properly implemented, will embody the principles of independent living for everyone, giving to all citizens the same freedom, choice, dignity and control in their lives, whether they are at home, at work or in the community. The bill will give everyone the right to secure practical assistance and support to participate in society and to live an ordinary life—something that, to date, has not been achieved. That point is emphasised in the briefing that was sent to members by independent living in Scotland, Inclusion Scotland and others, for whom it is crucial that the bill is viewed as a mechanism to support disabled people and those who live with long-term conditions in realising independent living.
The current system of direct payments to those who wish to select and pay for some of or all their social care entitlement was first introduced in the late 1990s. That system has not worked as intended, with uptake being less in Scotland than south of the border and patchy across the country. It is widely felt that legislation is now required to enable everyone to choose how they wish to receive the social care that they require. The only dissenting voice has been COSLA, which does not see the need for legislation at the present time.
We have heard about the four options, which are on a sliding scale, that will be available under the legislation to those assessed as requiring a package of social care, so I will not repeat that information. Of course, SDS options are currently available to service users, but the bill would place a duty on councils both to offer them and to act on the service user’s choice, and should result in greater consistency of provision across local authorities.
Although they are implicit in the bill, I agree with organisations such as independent living in Scotland that the principles of independent living should be made more explicit—there should be a direct reference to them in the bill. I am pleased that the minister is exploring the possibility of an amendment to that effect. I am also attracted to the suggestion of including a statement of intent in the bill, to further strengthen the link between SDS and its role in supporting independent living.
If the legislation is to be effective, there must be a clear focus on the requirements of the service user rather than those of the provider. A market will emerge for service users as SDS develops. It may be that, in the fullness of time, facilities such as council-run day centres will cease to be required if they are generally not what service users want. There are bound to be tensions, and a change of culture will be required in how the public sector meets individual needs, which will no doubt throw up problems along the way. However, the general thrust is that the end result of real independent living is what should be available in a fair 21st century Scotland.
The Royal College of Nursing voiced concern about users opting to use social care resources to pay for health-related provision, such as physiotherapy—or vice versa. However, such provision is precisely what should be happening if that is what would give the user most benefit and if provision is not readily available in the national health service. I hope that that issue will be dealt with as the integration of health and social care develops, on which I personally eagerly await the details of the Government’s proposed legislation. Indeed, I feel that the benefits of SDS will only be fully realised once the promised integration is complete.
There are legitimate concerns about the lack of an appeals process in the bill or the failure to include the right to independent advocacy as a statutory provision. There are issues about support for adult carers, which the minister has spoken about—carers organisations want to see a duty on rather than a discretionary power for local authorities. There are also concerns surrounding the management of transition planning from children’s services to adult services, particularly from school to further education.
Also worrying a number of people is the Government’s decision not to regulate personal assistants but instead to rely on the protecting vulnerable groups scheme to mitigate some of the risks for those wishing to employ a PA, and I am not sure that the response given by the minister will completely reassure those who have raised such concerns. I note that there are plans to launch a consultation exercise on the employment of relatives by service users, once the bill is passed—I look forward to that.
As we have heard, there have been disagreements between COSLA and the Government about the cost estimates for implementation of the bill’s provisions and whether promised Government resources will be sufficient to facilitate the process of change required. I am pleased that those discussions will continue.
Although there are a number of important details and concerns to be dealt with as the bill goes through the parliamentary process, and no doubt there will be amendments from those who think that changes need to be made, I think that, overall, there is consensus that the legislation will be of significant benefit to those who are assessed as requiring social care. Provided that it is perceived not as a cost-cutting opportunity, but rather as the chance to give greater independence and a better quality of life to service users, the bill, particularly when it is seen in conjunction with the forthcoming legislation on the integration of health and social care, will be widely welcomed across Scotland.
I agree with Barnardo’s Scotland that there will need to be robust oversight of the implementation of self-directed support, with sanctions imposed on local authorities that are deemed to be failing. However, Scottish Conservatives will be happy to support the general principles of the bill at decision time.
- Gil Paterson (Clydebank and Milngavie) (SNP):
As someone who supports the principle of independence for Scotland—I am doing a bit of multitasking—I fully support the bill, as it will empower people with disabilities to have more control over their lives. That is the key message that drives the bill—giving disabled people the same freedom, dignity and choice as their fellow citizens in all walks of life.
As a member of the Health and Sport Committee, I listened to a great deal of evidence during our meetings on the bill, from organisations with a stake in the issue to individuals who live with it on a daily basis. The evidence was wide ranging and informative, and it gave me more clarity about what is needed to ensure that everyone in Scotland is given every opportunity to achieve some level of choice and control in their lives.
At present, two options for receiving support are available to people with disabilities. Direct payment involves the local authority paying the supported person directly. They then spend the money on the support that is required. There is also the more traditional method, whereby local authorities are given the responsibility of selecting the support that is required and paying for it without the direct involvement of the supported person. The bill aims to strengthen both those methods and to offer further options.
In some cases, people would feel generally more confident if they could choose the support that they receive without being burdened with having to deal with the financial side of the equation. The bill offers people that option while recognising that individuals have different levels of support needs, which is why I am pleased that the fourth option is a mixture of the three that I have already set out. The bill aims to consolidate, modernise and clarify existing laws on direct payments, which it is hoped will lead, in turn, to an increased uptake of direct funding, thus expanding the empowerment of disabled persons.
The bill is invaluable not just in helping disabled persons to take more control of their lives. For most, if not all, members, a week will seldom go by without constituents contacting our offices to ask for help on carer issues. As the unsung heroes of Scottish society, carers need all the help that they can get, and I am pleased that the Scottish Government has announced a number of initiatives to alleviate their problems. The investment of £24 million in direct support over the next three years will be welcomed by carers across Scotland, as will the allocation, through the change fund, of £46 million to support carers of older people, which will be spread over the next three years. However, more can be done, and I am sure that the Scottish Government will look further into how it can support those who require further assistance.
A major concern for some people who receive support is the prospect of a close family member using undue influence to become the employed provider of support to the disabled person. The fear is that, because money is involved, the family member’s need for additional income may be considered to be greater than the disabled person’s need for high-quality support. The family situation might mean that the strength of being an employer could be lost by people who are unable or unwilling, for whatever reason, to say no to employing a family member to look after them. That is a particular concern in situations in which the family member who would be employed is not equipped to provide the high levels of care that are demanded and expected. If a family member applies pressure to have a particular person appointed, a situation will arise in which the employer—in other words, the disabled person—will be forced, in effect, to fire someone who has been doing the job to a good standard, perhaps for a considerable period of time.
Such family coercion would be completely counterproductive to the achievement of the goal of independent living and giving people with disabilities more control over their own lives. It would create issues that would restrict further measures to empower them to live more independently. Just how difficult would it be to fire a family member who is not up to the job, or to deal with someone who, part-way through a chore, decides that they have done enough for the moment?
I listened carefully to the minister’s speech and I am pleased that the Government has taken the matter seriously, has looked at the possibility of failings in human nature and is consulting on instructions and guidance to ensure that assessments are regular and meaningful, so that the individual who is seeking support is protected.
- The Deputy Presiding Officer:
You must close now, please.
- Gil Paterson:
I very much want to thank the Government for attempting to provide solutions to tackle the potential difficulties.
- The Deputy Presiding Officer:
- Gil Paterson:
We all want people to have control of their choices—that is essential. I very much support the Government in its deliberations.
- Malcolm Chisholm (Edinburgh Northern and Leith) (Lab):
I welcome the bill, which is the first piece of legislation in this policy area since the Community Health and Care (Scotland) Act 2002, which extended the scope of direct payments to all care client groups. Self-directed support, however, is about much more than direct payments. I particularly welcome the new option 2, whereby the supported person decides the support and the local authority arranges it.
Self-directed support requires profound cultural change to make it work properly, and action on the postcode care issue, which will require some central direction, as Jackie Baillie outlined.
Culture change is certainly necessary. Not that long ago, the City of Edinburgh Council was preparing to change social care provision for hundreds of disabled people without any consultation with those who were about to lose a trusted carer. That was stopped because of a great campaign against it, but it leads me to agree totally with Professor Frank Clark, who said:
“The situation is a bit like what happened with the integration of health and social care, in that there is no point in getting the structure right unless practitioners on the ground behave differently.”—[Official Report, Health and Sport Committee, 15 May 2012; c 2266.]
That is partly about training, and it is certainly about an understanding of the personalisation agenda in health and social care and a determination to do things with people rather than to them.
Self-directed support has to be about promoting human rights and independent living rather than consumerism and the cost of services. To make it work effectively, however, there has to be investment in independent advice and advocacy to help people access it. Age Concern and the Scottish Association for Mental Health argued for that in their submissions on behalf of their respective client groups.
It is also crucial that people should get the appropriate level of direct payment; a related point is that, where charging is permissible, they should be charged fairly. More central direction is required for that via a framework of standards, and an appeals system is probably necessary to ensure equity.
- Bob Doris:
Malcolm Chisholm raises a vexed issue—the expression “postcode lottery” is sometimes used—but does he accept that charging is sometimes directly related to the amount of money that local authorities decide to invest in their social work departments, and that that is a local democratic choice for them? The situation must be monitored nationally, but how much local authorities want to invest in their social work departments should be a real local democratic choice.
- Malcolm Chisholm:
That will become quite an issue during discussion of the bill and the forthcoming health and social care legislation. There is always a balance between local decision making and national decision making—I have been having a Twitter conversation with Roseanna and others over the weekend about that. My general view is that there needs to be a bit more national direction—a framework of standards—because otherwise people will feel that the system is simply not fair. Charging people very different amounts and assessing them in different ways will be a threat to this excellent bill. That is why we need a framework of standards and an appeal mechanism.
I accept that there are no large sums of extra money available for self-directed support, but it is important to ensure that the policy is not used as a cost-cutting exercise. The principle of equivalence of resource is important in the context of the bill. There are fears about costs—Duncan McNeil talked about COSLA’s view—but we should remember that, in his report, Professor David Bell said that self-directed support costs are similar to the costs of existing commissioned services. The issue to do with bridging costs has been recognised for a long time, and it is interesting that the financial memorandum draws on the direct payments finance project report of 2003—the situation has become easier since then, because of the move from block to spot contracts. Such issues can be resolved.
Many more issues will be discussed in detail at stage 2; I will touch on two or three matters in the remaining time that I have. There is an issue to do with personal assistants, who were not included in the Regulation of Care (Scotland) Act 2001. Barnardo’s is calling for a register of carers and personal assistants who are eligible to be employed. I am not sure that we need to go that far, but we should certainly ensure that all carers and personal assistants are covered by the protection of vulnerable groups scheme. The Government should consider the SSSC recommendations in that regard, because there needs to be protection for vulnerable people. As SAMH pointed out, many potential employers will be vulnerable.
I agree with what the minister said about the employment of family members. The move in that regard from exceptional to appropriate circumstances is entirely right.
The interplay between the bill and the health and social care integration agenda needs greater clarity. In a sense, it is unfortunate that we are not discussing two bills together. The committee said in paragraph 199 of its report:
“the Committee encourages the Scottish Government to ensure that the principles of self-directed support enshrined in this Bill can be extended to address the health needs of people also in receipt of social care.”
I support that.
I strongly support the inclusion of children and young people in the scope of the bill, but I was interested in Barnardo’s comment that not enough evaluation has been done. It is important that there is full analysis of current projects that involve children. In general, I certainly agree that children and young people should be included in the bill.
- Richard Lyle (Central Scotland) (SNP):
The bill will enshrine in law the opportunity for adults and children who use social care to exercise choice and control over their care. The Government will support independent living and the right of supported people to participate in society to the full, so that people can be helped, quite rightly, to live an ordinary life. If that is to happen, we must redouble efforts to increase take-up of self-directed support. We must not just shift the balance of care towards home and the community but shift the balance of power towards users of support services.
Independent living means that supported people of all ages have the same freedom—I like the word “freedom”—to exercise choice and control over their lives as is enjoyed by many citizens of this country. Supported people can exercise the rights and duties that come with being a citizen of this country in a full and equal way, participating in society. SDS presents people with essential, practical assistance, to ensure that they are free to live their lives as they want to, with the dignity that they deserve.
The SNP Government is committed to Scotland’s estimated 650,000 unpaid carers. The extension of direct payments to carers, as proposed in the bill, is further proof of that commitment. I note that more than £46 million will be invested during the spending review period.
What happened in the past will not work in modern Scotland. Legislation is needed to ensure consistent provision and to ensure that supported people have greater choice and control over the services that they receive and need if they are to live their lives to the full. Progress has been made on increasing uptake of direct payments, and legislation is needed to ensure that further progress can be made.
The bill will give eligible people four options: direct payment, whereby the local authority makes a direct payment to the supported person, for them to spend on the support that they require; direction of the available budget, whereby the supported person selects support, which is then arranged by the local authority; local authority-arranged service, whereby the council selects and makes arrangements for the support that is to be provided; and a combination of options 1 to 3, to suit the individual’s needs.
As a member of the Health and Sport Committee at stage 1, I thank its convener and deputy convener for the excellent report on the bill. I am sure that the bill will receive the support that it deserves. I will monitor its progress through the Parliament—I am sure that many others will do so, too. I believe that it will receive the full backing of all members.
I also thank all the organisations that sent us briefings on the bill. I note that the minister received a request from the director of the Royal College of Nursing about the possibility of delaying the legislation. I for one would certainly not agree with that. Carry on, minister, with the bill, which I fully support. I hope that he will say in his summing-up speech how he has responded to the letter from the RCN.
- Siobhan McMahon (Central Scotland) (Lab):
There has been a concerted effort in both Scotland and the UK for a number of years to give care recipients greater power and influence over decisions that will have direct and tangible effects on their everyday lives. That effort has been accompanied by attempts at local and national levels to tailor individual care to personal specifications. The general principles of the bill—involvement, informed choice and collaboration—attempt to reconcile those two objectives in relation to social care. The bill’s aim is to ensure that service users are engaged partners as opposed to passive recipients in the commissioning and delivery of care. As a passionate advocate of independent living, I fully support that aim, but as the Health and Sport Committee’s report has already highlighted, there remain aspects of the bill that must be addressed.
The bill in its current form promotes independent living, but I would like that to be strengthened by the inclusion of a statement of intent that would underpin our common right to live an independent life. To ensure that that right becomes a reality, we must continue to work towards integration of health and social care. That is an explicit Government aim, which the Labour Party supports, and that is why we have called for the creation of a national care service. We believe that that is the best route to achieving that aim, but it is not currently on the agenda. Therefore, we must focus on the other obstacles that we must overcome.
The first and foremost of those obstacles is cost. We agree that, where possible, individuals who are currently cared for in hospital should be cared for in the community. The bill is part of the process, but the transition of care necessitates a transition of budget. Significant bridging finance is needed to shift the cultural balance from hospital to home-based care. At present, it seems to be doubtful that the bill will make adequate financial provision for the increased numbers of people who will receive care in their own homes, as is their right. That is precisely the sort of detail that we must have regard to if we are to ensure that the spirit of the bill is matched by its outcome. I would welcome any assurances that the Government can give me on that.
- Bob Doris:
The convener of the Health and Sport Committee, Duncan McNeil, has already made clear one of the reasons why there is uncertainty about the finances behind the bill. The Scottish Government has clearly stated what it believes the proposals will cost and it has shown the workings behind that figure, but COSLA has simply made broad assumptions and will not share with the committee how it reached its figure. Does Siobhan McMahon agree that that is unsatisfactory on the part of COSLA?
- Siobhan McMahon:
All the information should have been provided to the committee so that an informed choice could be made. I call on both sides to provide that information so that such a choice can be made.
Statutory access to self-directed support is undoubtedly empowering, but it may also be intimidating. Individual care requirements will vary a great deal in their nature and complexity, so it is imperative that the available options be promoted clearly and consistently across local authority boundaries. That will enable individual service users to make informed choices and will help to ensure that a constantly high standard of care is maintained across the country. That is especially the case when it comes to direct payments.
Taking sole responsibility for commissioning one’s own care is a daunting prospect. In many cases, it will entail the removal of the local authority as the traditional middleman in provision of care, but local authorities must remain part of the process, with a statutory obligation to ensure that the appropriate advice and support are available prior to the allocation of a direct payment.
Service users who choose this path should have access to budget management training and must be made aware of their rights and responsibilities as employers. In addition, the bill must make provision for any incidental costs arising from direct payments.
Capability Scotland cites examples of cases in which direct payments have been discontinued immediately upon the death or long-term hospitalisation of the recipient, which has left families being liable for redundancy payments that are owed to personal assistants. The bill must stipulate that the amount of the award is commensurate with the overall costs of care, including those that arise from sudden death or hospitalisation.
Another matter of note is that the bill will, in effect, create a market in provision of care by placing local authorities and other service providers in direct competition. Some people have argued that many local authorities offer less in direct payments than the equivalent cost of arranged services, in an attempt to keep service provision in-house. As a consequence, it has been suggested that primary responsibility for setting the value of direct payments be passed to an independent arbiter.
In addition, Capability Scotland has argued for the establishment of an independent statutory appeals process to allow for decisions on assessments of needs and the cost of care packages to be effectively challenged. That seems to be a sensible request. The formation of an independent appeals panel would offset the fears of many service users that their challenging of decisions through existing internal mechanisms will result in prejudicial treatment in the future.
As self-directed support becomes more established, there is likely to be increased uptake of direct payments. Although that will be a positive development, it may lead to more use of personal assistants as opposed to service providers. In 2011, 39 per cent of direct payments involved use of personal assistants, with 34 per cent using service providers and 3 per cent using some combination of both.
Personal assistants are not regulated and little is known about the PA workforce. In order to guarantee a consistent high level of care to service users, and to safeguard the PA workforce, the Scottish Government should, I believe, consider developing a register of all carers and personal assistants, as has been suggested by Barnardo’s Scotland. I was disappointed to hear the minister ruling that out in his opening speech. Inclusion on such a list should be made a precondition of funding, especially in the provision of care for children and young people.
Finally, it is imperative that the provisions of the bill be implemented. There should be robust oversight to ensure local authority compliance because we cannot allow any party to fail in its obligations. There is too much dormant legislation on the statute book. Self-directed support must not be allowed to join the list.
- Christina McKelvie (Hamilton, Larkhall and Stonehouse) (SNP):
The term, “independent living” is defined by the Government as:
“disabled people of all ages having the same freedom, choice, dignity and control as other citizens at home, at work, and in the community. It does not mean living by yourself or fending for yourself. It means rights to practical assistance and support to participate in society and to live an ordinary life.”
What does independence mean to members? I believe that its meaning is enshrined in that statement. Imagine having the same choices as a non-disabled person and the freedom to make that choice. Imagine taking part in the same activities as your friends without having to sit on the sidelines. Imagine taking part in civic society, in a work place, in a recreational activity, without the stigma or barriers that can so often stop people, literally, in their tracks. Imagine being empowered not just to take control but to actually be in control, when much of your life is in other people’s hands. Imagine the dignity of not only being consulted, but of being respected in the choices that you make for yourself, without fear or favour, safe in the knowledge that the choices that you make for yourself are yours to own, to decide, to control.
Those are all things that non-disabled people take for granted. We cannot imagine how difficult life can be in some respects, and as non-disabled people we cannot understand the sense of liberation a person has when they take control and ownership of their life. Imagine how you would feel as a young person trying to make your way in the world and attempting to keep up with your siblings and friends.
The story I am about to tell illustrates the need for underpinning legislation. I have the permission of the people concerned, but I will maintain confidentiality. This is the story as told to me by a father; these are his words and his experiences.
“We first heard about self-directed support via parents at the Scottish Spina Bifida Association and we thought it would be great for my child with the outcome being that Mum gets some respite and my child’s care needs are being addressed, including personalisation, socialising and learning social skills for her to learn independently without her mum; the perfect all-in-one package.
What we did not realise is that we were entering a minefield of events that would have us unnecessarily stressed, resulting in submitting complaints to the local authority to fight for our rights and receive what we are entitled to.
Our first appointment with our local social worker was within 6 weeks of expressing our interest in self-directed support, the meeting went well, we explained that we were interested in self-directed support and the outcome for my child would be care needs being addressed along with independence, personalisation, socialisation and learning social skills independently while her mum gets respite—the social worker went away with our request to report back to her team leader.
A few weeks passed and we received a call to arrange a follow up appointment—on arrival the social worker asked similar questions to the first meeting, we were confused and said that it was self-directed support that we were looking for for my child. The social worker in surprise looked at us and asked for more information, and so once again we explained why we wanted the self-directed support and the social worker went off to report to her team leader.
A few weeks passed and we received a call to arrange a follow up appointment—on arrival the social worker asked similar questions to the first and second meeting, we were very confused and I asked if she was having a laugh as we had spent the last two appointments discussing this—at this point the social worker admitted that the team leader is unaware of the details of self-directed support—I asked that if I did not quiz her then would we be having a coffee in another few weeks to talk discussing self-directed support? Talk about déja vu. We gave the social worker in-house contact details within the local authority to request the process of self-directed support.
A few weeks passed again and we received a call to arrange a follow up appointment—on arrival the social worker smiled and the assessment began all over again.
A few weeks further passed and we were informed that there was no money in the budget to pay for the self-directed support which would be revised at the next financial year.
And now the complaints start as we arrange meetings with the social workers, team leaders, people at Scottish Personal Assistants Employers Network, Christina McKelvie MSP, the Head of Adult and Older People Services, the executive director of social work in South Lanarkshire Council—resulting in my child being awarded 2 hours per day which was awarded from another budget as there was no money in the children's budget, even though Scottish Government had awarded SLC with £600,000 every year for the next 3 years, £1.8 million swallowed into other budgets.
The social worker verbally gave us permission to arrange a personal assistant for my child as the first payment would be processed at month end. Lesson number one, take nothing verbal from a social worker as my child's first payment took 3 months and was not back dated—so who would have paid the wages if I had managed to find an appropriate personal assistant for my child?
A few weeks later we received an email from the social worker and team leader requesting for more information, (remember that I have taken everything to every meeting) which may now result in monies being paid back, 6 months later my child's 1st review is still waiting to be heard.
This will leave the matter of respite for Mum not dealt with, with her having caring duties for my child's twin sister who is now recognised as a young carer. We have requested a review to receiving extra hours for respite on a weekly basis to support Mum—6 months later we are still waiting.”
There is nothing more powerful than a person’s experience of trying to navigate a system that does not have legislative backing. For that reason alone, I welcome the plans to legislate and hope that families will not have to experience what I have detailed this afternoon. I ask the minister to pay particular attention to children’s needs during the bill’s process.
- Liam McArthur (Orkney Islands) (LD):
I, too, congratulate Duncan McNeil and his colleagues on the Health and Sport Committee on the production of a very thorough report. I am also happy to confirm the Liberal Democrats’ support for the bill. As others do, we think that it is overdue, but it certainly represents an important step in giving adults and children, carers and young carers, more control over meeting their social care needs.
Although the idea of self-directed support is increasingly prevalent, there is still a lack of consistency in the options and where they are available. The headline figure comparing direct payments in England and in Scotland provides a stark illustration, and the Christie commission was right to highlight that further action was needed to increase uptake of self-directed support.
In that respect, I welcome the Government’s intentions behind the bill. Enshrining in law a requirement for all local authorities to offer people with support needs four distinct options—receiving direct payments, directing available resources, having the local authority arrange support, or a combination of the three—represents a significant step in the right direction and I hope that it will ensure that everyone is able to make the choice that best fits their circumstances.
I understand that questions have been raised in committee about implementation of the new duty. Local authorities and providers will certainly face challenges in adapting to what will inevitably be changing demands for certain services and—as we have heard from Siobhan McMahon, Duncan McNeil and others—providers will, no doubt, be wary of the cost implications. The Coalition of Care and Support Providers in Scotland highlighted, for example, that
“High demand for out-of-hours care and flexible care could mean a more expensive workforce.”—[Official Report, Health and Sport Committee, 22 May 2012; c 2309.]
As I mentioned to the minister earlier, there are specific issues in Orkney. In our small rural island-based community, there is certainly demand for more self-directed support, but the scope for making savings in the provision of other services is limited. That has been our experience to date. I hope that the minister will reflect on the specific challenges that are faced in Orkney and, probably, in Shetland and the Western Isles.
We must ensure that providers can meet the demands that self-directed support might place on them. Key in this is maintenance of levels of funding and of transparency. A number of groups have raised concerns that implementation of self-directed support must not be used as a cost-cutting exercise, so I welcome the strong statement that the minister made on that in his opening remarks. Examples have been cited; Bob Doris and Duncan McNeil both mentioned the situation in Glasgow, which offers a cautionary tale. The Government must ensure that sufficient funding is in place for implementation of self-directed support and that it is clear where the money is going.
I also welcome the requirement on local authorities to ensure that individuals can make informed choices about the options that will best meet their needs. However, concerns have been raised with me about the omission from the bill of the right to access independent advocacy. I know from experience in Orkney that advocacy services are vital in helping people—particularly vulnerable people—to make informed choices, so I support the calls for a right to access to independent advocacy to be included in the bill.
I turn to the second aspect of the bill. It is equally important that, as well as putting in place better options for people with support needs, we ensure that their carers have full access to the help that they need. The bill gives local authorities the option of providing support services to carers as well. At stage 1, the committee heard a great deal about that provision—in particular about the fact that the bill will not impose a duty on local authorities in that regard. Carers Scotland argues that
“enacting the legislation simply as a power will result in inequity with significant variances in practice, and thus support for carers, across local authorities.”
There are readily identifiable benefits to having proper levels of support in place universally. Carers Scotland also stated that
“Providing support at the right time can also prevent carers from having to give up paid employment and activities that sustain their life outside caring, resulting in negative consequences for their finances, health and wellbeing.”
Although I acknowledge the concerns that placing a duty on local authorities could lead to strict eligibility criteria, I believe that the argument for such a duty has much to commend it. Many carers have worried that the bill as it stands would not deliver the necessary improvements for them. I invite the minister to reflect further on the evidence that was presented to the committee on that aspect before stage 2.
A further concern, which is particularly relevant for young carers, is about the impact that the need to manage self-directed support budgets might have on people. Carers might end up having to manage personal budgets for family members on top of their caring responsibilities, which could be an unwanted burden. Several members have highlighted the views of Barnardo’s Scotland, which advocates the introduction of training and support for budget holders. That suggestion certainly warrants further consideration.
Finally, the bill opens up the possibility of unpaid carers being charged for services that help to support them in their caring role. Clearly, that would not be welcome, and the matter needs to be addressed. I ask the minister to clarify the situation.
As we have heard today, although the principles of the bill are sound, a number of details need to be dealt with. The minister touched on a number of them in his opening speech, but I hope that he will cover a few more in closing the debate so that we can be confident not only that the bill will be implemented successfully and smoothly to help people with support needs to manage their care, but will bring meaningful change for carers as well.
The Liberal Democrats will be only too happy to vote in support of the general principles of the bill at decision time. We look forward to working with the Government, other parties and people outwith Parliament to improve and strengthen it as it progresses through its various stages.
- Dennis Robertson (Aberdeenshire West) (SNP):
As other members have done, I thank all the various agencies that provided information for this afternoon’s debate.
I did not intend to stand up and defend social work, but having heard Christina McKelvie’s story, which was very real, I will say a few words on the subject. As a former social worker, team leader and service manager, I think that there is a failure in process. That highlights an essential point about the bill—that it is not about process but about people.
The bill is about enabling people to make a choice, but they cannot make the right choice if they do not have the information. To enable choice, the information must be free of bias and it must reflect the needs of the individual, their family and their carers. In my 30-odd years in social care, I met many families with many different needs. However, the principle of doing the assessment to identify that need must not be and should never be resource driven; it must be outcome based. We must divorce what resources are available from that consideration in order to ensure that we provide an assessment that is free of that information. We must ensure that when we carry out an assessment we assess the need of the individual and their carers at that time. We must come up with an informed care package, not one that is decided for them. As Malcolm Chisholm eloquently pointed out, it is not what we do to people, but what we do with and for them.
The setting up of a care package and the establishment of what a person’s needs are is a partnership. It is about establishing what the person needs and when they need it. There are many good examples and we have been given many case studies in the briefing for the debate. I can take members back to a case of my own many years ago when I was practising in social work. In my early days in social work, I came across a young lad in Inverclyde who had very limited communication skills. He had no speech, but was able to smile and laugh. Unbeknown to me, when I walked into the room to come and see the family his eyes apparently lit up, because I sat beside him and he held my hand. He got immense pleasure from that very basic contact.
That is the principle behind the bill. It is about identifying basic needs. It is not complex; it is about identifying people’s basic needs, ensuring dignity and ensuring respect. We cannot lose sight of that.
I remember an occasion when I achieved independence as a result of being able to use a computer through screen-reading technology. That gave me the ability to do things for myself rather than be dependent on others. Fortunately for my wife, the screen reader does not read the bank statements, so I have no idea about those.
Independent living is not about the person living on their own, but about their living with the appropriate supports. None of us lives in isolation. We live with support from others, whether that is through partnership or marriage or the support of colleagues in our profession. We are interdependent, but at different levels. We must respect that and identify it. We must recognise that the person’s needs must be met. As I said, the process must be outcome led, not resource led. We must meet a person’s needs in the best way that we can.
We have heard much about carers. I welcome the fact that Parliament will hold its first carers parliament on 1 October. Carers will come together in the chamber so that we can hear their voice. That is a step forward for Parliament, for our communities and for our carers.
I endorse the work that the Government has done on the bill so far and I endorse the support that it has received from the chamber.
- Mary Fee (West Scotland) (Lab):
Given the concerns that I have shared with Parliament in previous debates on care, I welcome the chance to take part in today’s debate. Like my Labour colleagues, I welcome the bill and the general principles that are enshrined in it. The hope must be—as, I am sure, it is—that the bill will increase uptake of direct payments, which has slowly increased in the past decade. It is welcome that carers groups, service users and trade unions have been supportive of the bill and that they have been involved with the Health and Sport Committee through the evidence-gathering process.
After stage 1, changes will be proposed. I feel that an amendment is needed to include in the bill a right of access to independent advocacy. In his response to the committee, Michael Matheson said:
“The Bill will place a duty on local authorities to give people information and advice about the decisions that they make and point them in the direction of independent advocacies.”
I take a slightly different view from the minister; I feel that local authorities will not have the impartiality that independent advocacy services can offer from the outset.
- Fiona McLeod (Strathkelvin and Bearsden) (SNP):
Will the member take an intervention?
- Mary Fee:
If I have time later, I will take an intervention, but I am really tight for time and I have a lot to get in.
In its submission, Independent Advocacy Perth and Kinross said that it had
“concerns regarding the quality of information ... provided to people making decisions around whether they should use this method of personalising their care. In some instances”,
it has been noted
“that the person has not always been made aware of the responsibilities connected with direct payments and has only been informed of the benefits”.
For the bill to work, service users and carers must know all aspects of what they will be taking on.
In the past year, there has been much discussion about carers and the carers strategy. We all appreciate the important role that carers play, and the bill provides the best opportunity to give something back, by creating a duty instead of a power to offer carers self-directed support. In its submission to the committee, Carers Scotland pointed out that a power will
“result in ... significant variances in practice, and ... across local authorities ... By legislating for a statutory duty rather than simply a power, this Bill presents an opportunity to deliver a limited right to some practical support, subject to assessed need.”
The creation of a duty would give some carers back their normality, let them be themselves again and ensure that their own health and wellbeing are paramount.
I listened with interest to the minister’s comments on personal assistants. I accept that the use of PAs has decreased in recent years, but I still have concerns about their training and qualifications and about monitoring them. Some of my concerns were highlighted by others in evidence to the committee. The Coalition of Care and Support Providers in Scotland called for
“some basic level of accreditation for Personal Assistants, and as a minimum a requirement that they be made subject to PVG checks.”
The Scottish Social Services Council added that
“agencies providing personal assistants, and indeed other social service workers should be regarded as care services and required to register with the Care Inspectorate.”
The need for regulation is a safety net not only for service users, but for the workforce.
During my time on the Health and Sport Committee, many stories that related to care of the elderly attracted national press coverage. To ensure that cases of neglect, abuse or poor care provision do not occur, regulation of PAs is a must. I have a reservation about the employment of family members, which concerns how they are trained and regulated. Much of what I said about PAs can be applied to family members. However, what is most important is that employment of a relative must be in the service user’s best interests. Much unpaid care is provided by family members, so it is right to reduce the restrictions, but training and regulation must balance that reduction.
A constituent contacted me to ask me to use the following quotation in my speech. It is fitting, because it reflects carers’ uncertainty and feelings about the bill. My constituent said:
“As a carer for my husband who has a spinal injury, I find myself increasingly worried for the future. What happens when we really do need support? What hoops will we have to jump through? It took five months and four different professionals when all we wanted to do was put an emergency plan in place. We gave up, and did something ourselves. The first professional we met didn’t know about Direct Payments.
So when things get worse—as they will—will we be able to get help to lift my husband? To get him to bed? Support that means I can continue working?
Or will I have to give up a job I enjoy? Will any help we get in future work around our needs as a family? We don’t mind paying for services which support us ... but they need to work around my husband’s life and let him have some dignity. Will the SDS bill enable this to happen?
I watch with sadness some of the battles my friends have had to go through to get help with caring—and I know some for whom self-directed support has been a godsend. So I want it to be easier for others to get the help they need.
So my plea is to recognise that carers need their own rights—the SDS bill provides a starting point.”
- George Adam (Paisley) (SNP):
I, too, welcome the bill and the debate.
I am speaking as a member of the Health and Sport Committee but, unfortunately, I cannot take any credit for the great work that Duncan McNeil and the committee have done on the bill because I have been a member for only two meetings—and, as of 5 pm tonight, I will be a Health and Sport Committee member no more.
In football parlance, I asked for the transfer to the committee not only because it was the only committee that I wanted to play for but because it deals with issues that are close to my heart. My wife Stacey suffers from multiple sclerosis, and seeing her on-going struggle with it I have experienced what it is like for someone who has had to access services as the years have passed.
Stacey is quite lucky compared with others with whom I have worked as an elected member in seeing what difference the bill could make to their lives. As Dennis Robertson said, the bill is about people, and that is the most important thing.
Part of the evidence that the committee received involved a dialogue between Bob Doris and Margaret Cassidy, who has been a user of social work services in the past. He said to her:
“Your prepared statement mentions that you now do things like go dancing and go swimming, not when you are told to go swimming, but at a time of your choosing”.
“They told me to do things when they wanted.”
Bob Doris then said:
“I suppose that I am trying to give you the opportunity to put on the record whether you thought that enough choice was previously offered to you”.
Margaret then told an interesting story that is a perfect example of why the bill is so important:
“It was so-so. I will tell you a wee thing. One time I wanted milk and the woman who was helping me said that that was not her job. I was only asking for a pint of milk, but she said, ‘By the way, that’s not my job.’ I said to her, ‘What is your job?’ We had a falling out and I told her, ‘There’s the door. Don’t come back.’”—[Official Report, Health and Sport Committee, 29 May 2012; c 2358.]
The bill gives people such as Margaret Cassidy the power to do that and take control of their own lives. That is an important point to take on board.
As the minister and Duncan McNeil have said, the bill should be seen not as an agenda for cuts but as a vision of the independence that it offers families across our nation. I support the core values of the 2010 strategy—respect, fairness, independence and freedom—and I see those values in the bill and in its ensuring that supported people have the independence to lead a fulfilled life.
As others have said, it is important to acknowledge the 650,000 unpaid carers in Scotland. The extension of direct payments to carers is proof that the Scottish Government acknowledges them. The Scottish Government is also providing other investments of more than £24 million over three years in direct support to carers, plus £46 million to support the carers of older people, because we live in a society that is getting older.
Another great addition, which has been mentioned, is the carers parliament. I have already booked my place and look forward to the first carers parliament. It is important that we in this chamber engage with everyone across society. Hearing their stories in that forum, and not just at our surgeries, brings the importance of the issue home and makes this place relevant to the people whom we serve.
The issue is close to my heart because I am, technically, a carer. My wife might say otherwise but, technically, I care for her. I am lucky because I have the support and help of my mother-in-law and father-in-law. Without their support, I would not be able to do the job that I do as well. I have that support, but there are other families who need further support. We must never forget the contribution that those 650,000 unpaid carers make. We must strive to provide as much support as possible, which is one of the reasons why I support the bill.
The most important support that the bill offers is choice. I would like the minister to look at the potential for making the application process for direct payments a wee bit easier at local authority level. I know from various cases that I have dealt with that the process can be quite difficult and that payments can take a long time to go through. Although people who have taken up the idea of self-directed support have done extremely well and have enjoyed it, there is still the traditional local-authority arranged service, directing the available budget and a combination of eligible options.
I am particularly looking forward to the clarification of the existing laws on direct payments as they are haphazard and something of a mishmash at present. The minister spoke about family members being in receipt of direct payments—I welcome that flexibility. That is something that we have to look at because it is a natural process for families to look after individuals.
I add my voice to support for the bill. It carries forward the legacy of the Christie commission and ensures practical support for people and families throughout Scotland. I have mentioned Scotland’s 650,000 unpaid carers and their contribution to our communities. They and their families must be supported and assured of a quality, independent life. This is a strong bill, and I agree with the minister that it can make a difference to people’s lives throughout Scotland.
- Helen Eadie (Cowdenbeath) (Lab):
I echo the views of other members who have welcomed the bill, particularly Malcolm Chisholm in his support for option 2, in which the individual chooses and the local authority provides. I do not like the notion or the spectre of individuals hiring and firing at their will, which is the Tory proposition coming down the line at us.
I bring with me experience as a carer of my parents. I watched the tender loving care of my stepmother-in-law before the death of my father-in-law. He needed care at home for almost two years, which was quite a traumatic experience for her. We watched that experience and did what we could to support her.
I also bring the experience of 13 years as a councillor in Fife and a long-time member of the social work committee. When I first joined the council, home helps were provided free of charge by the Labour administration. In those days, home helps did everything that they were called on to do. Times have changed. The service was free when I first joined the council but by last year, when the SNP lost control of the council, charges in Fife had reached £11 an hour for those not on benefits—unsustainable for individuals who desperately need care.
My work as an MSP has helped to underline that problem for me. Myriad issues come before us in our case load as parliamentarians. I have read with interest much of what has been said before today and have been fascinated by the proposals that have come before us. When I cared for my parents 29 years ago, just before they died, we had none of the support services that will be in place. I welcome that support—it is critical for individuals and carers.
Given that my remaining time is so short, I shall dwell on representations made to me about Capability Scotland, which has been mentioned by others. I will go into no more detail than to say that I found compelling Capability Scotland’s call for the establishment of a new tribunal jurisdiction. Recent case law from the European Court of Human Rights suggests that, even cumulatively, the mechanisms in the bill do not amount to an independent and impartial tribunal. Capability Scotland says that, after extensive consultation, the Scottish Committee of the Council on Tribunals this month recommended
“the establishment of a new tribunal jurisdiction to deal with appeals against community care decisions”.
I hope that the minister listens carefully to what Capability Scotland has said.
The minister spoke about having the right policy framework for carers and about whether support for carers should be a duty or a power. The point that came over in the briefings on the bill is that we are talking about a discretionary power. I was moved—as I always am when I hear him speak in the chamber—when Dennis Robertson described a real, compelling situation and what it is like for the individuals concerned. That is why the minister has to think about those carers across Scotland: he has to understand that they will be at the mercy of every local authority’s financial consideration, which is what Dennis Robertson said should not happen. Decisions should not be based on financial consideration; they should be based on the needs of the particular individuals and their carers. It would be a great mistake if the bill goes through and we do not issue the minimum regulation of standards across the whole of Scotland, because we know what a postcode lottery means.
I note from the briefings that carers assessments are not common practice in all local authorities. I note too that there have been calls to ensure that the assessments are better publicised—that is important. There is also the issue of carers complaining that the assessment processes are too long, especially when a short or small intervention is required.
I need to ask the minister about the sheltered housing issue. Perhaps he can talk about how the bill fits in with sheltered housing when he sums up. Across Scotland, sheltered housing associations such as Bield Housing and Care charge for the services that they provide. Some of that money goes towards those services, but what happens when those sheltered housing associations cut back on the services that they provide? The individuals are still paying for the services, but the services are cut. It is an issue in the area that the minister represents and it has been an issue for me in Fife over the past three years. I hope that the minister will address whether that issue is affected by the bill.
Broadly, I welcome the support that all colleagues in the chamber have given to the bill.
- Fiona McLeod (Strathkelvin and Bearsden) (SNP):
Members have already heard about the vast army of 650,000 unpaid carers across Scotland who save the Scottish purse £10 billion a year through their work. I want to speak about one large section of those unpaid carers—family carers.
As a member of the Health and Sport Committee when it took evidence on the bill, I found it interesting to look at the Government’s decision to change from the payment of family carers under exceptional circumstances to payment where it is appropriate, and I welcome the minister’s comments on that.
When the committee was taking evidence, it was interesting to see the sharp divide on that question. It was perhaps reflected in Gil Paterson’s speech when he talked about the risk of undue influence and coercion by family members if they became paid carers. In the evidence received by the committee, it was councils and organisations such as the Association of Directors of Social Work that, illogically, talked about the right of everybody who receives care to choose the care that they think best and then said that we have to keep in place the exceptional circumstances criterion for paying family members through direct payments. That contrasts with carers organisations and such organisations as Age Scotland, which in their evidence talked about the facts that most unpaid care is done by family members and that, when those family members are able to provide the care, it leads to better outcomes for the person who is receiving care.
Reflecting on the dichotomy in the evidence that we received on the topic, I thought that I would take members in the chamber on a personal journey. For nigh on 23 years, I have been a family carer. When it happens to you, you start by thinking in a particular way: I thought that I was just being a good daughter and doing the things that my mum needed me to do. However, it escalated over the years, and I ended up doing the banking, the bills and the messages: if my mum said, “I want a pint of milk,” I went and got the pint of milk.
The work escalates: you take the family member you care for to health appointments, you do emergency hospital admissions, and you receive phone calls at work perhaps four or five times a day when they are not coping. There comes a point when there is a realisation and you think, “We need a care package here. This is not something that I’m doing well.” You set off on that route, but very quickly you learn about the limitations of the care packages that are on offer through local councils: the four times a day 15-minute visit, which is inadequate for anything—not just for cooking meals but even for giving company to somebody.
- Dennis Robertson:
Does that mean that the council is doing resource-led interventions and assessments rather than needs-led ones?
- Fiona McLeod:
As Dennis Robertson has suggested in his intervention and his earlier contribution, that is exactly what happens. If the person getting care has control through direct payment, they will choose the care that they need and not what a council says is what its resource limitations will allow it to provide.
I had some other examples of the limitations, but let me just take members to the next step. The next realisation is that the care packages do not work and that what they provide is certainly not support for independent living in the community. All the time that the care package is in place, the family carer is still doing all the jobs, such as paying the bills, doing the messages and taking the cared-for person to hospital.
It is at that point of realisation that you ask, “How do we get a personal service?” I found out about direct payments, but you have to know the system. Dennis Robertson has explained that, but I will give members a little anecdote. My son said to me once, “It feels like you’re having to beat the system, mum.” That is exactly what Christina McKelvie explained that her constituents had gone through. My son said as well, “Mum, you used to be an MSP. If you can’t beat the system, how does anybody else manage?”
When someone does get their direct payment, the family member who has been giving them their care is no longer considered under the exceptional circumstances condition. If a person who needs care gets a direct payment and decides that the family member who has been giving them their care is the most appropriate person to continue to give them that care, they should be able to use the direct payment to employ that family member.
I will just finish by talking about the toll on the family carer of going through all the hoops, processes and so on under the exceptional circumstances condition. You end up as a carer thinking not that you are a good daughter but that you are a bad carer. I ask members: please support this legislation and the move to the appropriate circumstances condition.
- The Presiding Officer (Tricia Marwick):
We move to the wind-up speeches.
- Jackson Carlaw (West Scotland) (Con):
For those in the chamber who were in the previous session of Parliament, this is going to be my Jamie Stone summation, in as much as I am tempted to say that I largely agree with everything that everybody has said and sit down. However, that might be unhelpful to you, Presiding Officer, so I would like to touch on some of the themes that I think emerged during the course of the debate.
First, I thank the minister for his pre-legislative courtesy in entering into discussions with Nanette Milne and me—and, I am sure, with others. I was certainly not in any doubt about his own personal sincerity regarding the bill that the Government has introduced. It is a subject about which he spoke before he was a minister, and it is clearly something that he wishes to see progressed. He clearly understands well the benefits that will come from the legislation succeeding.
The minister said that the overall purpose of the bill is to make a difference to those in society who need support. His response to the Health and Sport Committee was interesting. Mr McNeil detailed that in a fine speech that was characterised by its illustration of the personal examples that moved him and other committee members in taking evidence. He was too quick with Omar’s surname for me to scribble it down, but the name was mentioned several times. Through Omar and others, the committee became clear about the difference that can be made. In Omar’s case, that is through a direct payment to a personal assistant.
I was also interested in Duncan McNeil’s comments on the strength and resonance of the appeal against prescription from Pam Duncan of the independent living in Scotland project, who wanted to ensure that, as a result of the bill, as many people as possible have a chance to plot their own lives.
Mr McNeil identified a conundrum that worries me in relation to the bill and the forthcoming adult health and social care integration bill. It is easy for us in the Parliament to agree that we approve of the principles but, if forces elsewhere are not wholly committed to the process, it will be much harder for our understanding of and support for the principles to translate into the successful introduction and implementation of what we seek to achieve. We know from previous examples such as community health partnerships that such a situation can be unhelpful if we are to make progress.
Mr McNeil talked about COSLA’s inability to produce detailed costings, despite the fact that it challenged the Government’s costings. That inability is extremely unhelpful, because I imagine that the Government would welcome alternative suggestions so that it could robustly test whether its assessment of the costs is correct.
Some bills will get a second chance in the public mind, but this is one bill that will not. The test of whether the bill, when enacted, has succeeded will be whether people, at the start, feel that they can trust the legislation as implemented and that it meets the challenge it seeks to address.
Jackie Baillie warmly welcomed the proposed legislation. She made pertinent points when she said that she supported it on the basis that it extends choice. It was hitherto unknown to me that that was a principle in the Labour Party, but I took that at face value and welcomed it. Jackie Baillie touched on the independent advocacy issue, which Mary Fee returned to, and the appeals process, which several members mentioned.
Gil Paterson touched directly on a difficult area, which is the involvement of family members in the personal assistant role. In a gentle and sensitive way, he made the point that, as the minister said, we need to be able to determine whether there is appropriate involvement and that the circumstances and criteria are appropriate without ending up with a system that is difficult and which obstructs individuals from exercising their first choice.
Malcolm Chisholm alarmed us all with his talk of a Twitter conversation, which I think he said was not with “the minister” or “Ms Cunningham” but with “Roseanna”. I was quite jealous. I thought that I had the perfect working relationship with the previous health secretary, but I called her “cabinet secretary” or “Ms Sturgeon”, and I never got any more familiar than that. Malcolm Chisholm’s point goes back to the point that I tried to make a moment ago that there is an awful lot of detail and that, unless it is properly understood and worked out, there is a capacity for us to trip over it as the legislation is implemented and for the achievement of our aims to be frustrated.
Siobhan McMahon is probably a bit worried about the fact that she, the Conservatives and the SNP are similarly minded to progress on the issues. Normally, she would follow me only if I was walking towards a hole in the ground, but in this instance, as a Parliament, we are agreed that we support the general principles of the bill and want it to succeed.
Christina McKelvie, Dennis Robertson, Fiona McLeod and George Adam all used personal experience to illustrate their points. One point that struck me latterly in the debate was about how common or ordinary it is to have personal experience of self-directed support or care. People in this chamber, as with those outside it, have a first-hand experience of the subject and understand the difficulties and the obstacles that need to be overcome.
- The Presiding Officer:
Mr Carlaw, you need to close.
- Jackson Carlaw:
I will close on that point and say that we welcome and support the general principles of the bill and we look forward to the discussion that takes place as we move forward.
- Drew Smith (Glasgow) (Lab):
As another member of the Health and Sport Committee, I too associate myself with the remarks that others have made about the clerking team and, as Jackson Carlaw did, pay tribute to Duncan McNeil for the powerful way in which he set out the committee’s approach in examining the bill.
In opening the debate for the Scottish Labour Party, Jackie Baillie made clear our support for the Social Care (Self-directed Support) Scotland Bill at stage 1. If the purpose of the bill is to provide a framework for a more personalised system of social care, independent living or, as Richard Lyle would have it, freedom, the key point that the Parliament should understand is the level of service personalisation that users are able to direct already. I thought that Christina McKelvie, Liam McArthur and Mary Fee made it clear that, despite personalisation being a long-held objective of the Parliament, the situation across the country continues to vary enormously.
Variation in the services that people choose to make use of is no bad thing and, indeed, creating more flexible services that are better tailored to the needs of individuals is the goal of the proposed legislation. Scottish Labour shares the Government’s belief that the problem, in that respect, is not too much variation in individual care packages but, rather, too much variation in the choice and control that individuals exercise over their own care or support. In the case of those who require support to meaningfully exercise choice and control, the chances of self-direction are often slim.
The Government has set out in the bill a description of what a budget for self-directed support could be used for. By enshrining in law a right to self-directed support, Parliament is providing users of social care with a menu of four options. Those were set out by the minister, Richard Lyle, Duncan McNeil and others, and I will not repeat them. The committee heard and, indeed, proactively found, a number of examples of how such an approach—or components of it—is working in different parts of Scotland. However, Parliament should be clear that increasing direct payments—we should not forget that that has been a feature of our social care system for longer than the Parliament has been in existence—should not necessarily be the only or most important goal of self-directed support. Increasing direct payments should not be seen as the only measure of success, or the sole indicator of systemic change. Changes in the process of selecting and, ultimately, procuring social care, will not, in and of itself, lead to an improvement in the standards of social care provided or a better experience for those who are assessed as requiring support.
At a time of significant change in the welfare system and budgetary pressures in local authorities, as members across the chamber have said, there is a considerable risk that some will see SDS as an opportunity not to drive up quality, but to cut costs. Malcolm Chisholm pointed out that the bill comes in advance of changes that are needed to ensure adequate integration of health and social care, and that presents a significant risk to the legislation achieving the Government’s intended effects.
Scottish Labour believes that the most urgent change needed in social care is an improvement in quality with an emphasis on respect for—yes—choice and control but also for human dignity and fairness across Scotland. To deliver that, Labour believes in a more radical shift towards a national care service, based on local delivery and control, but with minimum standards of care to end the postcode lottery, as Jackie Baillie set out. We look forward to the minister’s continuing discussions with COSLA to ensure that postcode charging becomes a thing of the past.
Members have highlighted a number of other areas of concern. Siobhan McMahon talked about the greater focus that is required on how direct payments will be ended, when the need for them has passed. There also remain questions about whether the regulation of those employed through direct payments is all that it should be. Support for carers is spend to save, and there will continue to be questions about whether we are getting the right balance between support to carers and the desire to put the cared-for at the heart of the new regime. Equally, the appropriate role for family members—often—in a system that puts greater emphasis on individuals making their own choices and controlling their own budgets is an issue that I suspect Parliament will return to whether the bill passes in its current form or not, and I hope that the Government front bench will continue to have regard to the comments of both Gil Paterson and Fiona McLeod.
The interests of those who work in the care sector should also be considered, as should the regulation of workers such as PAs. As a member of the committee, I feel that it would have been useful to hear more directly, through oral evidence, from people who work in the care sector—I know that we received written evidence from such people.
The final and most substantial concern that I want to reflect on relates to the call for an enshrined right to advocacy. As well as having a right to make choices and exercise control, service users also have a right—which they may need—to the appropriate level of support to make their choices and control meaningful, as I said earlier.
- Fiona McLeod:
I draw Mr Smith’s attention to section 1(3), which says that a person
“must be provided with any assistance that is reasonably required to enable the person”
to express their views and
“make an informed choice”.
Is that not advocacy?
- Drew Smith:
I think that Mary Fee made the point when she talked about the relationship of trust that exists between those who rely on care and those who provide care. In that context, the key word in respect of advocacy becomes “independent”.
Individuals’ ability to make choices will be heavily influenced by the resource—or the lack of it—that is allocated to them as a result of a needs assessment. It is imperative that that is done properly, with the aid of advocacy, if required, and a system of review. The Government’s working group on appeals and review is welcome but, as Duncan McNeil argued, it is vital that the Government is mindful of the evidence that the committee heard that a complaints procedure is not a substitute for an appeals process. Assessments should be carried out properly in a way that can be monitored and challenged through a review process that recognises that circumstances can not only change but be misunderstood.
As the committee made clear in its stage 1 report, and as the debate has highlighted, the changes that are contained in the bill present significant challenges for service users and service providers, and it is the view of the Scottish Labour Party, in common with the Scottish Independent Advocacy Alliance and many other organisations, that support should include making independent advocacy available by right and ensuring that proper funding is available to local authorities to successfully promote and deliver self-directed support.
In supporting the bill at stage 1, I do not quite echo Richard Lyle’s call of “Carry on, minister”. Scottish Labour urges the Scottish Government to ensure that the best possible system of support is created to deliver effectively the changes that ministers seek to make.
- The Presiding Officer:
I call Michael Matheson to wind up the debate. I would be obliged, minister, if you would continue until 4.58.
- Michael Matheson:
Thank you, Presiding Officer.
This has been a very good debate, involving a range of contributions from members across the chamber. In his remarks, Jackson Carlaw referred to the way in which the personal experience of a number of members helped to shape their views on the personalisation of care and self-directed support agenda.
When Duncan McNeil set out the case of Omar Haq, who gave evidence to the Health and Sport Committee, he spoke about direct payments giving him flexibility and raising his ambitions. I know from meeting people across the country who have benefited from self-directed support that those are consistent traits. The flexibility that self-directed support provides addresses the difficulty that Jackie Baillie highlighted to do with choice for people who receive a tuck-in service. Should the tuck-in service come in at 6 o’clock, 7 o’clock or 8 o’clock? We know that Jackson Carlaw goes to bed early, but I am assured that he also rises early. That illustrates some of the small issues that have a real impact on the quality of someone’s life—but which can often be forgotten—that self-directed support can assist us in addressing. As Pam Duncan said to the committee, we need to ensure that we focus on empowerment and how it can enable someone to lead an independent life.
Nanette Milne referred to the low uptake of direct payments and the variation across local authorities. Direct payments have been in place for several decades. On average, about 3 or 4 per cent of people will make use of a direct payment. In recent years, there has been an increase in uptake, but it has not been sustained to the level that one would expect. Why is that the case? I know that some local authorities actively dissuade people from looking into direct payments by saying that they do not provide them, although the neighbouring local authority happens to do so. People can also be anxious about the implications of and responsibility involved in employing directly a member of staff to meet their care needs.
That is why the four options—to which Malcolm Chisholm referred—that are set out in the bill are drafted in such a way as to maximise the opportunity for individuals to have much greater control over their personal care. It will be their choice whether they want to make a direct payment, direct the way that the resource is used by the local authority, have the local authority provide everything, or have a mix of those three options. I say to Helen Eadie—and I may disappoint her—that the bill clearly sets out that the local authority must offer those four options. It will not be a case of just offering option 1 or option 2. Helen Eadie obviously thinks that option 1 is a Conservative type of privatisation agenda, but I disagree. A person’s ability to choose when someone comes in to meet their care needs is about their personal needs and independent living, rather than about any political ideology.
- Helen Eadie:
Will the minister take an intervention?
- Michael Matheson:
I will let Helen Eadie in shortly.
What is important is allowing people to have choice on these issues and putting in safeguards that empower people and allow them to fall back on the safety net of the local authority when they do not have the confidence to take forward their care arrangements on their own.
- Helen Eadie:
The minister misunderstands what I meant. My concern is fundamentally this: the Conservative Government is introducing legislation that Vince Cable has talked about, which will erode all the workers’ rights that we have across the United Kingdom. If we go down the route that the minister proposes by not following option 2, we could find that we are leading the charge on that. Many individuals just do not have the human resource capabilities that we would expect them to have.
- Michael Matheson:
The bill is about empowering people to be able to make a decision that best suits their needs. It is not about laying down that people must choose option 2, option 3, option 4 or option 1—it is about giving people choice. Individuals in the independent living movement have been calling for that for years. My understanding was that it had broad support in all political parties in Scotland and the UK.
I do not want to intervene in the Twitter conversation that Malcolm Chisholm was having with Roseanna Cunningham over the weekend. I have never understood why someone would have conversations over Twitter rather than phone someone for a discussion. However, the conversation illustrates the point that the debate about national and local will go on and we should continue to have it. Christina McKelvie illustrated in her speech why we need to have statutory underpinning of people’s rights and choices around how their care is managed. Her case illustrated the types of hurdles that can often dissuade people from moving forward and arranging care in their own way.
I want to try—in the limited time available—to touch upon a number of points that members raised. Several members raised the issue of charging by local authorities. Jackie Baillie asked me to tell the chamber when the working group will report. The review is a COSLA review. The last time I looked, COSLA had a Labour leadership, so perhaps Jackie Baillie can help by telling us when the working group intends to get to the point of finalising its report. I assure her that we are contributing to that process to assist the working group in taking forward that piece of work. The sooner it is completed, the sooner we can consider how we move forward on the issue.
- Jackie Baillie:
Will the minister take an intervention?
- Michael Matheson:
I will let Jackie Baillie back in later.
I say to Helen Eadie that I cannot comment on the charges that housing associations apply. I noted her point about the change of administration on Fife Council. I can tell her that in the Falkirk Council area some homecare services were completely free until Labour and the Conservative Party took over the administration and introduced a wave of charges that the previous SNP administration had never applied.
- Jackie Baillie:
Will the minister remind members that the working group was set up by COSLA at the behest of the Scottish Government and that the Scottish Government is represented on it? Three years later, there is still no progress on ensuring that care charging is consistent across Scotland, which is surely an ambition that we share.
- Michael Matheson:
It is a COSLA review group, and we are helping it by providing information—
- Jackie Baillie:
You are on it.
- Michael Matheson:
Maybe Jackie Baillie will use her political influence, if she has any, to tell the Labour leadership to get on with it and give us a report, so that we can move forward.
Members asked whether advocacy services will be provided. I think that there is a misunderstanding and that some members think that there is no provision for advocacy in the bill. Section 8 will confer on local authorities a duty to direct people to a source of impartial advice and support, to assist them as they consider the issues. I am more than happy to consider whether we can enhance the provision. It is about independent advice, rather than local authority advice, and I refer members to what the bill says in that regard.
Dennis Robertson talked well about the need to be much more focused on the outcomes that we intend to achieve through the bill. The bill has the potential fundamentally to change how social care services are delivered in this country, in a way that reflects the needs of individuals and gives people greater choice and an opportunity to lead an independent life.
I am delighted that the bill appears to have cross-party support at stage 1. I have no doubt that the people who have been calling for such legislation for many years will welcome the way in which the Parliament is uniting behind the bill. If we are successful in taking the bill through Parliament and it receives royal assent, I am determined to do everything in my power to ensure that it starts to transform lives in Scotland in a way that has never happened before in social care provision in Scotland.