Care Inquiry (Participation Event)
Item 5 on the agenda is a brief discussion about the care inquiry participation event that took place last Thursday in Perth under the auspices of the Health Committee. I welcome Margo MacDonald, who wanted to join us for this part of our discussion.
I invite members to comment briefly on what they consider to be the key issues and themes arising from last Thursday's meeting. We will agree the remit of the inquiry at the committee meeting on 27 September, so we are a considerable time away from a final decision on the matter, but we need to have a brief discussion today to help to inform the preparation of a draft remit for consideration at that meeting.
I was at the free personal care session in which two issues predominated. First, although there was complete agreement that the legislation is good, there are problems with implementation with regard to funding, which is key. Some of the evidence that was given in the general session was also quite moving. The other issue was whether free personal care should be extended to all people who would benefit from it, not just the elderly.
In the workshop that I was in and in the main sessions, implementation seemed to be more of an issue than the legislation itself. One of the main concerns that came out of all the workshops was the effect on fees of the care commission being self-financing. We should consider that.
I agree with Mike Rumbles that we need to consider extending the scope of personal care to cover other adults who have special needs. Care must be geared up to meet the needs of the individual, and the people who receive care must be far more involved in the strategic planning and focus of the care that they receive.
I was at the regulation workshop. The key point that came out of it was about the duplication of regulation, which causes some providers to feel that they are being reviewed and regulated by a number of bodies at different times in different ways for different purposes. Cost was also an obvious issue.
The fees issue also came up. In the light of our discussion, it is interesting to see in the papers for agenda item 6, on the budget process, a proposal for savings to be made from the care commission.
There was also a sense that local authorities were doing their own thing or implementing the legislation in different ways. We felt that that issue should be examined.
I was in the joint working group. The key point that came out of it was the need for honesty and to manage people's expectations about what is available. It is important not to kid folk on that they can get everything that they need in the way of care and to be realistic about what can be provided.
There was also some talk about breaking down professional barriers, which has been a bit of a problem in getting joint working going. It was said that there is a need for funding to come together—ideally in one particular body, whether through community planning, community health partnerships or whatever. The point about honesty came up again and again.
We were all very moved when we heard from Pam Duncan about the ridiculous trap that she was in, which opens up the issue of extending free care to under-65s. As it happens, shortly after the event a constituency case raised with me the negative impact on respite day care of the registration fees that the care commission requires for each activity. Some care homes are in effect withdrawing certain aspects of what they do, which might well have a negative impact on the number of respite day care places.
When we talk about the care commission, the costs and all the rest of it, it is important to explore the potential impact on delivery of the service. The matter is not just a bureaucratic, administrative issue for the care commission; it is about what happens on the ground. The care commission must be self-financing. If we take money out of its budget, it will try to get the money from somewhere else. What does that mean for the provision of care? People may decide that they are not able to afford it. All those issues are connected.
Margo MacDonald wants to comment on the matter.
On the last point that you raised, I am horrified to think that the care commission might be self-financing, but that is just a personal comment.
I ask the committee whether it will examine the position of care homes. I am sure that members are aware that there has been a huge amount of publicity recently about negative aspects of care in some homes. I have been approached by various groups and trade unions in Edinburgh, which has a particular problem because of house prices, land prices and so on. When the gap between what voluntary sector and private sector homes consider it costs to provide the service that they provide to the required standard and the per capita payment that they receive became bigger than it was before—to the best of my knowledge, a gap has existed for at least 20 years—many businesses and voluntary organisations found that because of land prices and house prices their books balanced much better if they got out of the business of providing care and went into some other business. Therefore, there is a tremendous shortage of care homes in and around Edinburgh, which in turn feeds back into hospital bed provision—I do not need to bore the committee.
For that reason, as the committee is going to conduct an inquiry, I am anxious that the committee should examine the position of care homes. I would also be grateful for an objective overview of any real or perceived differences in the quality and standard of care that is provided between the private sector and the public sector and of whether the standard of staff training—and, ultimately, the quality of personal service that is offered—is better in the public sector. There is usually a greater awareness in a local authority bureaucracy of the necessity for staff training.
Thank you. We heard quite strong views about announced versus unannounced inspections, which is not quite the issue that you are talking about but which relates to standards.
There was a pretty big difference between the priorities of the service users and those of the service providers, who had very different views about what is important. It will be for the Health Committee to juggle those priorities when it comes to setting the remit of the inquiry.
The funding of cares homes is a huge issue. Joe Campbell of Scottish Care was not well on the day of the meeting but we would have heard a lot more about that if he had been there. We should consider it because it is a massive issue.
We must try to depoliticise the issue. The committee is a political body, but the members are the people who can depoliticise the remit.
Top-up fees and direct payments were mentioned, although not in my group. Finance does come into the picture.
I was in the carers group and everyone agreed that the legislation was a good idea; it is implementation that is difficult. Finance is behind many of the problems.
It is true that many homes are going out of business or are struggling to stay in business because they are not getting enough money to provide services. Often they do not provide the services that are shown in the glossy brochures. Some people live in homes that have no money at all; everything has been taken away and their families have to fork out extra cash.
An important point about carers is that a huge number of them look after people in their own homes. As has been said, respite is most important and if funding for that is cut, the burden is greater and people become patients in the NHS. Carers do not want much; Pam Duncan who was in our group said the same. I am not really asking for much. I know from my previous occupation that getting respite care was always difficult, but it is becoming very difficult.
There are two types of respite: the kind that gives the carer a holiday and the kind that is needed every day. Convener, you seemed to be saying that you know of people who need daily respite but are not getting it.
I am exploring the issue separately but it does impact on the inquiry and contact might have been made because of the publicity for the inquiry.
Qualifications and training were also raised. Again, there were two sides to the issue. Service users and the groups that represent them welcomed the fact that there is a benchmark for training and qualifications, but care home owners felt that the benchmark is just an unnecessary financial burden. I was not very happy about the attitude of one care home owner, who said that a person does not need qualifications to learn how to change an incontinence pad. In fact, they would need to be trained in how to change incontinence pads—I am someone who changed incontinence pads in a previous life—and it is worth exploring the level of training and qualifications. The matter is not in the legislation but it is in regulations and we should consider it.
I guess that training could be a financial burden on care home owners, but it is important for people's safety and dignity that carers have appropriate training. However, the qualifications that are being asked for should be necessary and appropriate and it would be worth considering what appropriate and necessary training is.
Training is also important for staff, especially if they are to avoid injury to themselves. That issue has been raised in the past.
I am sorry to come in again, but I forgot to mention that, in our workshop, one of the relatives pointed out that what happens post-complaint must be monitored. Perhaps this evidence is anecdotal, but I have certainly been told on enough occasions that when a complaint is lodged there can sometimes be perceived repercussions. In fact, the perception that there might be repercussions stops relatives making a complaint in the first place. I have certainly come across cases in which constituents did not want to use official channels because they were worried about repercussions for their affected relatives. Whether those repercussions are perceived or actual, we need to take the matter seriously and consider it in our inquiry.
I do not know who organised last week's business, but it would not be exaggerating to say that everyone to whom I spoke was ecstatic that the committee had chosen to consult on the remit of the inquiry. It was certainly an example of best practice. Whoever in the team of clerks had the idea, it was first class, because it really struck a chord with the public. Indeed, perhaps other committees could learn from our experience, because it proved to be very popular with care people and professionals.
An evaluation form has been e-mailed to all members. I have certainly filled mine out and sent it back and I encourage everyone else to do the same, because it might well play back into the rest of the committee system. As I said to one or two folk, politicians—perhaps surprisingly—do not always have all the answers right at the start. It is sometimes useful for us to say so and to ask people to help us to find some of the right answers.
I do not want this item to go on any longer. Members have the capacity to communicate directly with the clerk. We will draft a paper that will lay out some of the ideas for the remit. We will kick that around for a while, because we do not have to reach a final decision until the end of September.