Joint Future Group Report
Our next agenda item is on the joint future group report, although I do not know whether we can comment on it.
As colleagues know, the Executive set up the joint future group to consider certain issues. As the committee's reporter, I outlined those issues in section 1.2 of my draft response. The group went through the process contemporaneously with the work that we did on our report into community care. Its remit was slightly different from ours, as it touched slightly on housing as it relates to the voluntary sector, for example. Some of our recommendations were in those areas, and they do not necessarily overlap.
I have been fairly generous to the group—it was Christmas and the season of good will. There is a fairly large common agenda. A lot of work that was being done was taken on board by the Executive in the minister's statement on 5 October, which was then echoed in the committee's report on community care. I think that the outstanding issue is the manner in which the joint future group thinks joint working will take place locally.
There is some general overlap between what we said and what the joint future group said: national standards must be tightened up; there must be benchmarking; and good practice must be shared, in a structured and strategic way rather than loosely or on an ad hoc basis. However, we said that at local level there should be a single body delivering care, a single point of entry for services, a single budget and a single body responsible for commissioning.
The committee did not name that body. We did not say that it should be the trust or the local health care co-operative—this person or that person. We discounted some bodies but left the matter open to allow local flexibility. We know from our discussions and in other ways that it is unlikely that one size will fit all. For example, there are differences between rural and urban circumstances. In some areas there is a high degree of private sector involvement, but in others there is not; some areas have strong voluntary sectors, but others do not. There are many differences, so we left that question open, although we took the view that there should be a single body.
To some extent, the joint future group mirrors what we said. It proposes that there should be a national programme planning group to set targets for the implementation of priorities and that the people in local partnership agreements should pool new resources in community care. I was concerned by the constant reliance on new resources, so my report highlights the fact that the committee said that it is also important to take stock. We have to ask where we are at the moment, what we are spending on community care services, whether we are doing so wisely and what is happening in relation to revenue and the crucial capital that is tied up in long-stay facilities.
The resources that exist across the board for community care, as well as new resources, must be pooled. The joint future group is saying that the new resources for community care services, including social work, the relevant NHS acute services, and social housing, should be pooled, and then a decision should be taken on the targeting of those resources and the required outcomes. The committee took the view that there should be a single commissioning body, with a single commissioning budget and a single point of entry. Those positions are not necessarily incompatible.
People may have a view on whether the joint future group's approach is right, but there is still much work that can be done on the effectiveness of pooling budgets. When committee members went round the country, we all saw effective programmes and projects. Local people—or perhaps a health board or council—had identified a need for a service and a representative from the social work sector, or the health sector, had become involved. Over time it became almost impossible to say where the care manager had come from—was he or she a social worker, a community nurse, or what?
When services are joined together, about 18 months of tension will probably follow. The services then develop. When Mary Scanlon and I were in Inverness looking into mental health facilities, we were told that, five or 10 years down the line, no one worried about where they had come from—they just provided the service.
There are different approaches, and the committee's recommendations allowed for a level of local autonomy. However, that should be put against the backdrop of national targets. My report on the joint future group is a draft report, and I have simply said that we have noted the joining together of services. If committee members feel that they want to endorse, or criticise, a particular approach, they can do so.
Where, in the report, I have said that the committee had a view on any issue, that has come from our committee report or from deliberations in committee meetings. I hope that our new members will bear with us when our approach, based on our committee report, diverges from that of the joint future group. We take a divergent approach on charges for home care services. My view, and the view that we put in the committee report, is that we endorse the full implementation of the Sutherland recommendations on free personal care.
I have welcomed the joint future group's suggestion that older people should receive up to four weeks' free home care—when we consider things as they are now, that suggestion has to be welcomed—but the committee takes a different view on free personal care. I certainly take exception to the group's proposal that free personal care would
"do nothing to develop better community care services".
If anything was clear to the committee, at the end of 10 months of taking evidence on community care, it was that—apart from evidence of the fairness and equity of free personal care—there was overwhelming evidence that free personal care could deliver better community care services. It was not only about the heart, but about the head, and it was what the professionals told us. I have taken exception to that point in the joint future group's report. I hope that members agree that that reflects the committee's report into community care.
This draft report is not of the quality that we have come to expect from Richard Simpson's reports. It was put together at the end of the Christmas holidays. I have to confess to muttering to myself quite a lot that, although I had gone off on holiday with the best of intentions of tackling the report early on, I had, as usual, left it late, which led to a severe reprimand from my children, whom I constantly reprimand for leaving their homework until the last minute. I hope that it is a fair reflection of the group's report. The Sutherland commission's report is at the top of the agenda, and we expect a statement in response to our report later this month. That will obviously include an Executive statement on Sutherland.
I was quite disappointed in the joint future group's report. To be perfectly blunt, it has added very little to the debate. It has done little more than state the obvious. Many of its recommendations had already been accepted and implemented by the Executive—I have talked about the statement of 5 October.
It would be a retrograde step even to consider some of the measures that the group has proposed, as they are counter to Sutherland's recommendations on the single body and point of entry. I do not want the committee to return to the discussion about jointly resourced and jointly managed bodies. We have been at this issue for 10 months and, as I said, any discussion on the group's points would be a retrograde step.
The highlight of the report—that free personal care would do nothing—illustrates that the thought of the joint future group is well out of kilter with thought in the rest of Scotland. Given the time the committee has put into discussing community care, and after the Sutherland report and all that has been done—I commend the Executive on much of its work over the past year—I question the need for a joint future group.
To be fair, after conversations with ministers over the past year, I think the Executive's decisions on 5 October were based to some extent on background work by the joint future group. That work has certainly fed into the Executive's decision-making process. The package was announced on 5 October—which was before the group's report was finalised—but the Executive was not going to announce something that was totally at variance with the work of that Executive-inspired group.
We should not say that the joint future group did not have an impact; I think it probably did. That is a feeling that I have picked up from conversations with ministers—the minister herself alluded to that in comments on 5 October. Although some of the gloss might have been taken off the report, we should not forget the fact that the group contributed to the decision-making process.
Although I am prepared to believe that, I think that Mary Scanlon's comments are well made. At this stage in the debate, the joint future group report adds nothing whatsoever to the Sutherland report or the committee's report. As the group's recommendations have been discussed endlessly, we should not spend too much time going over them. Instead, we should refer the Executive back to the Sutherland report and the report of the committee and respectfully suggest that it gets on with implementing the recommendations in them.
Convener, you made a valid point. This is simply a compression of the previous system in which we would receive a report and have a period for consideration after which the report would be implemented. The Executive is now implementing things as it goes along, which is not a major difficulty as it is often acting on best practice anyway.
Certain important issues link these various reports. Taking into account the points made by Mary Scanlon and Nicola Sturgeon, I think that we should highlight those issues, as you do in your report. Paragraphs 4.1 and 4.10 of your report refer to the closures programme. As far as I know, we have not yet had any details about bed closures, apart from the learning disability bed closures, as your report indicates. No one can make any reasonable comment about the costs of implementing Sutherland and its effect on the community care budget until we know the balance between free NHS care and whatever system will be put in place when Sutherland is brought in. We should highlight that issue and press the Executive on it.
We have received a letter from the Executive.
You have?
Yes. It is in the papers for the meeting and is headed
"Plans for closure of long-stay hospital beds".
Right. I have not seen that. That is excellent.
The letter says:
"Figures show a substantial reduction in the number of long-stay beds in geriatric and psycho-geriatric specialties"
which
"reflect changing patterns of care".
The figures in the letter are for previous years. This is what I mean. The letter does not contain new figures—well, they are relatively new; they have been brought up to date.
Your point is that the letter does not contain any projections.
The question is what will be the Executive's final position on NHS beds.
Right. Have I covered that point in paragraph 4.1 of my report?
Yes, and you refer to it again somewhat in paragraph 4.10.
I have forgotten my other point. Perhaps I will come back to it later.
If there are no other comments, I will bring the public session to a close.
Meeting continued in private until 12:33.