We now move to the Carers (Scotland) Bill.
Section 28—Duty to prepare local carer strategy
Amendment 25, in the name of the minister, is grouped with amendments 26, 27, 30, 33 to 35, 37, 39 to 44 and 47 to 57.
This group of amendments concerns responsibility for the preparation of the local carer strategy. Health boards have a vital role in identifying and supporting carers. I agree with the Health and Sport Committee’s recommendation that the Carers (Scotland) Bill should complement the new integrated health and social care arrangements. To that end, we will make provision so that all functions under the bill that relate to the delivery of services to adult carers will require to be delegated under integration schemes under the Public Bodies (Joint Working) (Scotland) Act 2014. For young carers, all functions are capable of being delegated to the local authority and the health board.
To further recognise the key role of health boards in identifying and supporting carers, I have lodged amendment 25, which amends section 28(1) of the bill so that the duty on local authorities to prepare a local carer strategy for each local authority area will be placed jointly on the local authority and the relevant health board.
There are a number of amendments that follow on from that key amendment. Amendment 47 amends section 28(5) to set out the definition of “relevant health board” in relation to a local authority. Amendments 48 and 49 make the existing duty on local authorities to have regard to the factors set out at paragraphs (a) to (e) of section 29 in preparing the local carer strategy a joint duty on local authorities and health boards. Amendments 50 to 57 are also consequential to amendment 25. They modify section 30, on publication and review of the local carer strategy, so that the duties on local authorities set out in that section are placed jointly on the local authority and the relevant health board.
I ask members to support the amendments in the group.
I move amendment 25.
Thank you. No members have indicated that they wish to speak. Do you have anything to add, minister?
Indeed not.
Amendment 25 agreed to.
Amendments 26 to 38 moved—[Jamie Hepburn]—and agreed to.
Amendment 82, in the name of Rhoda Grant, is grouped with amendments 104 to 106.
This group of amendments concerns the local carer strategy. Amendment 82 ensures that the strategy looks at preventative support in order to decrease the number of carers who break down in their role. A good preventative strategy will also cut down the number of people who will require an assessment. It is really important to value the work that carers do and to support them to continue that work. The carer strategy must deal with that issue.
Amendments 104 to 106 deal with equality issues by ensuring that the strategy takes into account protected characteristics and considers how people in those groups can be supported in their caring role. The situation in which they find themselves and their ability to access services can be affected by language, culture and relationships. It is important that the strategy recognises those differences and makes sure that services are person centred and delivered in a way that is accessible to all who need them.
I move amendment 82.
I thank Rhoda Grant for lodging the amendments. I see the preventative approach as important: as the policy memorandum sets out, it is one of the key principles underpinning the bill, which contains provisions that aim to promote such an approach. For example—as I mentioned to the committee last week—we are removing the regular and substantial test for someone to be recognised as a carer, so that all carers will have access to an adult carer support plan or a young carer statement.
Enabling people to request an adult carer support plan or a young carer statement as soon as they become a carer, or offering one to adult carers and young carers as soon as they are identified, should mean that a plan can be put in place at an early stage. That should reduce the need to deal with crisis situations. Less critical support needs will also be considered as part of the adult carer support plan process or the young carer statement process. Nonetheless, prevention is important and I can see that there could be merit in local carer strategies setting out plans for supporting carers on a preventative basis, which is the main thrust of Ms Grant’s amendment 82.
However, I think that we need to consider the amendment further. As it stands, there are questions about whether it would be possible for a local authority to “reduce” a carer’s support needs once they have arisen, other than by providing them with support. There might also be a compliance issue with regard to the way in which the bill is drafted. I therefore ask Rhoda Grant to withdraw amendment 82 so that we can work together on a stage 3 amendment that achieves the aim of having local carer strategies that set out preventative plans without there being any unintended consequences.
I also consider it important that the provisions set out in the bill meet the needs of carers with one or more protected characteristics, but I believe that amendments 104 to 106 are not required to achieve that aim. Local authorities and health boards already have a general public sector equality duty under the Equality Act 2010, and it would be unnecessary and wasteful of local authorities’ compliance resources to duplicate an existing legal duty. To the extent that amendment 104 might ask for more than the current duty in section 149 of the 2010 act, it could give rise to legislative competence concerns. If compliance needs to be addressed, the 2010 act already contains powers to do that.
As the statutory duty already exists, I ask Ms Grant not to move amendments 104 to 106 and to meet me to have further discussions about amendment 82.
I am happy to meet the minister to discuss amendment 82 and will therefore seek to withdraw it.
However, I am concerned that the minister sees no need for amendments 104 to 106. When the committee took evidence, it was made quite clear to us that if such provisions were not in the bill the issues might be overlooked when the strategies were drawn up. Having listened to the minister’s comments, I do not believe that he is willing to have further discussions on the matter, so I might well move those amendments when the time comes.
Amendment 82, by agreement, withdrawn.
Amendment 104 moved—[Rhoda Grant].
The question is, that amendment 104 be agreed to. Are we agreed?
Members: No.
There will be a division.
For
Chisholm, Malcolm (Edinburgh Northern and Leith) (Lab)
Grant, Rhoda (Highlands and Islands) (Lab)
McNeil, Duncan (Greenock and Inverclyde) (Lab)
Milne, Nanette (North East Scotland) (Con)
Against
Keir, Colin (Edinburgh Western) (SNP)
Lyle, Richard (Central Scotland) (SNP)
MacKenzie, Mike (Highlands and Islands) (SNP)
Robertson, Dennis (Aberdeenshire West) (SNP)
Russell, Michael (Argyll and Bute) (SNP)
The result of the division is: For 4, Against 5, Abstentions 0.
Amendment 104 disagreed to.
Amendment 83 not moved.
Amendments 39 to 42 moved—[Jamie Hepburn]—and agreed to.
Amendment 84, in the name of Rhoda Grant, is grouped with amendment 85.
Amendment 84 seeks to ensure that colleges and universities are consulted in the development of carer strategies. Schools are already included in the bill as part of the local authority, but young carers are also concerned about the support that they receive from colleges and universities, and amendments 84 and 85 will ensure that those institutions look at how they support carers and allow them to access further and higher education.
I move amendment 84.
10:00
I am not entirely clear that amendments 84 and 85 are necessary. If they are seeking to ensure that the needs of young carers approaching the transition to adult carers are taken into account when the local carer strategy is prepared, I advise Rhoda Grant that the bill already contains provisions to that effect. The provision in section 28(4)(a) provides that local authorities and health boards must involve whichever carer representative bodies they consider appropriate in the preparation of their local carer strategy, while section 28(4)(b) provides that they must take such steps as they consider appropriate to involve carers. The list is not exclusive. If a local authority and a health board believe that it is necessary to consult any educational body in the area, they can choose to do so. I am therefore not convinced that it is necessary to legislate for that.
On that basis, I ask the member to withdraw amendment 84 and not to move amendment 85.
I do not think that colleges and universities are seen as bodies that represent carers. There is a real issue about young people accessing education. I think that the bill will deal with the issues in schools, but there are also issues to deal with in colleges and universities. Indeed, young carers are often penalised for not attending as often as they should, and quite often they do not get the support that they should get from colleges and universities.
I believe that the bill requires to be amended in this way, so I press amendment 84.
The question is, that amendment 84 be agreed to. Are we agreed?
Members: No.
There will be a division.
For
Chisholm, Malcolm (Edinburgh Northern and Leith) (Lab)
Grant, Rhoda (Highlands and Islands) (Lab)
McNeil, Duncan (Greenock and Inverclyde) (Lab)
Milne, Nanette (North East Scotland) (Con)
Against
Keir, Colin (Edinburgh Western) (SNP)
Lyle, Richard (Central Scotland) (SNP)
MacKenzie, Mike (Highlands and Islands) (SNP)
Robertson, Dennis (Aberdeenshire West) (SNP)
Russell, Michael (Argyll and Bute) (SNP)
The result of the division is: For 4, Against 5, Abstentions 0.
Amendment 84 disagreed to.
Amendments 43 to 46 moved—[Jamie Hepburn]—and agreed to.
Amendment 105 not moved.
Amendment 47 moved—[Jamie Hepburn]—and agreed to.
Amendments 85 and 106 not moved.
Section 28, as amended, agreed to.
Section 29—Preparation of local carer strategy
Amendments 48 and 49 moved—[Jamie Hepburn]—and agreed to.
Section 29, as amended, agreed to.
Section 30—Publication and review of local carer strategy
Amendments 50 to 57 moved—[Jamie Hepburn]—and agreed to.
Section 30, as amended, agreed to.
Section 31—Information and advice service for carers
Amendment 58, in the name of the minister, is in a group on its own.
Third sector organisations and carers have raised a concern that the bill as currently drafted may be interpreted as imposing a requirement on local authorities to establish a new information and advice service where such a service, or part of it, is already provided by organisations other than the local authority. Members will recall that the committee picked up on that issue during its consideration of the bill at stage 1.
Amendment 58 will add wording to section 31(1) to clarify the policy intention. Although local authorities will have a duty to establish and maintain an information and advice service, it is not envisaged that that duty will require local authorities themselves to provide every aspect of the information and advice that is required to be made available under section 31(2); rather, it is expected that local authorities will understand, co-ordinate and make effective use of other statutory or voluntary sector resources that can and do provide information and advice to carers within their respective areas.
I want the existing information and advice services that are provided so expertly by organisations such as carers centres, young carers projects and health boards to remain in place. I would expect each local authority, in establishing and maintaining an information and advice service or in ensuring the establishment and maintenance of such a service, to make the best possible use of what already exists.
Amendment 58 will make clear that where sources of information and advice for carers are already available within the local authority area, there is no requirement for the authority to create an additional information and advice service. That will also be made clear in the guidance that will be issued to local authorities about information and advice services.
I move amendment 58.
Amendment 58 agreed to.
Amendment 59 moved—[Jamie Hepburn]—and agreed to.
Amendment 86, in the name of Rhoda Grant, is grouped with amendment 88.
Amendment 88 proposes a carers charter. I am aware that work to draw up a charter is on-going and that carers groups are keen that the charter be enshrined in legislation. Amendment 88 does not prescribe what should be in the charter, but it ensures that carers will be involved in drawing it up. It is important that when the charter is in place carers are aware of it and the rights that it will enshrine. Consequently, amendment 86 places a duty on advice and information services to make carers aware of the charter and its content.
I move amendment 86.
As Ms Grant alluded to, a carers’ rights charter is not a new concept and such a charter is under development, although it has been somewhat delayed. The charter arose out of the carers strategy and was intended for adult carers only. Although a young carers’ rights charter was not required under the strategy, we commissioned separate work on such a strategy. That work is also on-going and we expect to receive the latest draft of a young carers’ rights charter from the Scottish young carers services alliance later this month.
The charter that is currently under development will include expectations—what carers can expect—which will be derived from guidance, and it will consolidate existing rights. The charter that is envisaged in amendment 88 is a bit narrower in scope than the charter that we are preparing.
There is not necessarily a burning requirement to have the charter set out in legalisation. I am happy to support Ms Grant’s amendments 86 and 88, but in doing so I say that her proposals will require some finessing at stage 3.
I will indicate to the committee some of the areas that may require further amendment. Amendment 88 refers to “any other enactment”, which would include United Kingdom legislation, but the Scottish Government may not be in the best position to provide up-to-date information on such legislation. It is important to be clear that the charter will collate and set out rights that have been conferred elsewhere and that it should not create new rights itself, because that would mean that there would not be proper parliamentary scrutiny if any future Government sought to bring forward new rights for carers in the charter; it would not be right to establish new rights in such a document on that basis.
Having set out the key areas that will require further attention at stage 3, I reiterate that I am happy to support Rhoda Grant’s amendments that seek to put a carers’ rights charter in statute.
I ask Rhoda Grant whether she would like to wind up and whether she will press or seek to withdraw amendment 86.
I will press amendment 86 and quit while I am ahead.
Amendment 86 agreed to.
Amendment 60 moved—[Jamie Hepburn]—and agreed to.
Amendment 87, in the name of Rhoda Grant, is in a group on its own.
Amendment 87 would place a duty on advice and information services to make carers aware of bereavement support. Too often, carers feel abandoned at a time of bereavement. They are often given little time to find their feet and adapt to their new circumstances. There can be quite intensive intervention in the final days of life; a carer will be used to having people in and out of the house at that time but might find that all that suddenly stops with bereavement, which means that they can become very isolated. Carers have quite often given up work and neglected friendships in order to carry out their caring role, so they need to be supported through the transition.
I move amendment 87.
I support Rhoda Grant’s amendment. I have heard from Marie Curie that a significant number of people feel totally bereft, quite apart from their proper bereavement, once the person whom they are caring for has died. It is very important to look after those people at what is a time of pretty great need for them.
I recognise that, as Nanette Milne has said, it can be difficult—even devastating—when a carer’s caring role comes to an end. I am aware that some local carers centres continue to support carers after their caring role ends, which a number of members spoke about during the stage 1 debate. There is provision for carers when their caring role ends. Following a death, bereavement care is provided to relatives and carers throughout Scotland in ways that are responsive to their needs and which reflect their spiritual, religious and cultural requirements. The information pack, “When someone has died—information for you”, which was developed to help people through the first few days of a bereavement, is widely used across the national health service in Scotland, and the bereavement zone on the NHS inform website offers a lot of practical advice on what to do after a death and on coping with grief. Both those resources offer specific advice for children and young people, which young carers may find particularly helpful. Information on how to access local services can be found on NHS board websites or obtained directly from NHS staff, and national services such as the breathing space service and support from Cruse Bereavement Care Scotland are available for those who need someone to talk to.
The caring role may also come to an end for a reason other than the death of the cared-for person. The cared-for person may, for instance, have been admitted to a care home, which may be difficult for the carer. The bill is focused on providing carers with access to support in order to sustain their caring role. The person-centred outcomes approach will ensure that carers are supported at the right time. As part of that it is critical to review outcomes to ensure the continued relevance of support services for carers. That is important when carers are caring for someone who is coming to the end of their life. The information and advice service provided by each local authority must provide information and advice about health and wellbeing, including counselling services for carers, which we envisage might include bereavement counselling. Despite the good range of services that exist, I recognise that carers might face particular issues and challenges, such as coming to terms with not having a caring role for their loved one or trying to get back into work after not being in employment.
However, Rhoda Grant’s amendment, is very wide in scope. It looks as if it covers the provision of information and advice on bereavement support for carers when people other than the cared-for person dies, which I do not think is necessarily the intention behind the amendment. I would like to work with Rhoda Grant so that she can lodge an alternative amendment at stage 3. On that basis, I ask her to withdraw amendment 87 so that we can discuss the matter and get it right for stage 3.
It is really important that carers get bereavement support, which perhaps should form part of the assessment of how they will be supported when their caring role ends. I take on board what the minister said about the breadth of the amendment. I do not want it to be that wide; I want it to provide for support when somebody’s caring role ends. With that in mind, I will have further discussions with the minister and will lodge an alternative amendment at stage 3.
Amendment 87, by agreement, withdrawn.
Amendment 61 moved—[Jamie Hepburn]—and agreed to.
Section 31, as amended, agreed to.
Section 32 agreed to.
After section 32
Amendment 88 moved—[Rhoda Grant]—and agreed to.
10:15
Amendment 107, in the name of Rhoda Grant, is in a group on its own.
Amendment 107 would ensure that the NHS identifies carers and would ensure that their health needs are attended to. Often, carers, especially young carers, have general practitioners and healthcare staff coming and going from their home but are never asked how they are coping and whether they are getting the support that they require. NHS staff are ideally placed to identify carers of every age and to refer them to support services. There are instances when that has happened and it has proved a godsend to the carers involved. However, often it does not happen and carers feel ignored and abandoned, without help or support.
I move amendment 107.
I understand and fully appreciate the need to promote carers’ health and wellbeing. All the provisions in the bill are designed to ensure that carers can continue to care, if they wish to do so, in good health. The identification of carers’ personal outcomes within the context of the adult carer support plan and the young carer statement is central to that.
The focus of the specific integration national health and wellbeing outcome relating to carers is on ensuring that carers are supported to look after their own health and wellbeing and reduce any negative impact of their caring role on their health and wellbeing.
I would like to take a little time to outline the new way forward for the GP contract, which is relevant to supporting carers. The Scottish Government has set a direction of travel around the future arrangements for the GP contract in Scotland, which is designed to reduce bureaucracy and to free up GP time for face-to-face contact with patients. We will be moving towards a more integrated GP contract that supports the GP’s role in the wider community.
As I have said, the whole purpose of the bill is to support carers’ health and wellbeing. The new way ahead for the GP contract will enable GPs to have more contact with carers, which will enable carers to ask for health checks when appropriate. Carers can also be encouraged, through the adult carer support plan and the young carer statement, to visit their GP to maintain their own health and wellbeing.
The national review of out-of-hours primary care services led by Sir Lewis Ritchie, which reported yesterday, recommends a multidisciplinary team-based approach to the delivery of urgent care services. That proposed new model of care will help to mitigate issues such as the recruitment and retention of GPs. It will also encourage health and social care staff to work together better. Having a person-centred and joined-up approach will help to improve the management of staff availability, especially during peak holiday times, the consistency of the service and the public’s expectations of it. All those crucial wider developments will support carers’ health and wellbeing.
Under future arrangements, GPs will have a focus on supporting the planning of services locally through clusters of GP practices coming together to plan and develop services for the community. The work to develop and support GP clusters will be a key strand of work for the health and social care partnerships and integration joint boards. Crucially, carers are to be represented on integration joint boards and, together with GPs, they will be able to influence the work to plan and develop GP services for the local community.
The new direction of travel for GPs will free up GP time to deal with patients with complex needs, including time to support their carers. I propose to write to NHS boards to encourage them to continue to identify carers and to support them in health settings. Those health settings include GP practices, but other health settings such as hospitals and community pharmacists are just as important in supporting carers’ health and wellbeing.
There are a number of provisions in the bill to support carer identification more generally. A key one is that each local authority and relevant health board must prepare a local carer strategy that sets out their plans for identifying carers in the area and obtaining information about the care that they provide or intend to provide. That will support carer identification by GPs.
In light of all that I have set out, I ask Rhoda Grant to withdraw amendment 107.
Although I welcome everything that the minister said, he set out only small changes. There is a culture out there that does not recognise carers. Some carers do not recognise themselves as carers and do not ask for help, because they are so taken up with their caring role that they feel that they need to continue it.
Health professionals are in a great place to identify carers, but they often do not do so. Some years ago, I wrote to GPs to ask how many young carers they had in their practices. I was surprised by the number of responses that came back saying that they had none. We know that about 25 per cent of young people are carers, and I do not think that that figure has changed hugely between then and now.
I will press amendment 107, because it is important that we make it a duty for everybody to identify and support young carers, especially those who are best placed to identify them.
The question is, that amendment 107 be agreed to. Are we agreed?
Members: No.
There will be a division.
For
Chisholm, Malcolm (Edinburgh Northern and Leith) (Lab)
Grant, Rhoda (Highlands and Islands) (Lab)
McNeil, Duncan (Greenock and Inverclyde) (Lab)
Milne, Nanette (North East Scotland) (Con)
Against
Keir, Colin (Edinburgh Western) (SNP)
Lyle, Richard (Central Scotland) (SNP)
MacKenzie, Mike (Highlands and Islands) (SNP)
Robertson, Dennis (Aberdeenshire West) (SNP)
Russell, Michael (Argyll and Bute) (SNP)
The result of the division is: For 4, Against 5, Abstentions 0.
Amendment 107 disagreed to.
Section 33 agreed to.
After section 33
Amendment 62, in the name of the minister, is in a group on its own.
Section 33 confers powers on the Scottish ministers to issue guidance to local authorities in respect of their functions under the bill. It also allows the Scottish ministers to issue directions to local authorities on the manner in which they are to exercise their functions. There is currently no equivalent provision in relation to the functions conferred by the bill on health boards and directing authorities of schools.
Amendment 62 will address that. It will allow the Scottish ministers to issue guidance and directions to health boards and directing authorities in respect of their functions under the bill, for example in respect of the preparation of young carer statements by health boards for young carers who are pre-school children. The provision will require health boards and directing authorities to have regard to any such guidance and directions when performing their functions under the bill.
I move amendment 62.
Amendment 62 agreed to.
Sections 34 and 35 agreed to.
Section 36—Interpretation
Amendments 63 and 64 moved—[Jamie Hepburn]—and agreed to.
Amendment 89 not moved.
Section 36, as amended, agreed to.
Section 37—Regulations
Amendment 65, in the name of the minister, is in a group on its own.
The power in section 1(3) and the regulations that will be made under it are intended to give effect to the policy that kinship care agreements under the Looked After Children (Scotland) Regulations 2009 are not to be regarded as contracts under the bill. The intention is also to put it beyond doubt that similar agreements that exist between foster carers and local authorities are to be regarded as contracts for purposes of the bill. Section 1(3)(b) is intended to make provision for those people who in policy terms are referred to as “mixed carers”. Mixed carers are carers who undertake both unpaid care and paid care for the same family member.
In its letter to the Scottish Government on 31 March 2015, the Delegated Powers and Law Reform Committee asked for further justification as to the choice of the negative procedure for the exercise of the power in section 1(3) and why the affirmative procedure was not considered to be more appropriate for the power. I have considered that committee’s concern that the power in section 1(3) could potentially expand or restrict the reach of the bill’s provisions on providing support to carers, depending on the manner in which it is exercised. It is certainly the case that unpaid caring is a complex area that could become more so in the future. For example, it is possible that as use of the Social Care (Self-directed Support) (Scotland) Act 2013, which is in the early stages of implementation, becomes more prevalent, further types of mixed carer may emerge.
In light of the Delegated Powers and Law Reform Committee’s concerns, I have lodged amendment 65 to make the power at section 1(3) subject to the affirmative procedure.
I move amendment 65.
Amendment 65 agreed to.
Amendments 66 and 67 moved—[Jamie Hepburn]—and agreed to.
Amendment 90 not moved.
Amendment 68 moved—[Jamie Hepburn]—and agreed to.
Amendment 91 not moved.
Section 37, as amended, agreed to.
Sections 38 and 39 agreed to.
Schedule—Consequential modifications
Amendment 69 moved—[Jamie Hepburn]—and agreed to.
Schedule, as amended, agreed to.
Sections 40 and 41 agreed to.
Long title agreed to.
That ends stage 2 consideration of the bill. Members should note that the bill will now be reprinted as amended. The Parliament has not yet determined when stage 3 will take place, but members can lodge stage 3 amendments with the legislation team at any time. Members will be informed of the deadline for amendments once it has been determined.
10:27 Meeting suspended.