Public Bodies (Joint Working) (Integration Scheme) (Scotland) Regulations 2014 [Draft]
Public Bodies (Joint Working) (Prescribed Health Board Functions) (Scotland) Regulations 2014 [Draft]
Public Bodies (Joint Working) (Prescribed Local Authority Functions etc) (Scotland) Regulations 2014 [Draft]
Public Bodies (Joint Working) (National Health and Wellbeing Outcomes) (Scotland) Regulations 2014 [Draft]
Public Bodies (Joint Working) (Scotland) Act 2014 (Modifications) Order 2014 [Draft]
Yes, please, convener. Thank you very much for the opportunity to do so and to introduce the affirmative instruments supporting the Public Bodies (Joint Working) (Scotland) Act 2014 to the committee for discussion.
I will say a few words about the important role that this legislation has to play in helping to ensure that Scotland as a country provides the best support to its people wherever they may live and however complex their support needs.
Health and social care systems around the world are adapting to meet the needs of populations that are living longer. Scotland is no different from the rest of the developed world in that regard; nevertheless, our partners across Europe and beyond recognise that Scotland is taking bold and ambitious steps to integrate care.
Our legislative framework for integration, which the instruments are an important part of, requires our health and social care systems to work together more closely than ever before. It places individuals, patients, service users, carers and families at the centre of planning and service provision, with outcomes set out in law and resources pooled to reflect and maximise support for the individual’s whole pathway of care.
The programme of reform builds on a long history of partnership working across health and social care. Its development has benefited greatly from the involvement of a wide range of stakeholders and partners across all sectors. I extend my sincere thanks to all the people involved. I look forward to continuing the work with them once the legislation is in place.
I will set out briefly the effect of the five instruments under consideration. The regulations on the integration scheme set out matters that must be included in the integration scheme that will be prepared by each local authority and health board in addition to matters prescribed in the act for inclusion in the scheme. That information provides the framework within which the integration authority—either an integration joint board or a lead agency—will operate.
The regulations on outcomes for national health and wellbeing set out the outcomes that every integration authority must work towards, providing a strategic framework for the planning and delivery of health and social care services. Together those outcomes articulate the core values of the integrated health and social care system that we are establishing in every part of Scotland.
The regulations on prescribed health board functions set out which health functions and services may, must and must not be integrated. I suggest that the most important aspect of the regulations is the list of health services that must be integrated as set out in schedule 3. Health services are included on the must list to ensure that integrating arrangements include at least adult, primary and community healthcare and aspects of adult hospital care that offer the best opportunities for service redesign and better outcomes. That is the approach that we have set out from the beginning of the process through consultation and the passage of the bill through Parliament.
The regulations on prescribed local authority functions set out which social care functions of local authorities must be integrated along with the health functions to which I referred.
Finally, the modifications order that has been included for the committee’s consideration will make technical amendments to the act for two purposes. The amendments that are made by the order will ensure that the application of section 1(4)(d) of the act is aligned with the policy intention where the lead agency model of integration is used. It will also amend a cross-reference to the National Health Service (Scotland) Act 1978 to ensure that the powers of the Common Services Agency are appropriately broad.
I welcome the opportunity to discuss the instruments further.
Thank you.
Do members of the committee have any questions for the cabinet secretary?
As you know, with the Convention of Scottish Local Authorities, we are reviewing the whole issue of funding. Let us take the example of funding for dementia sufferers. I know that care for dementia patients is not continuing care, but it is a similar situation. When free personal care was introduced, it was confined to people of pension age because they no longer qualified for working-age benefits. The assumption was made that anyone who required the kind of care that is required for dementia sufferers—dementia is a topical issue at the moment—would be of pension age or would receive working-age benefits. Around 3,000 of the 87,000 people in Scotland who have been diagnosed with dementia have not reached pension age. A big issue is what kind of care they should get. Some patients will be entitled to free personal care anyway—some people misinterpret the legislation as saying that it is necessary to be over 65 to get free personal care, but there are exceptions.
The problem is that, because of the changes that have been made to working-age benefits, there are people who have not reached pension age who are not qualifying for free personal care and who are not getting the level of working-age benefits that it had been assumed that they would get when free personal care was introduced. That is part of this mix. In relation to continuing care as well as conditions such as dementia, we are actively looking to identify how many people fall between the stools, in what circumstances they do so and what we need to do to close any gaps. That is due to be reported on by the end of the calendar year.
Yes. It has all been made very clear on the whole; the only area that I am still slightly concerned about is continuing care, because of the report that came out last April and the proposal that all continuing care should be provided only within a hospital setting. That seems to go against the general thrust of what the Government is trying to achieve, which is that people should be as close to their home as possible and that care homes—certainly a few of them, but not all of them—should be capable of looking after people with quite complex and high needs. That report indicated that the already very small numbers in Scotland who are involved and who will receive free care will be looked after in hospital.
In England, 58,000 people receive free national health service care in hospital or in a care home—many of them are in care homes. In Scotland, the figure is only around 1,700. I understand that 1,100 or so of them are in hospital and that 600 are in care homes. Proportionately, around 4,500 should receive free continuing NHS care, but we are not seeing that.
Frankly, I am not really interested in comparisons with England—it is what we do here that is critical—but I am concerned that, as far as I can see from my reading of the instruments, which are technical and complex, that issue has not been resolved, partly because the Government has not, as far as I know, decided quite how to act on that report yet. It has accepted the report, but action on it has not been agreed.
That seems to me to be an area of almost immediate dispute. If 500 patients or the potential new cohort of 500 patients are going to be transferred, that will be something of a problem.
I look forward to that.
Absolutely. That is happening in three different ways. It is not just the partnership board that is important; the make-up of the localities is also fundamental to the working and success of the legislation. Also, even at this stage, in drawing up the shadow boards’ strategic plans, we have made it absolutely clear that, as well as looking at the substance of the strategic plans, we will be looking at the process by which they have been drawn up. I want to be sure that all the key stakeholders—including GPs, who have a vital role to play, as many others have, in ensuring the success of integration—have had an opportunity to be involved and to contribute to the development of the strategic plan, and that they can continue to do so.
I made a statement to Parliament following that report in which I accepted its recommendations and principle, and outlined how the Government is moving forward. I intend to bring a progress report to the committee at some stage early in 2015.
The important, key difference that the report recommended was that, from April next year, continuing care should be defined as hospital based. We are not saying that there is a whole load of people with continuing care under the new definition and they will all be hospital based; rather, we are saying that, to be defined as continuing care patients for the future, they have to require long stays in hospital. Under the new system, every case will be reviewed at least every three months, of course.
In respect of integration, the care of those people will still come within the ambit of the relevant parts of the legislation, although obviously the day-to-day administration of their care will be for the clinicians who care for them. Therefore, there should be no dispute whatsoever. Those people are part and parcel of what the legislation does.
I welcomed the Public Bodies (Joint Working) (Scotland) Act 2014, because I had experience of situations in which people were not getting out of hospital because the social work department had not adapted their home. I am sure that the 2014 act and the subordinate legislation under it will help many people, and I know that you are totally committed to that.
I have a question about proportional representation on the boards. You want to be inclusive, as far as that is possible. However, there is a situation whereby some political parties are taking all the local authority representation on the board. I will not name the party that is doing that in my area, but I believe that that is wrong. From 2007 to 2012, we had joint working and all parties got a fair share through proportional representation, but I do not think that that is happening now.
Do you intend to introduce other subordinate legislation to fix that? I make a plea to everyone to share out the representation to ensure that all parties are represented on the boards.
As no members have further questions, we move to item 2, the formal debate on the affirmative SSIs on which we have just taken evidence. I remind committee members that they should not now put questions to the cabinet secretary, and I remind officials that they must not speak in the formal debate. I invite the cabinet secretary to move motion S4M-11455.
Motion moved,
That the Health and Sport Committee recommends that the Public Bodies (Joint Working) (Prescribed Local Authority Functions etc.) (Scotland) Regulations 2014 [draft] be approved.—[Alex Neil.]
Do any members wish to contribute to the debate?
Members indicated disagreement.
The joint operation.
I believe that there is a strong case for local authority representation on boards to be based on the proportionality of representation in the councils, but we have not made that statutory, because if we were to do so, that would introduce a new principle for the governance of external local authority representation, on which there is a wider debate to be had. Rather than prejudge that debate, we are not making proportionality a mandatory part of the representation of councils on boards, and we have no plans to do so.
That said, my personal view is that, for the stability of an integrated scheme, it would be beneficial to have proportional—and, certainly, cross-party—local authority representation on the board, because I think that we all agree that the measures that we are talking about are about everyone working together, parking politics at the door and doing what is best for service users and patients. I think that we will get more stability in the system if we widen the involvement of stakeholders and include minority parties in councils in the representation on boards. However, that is entirely a matter for each council to take a decision on. It is not mandatory. There is a wider debate to be had on whether in future the principle of proportional representation should be extended to all bodies on which local authorities have external representation, but I think that that debate is outwith the scope of the legislation that the committee is considering.
Absolutely. I do not know whether anyone wants to add anything to that.
I recently attended an event that was hosted by the British Medical Association, and that was one of the points that it made. Are you encouraging boards to ensure that general practitioners and so on are represented on the boards?
10:15
Cabinet secretary, I assume that you do not feel the need to sum up.
That is absolutely correct. The specialties within which those people may be treated will be either part of the integrated arrangement or not, depending on the details that are set out in the regulations. The focus is on what type and locus of care is best for the patient, and that is a medical decision.
No, thank you.
Motion agreed to.
Right. It is clear that funding that care will fall on the individual families if people are moved out of hospital.
Item 3 is our second formal debate on the affirmative SSIs on which we have just taken evidence. I invite the minister to move motion S4M-11456.
Motion moved,
That the Health and Sport Committee recommends that the Public Bodies (Joint Working) (Prescribed Health Board Functions) (Scotland) Regulations 2014 [draft] be approved.—[Alex Neil.]
I offer members an opportunity to contribute to the debate.
Good morning, and welcome to the 29th meeting in 2014 of the Health and Sport Committee. I ask everyone in the room, as I usually do at this point, to turn off mobile phones, as they can interfere with the meeting and the sound system. Those paying attention will notice that some of the committee members and officials have tablet devices, which they are using instead of hard-copy papers.
Agenda item 1 is subordinate legislation. We have five affirmative instruments before us. As usual with affirmative instruments, we will have an evidence-taking session. The Cabinet Secretary for Health and Wellbeing and his officials will provide evidence on the instruments. Once all our questions have been answered, we will have the formal debate on the motions.
I welcome Alex Neil, the Cabinet Secretary for Health and Wellbeing, and his Scottish Government officials, who are Alison Taylor, team leader; John Paterson, divisional solicitor; Frances Conlan, bill team leader; and Clare McKinlay, solicitor.
Cabinet secretary, do you want to make a brief statement?
The important thing is the clarity with which the regulations divide contractual arrangements from operational arrangements. That is extremely welcome, because it is one of the things on which the previous attempts to drive integration on a voluntary basis failed. I welcome the fact that the regulations make it clear that the board retains the responsibility for contractual arrangements on a whole list of issues but that the function will go to the new joint board, which will have the power to do the planning and to effect the operation of the systems.
There are no other members who wish to contribute to the debate. Cabinet secretary, do you wish to respond?
I agree with Dr Simpson. That is an important element in making integration a success.
Motion agreed to.
Item 4 is our third formal debate on the affirmative SSIs. I invite the minister to move motion S4M-11457.
Motion moved,
That the Health and Sport Committee recommends that the Public Bodies (Joint Working) (National Health and Wellbeing Outcomes) (Scotland) Regulations 2014 [draft] be approved.—[Alex Neil.]
Motion agreed to.
Item 5 is our fourth formal debate on the affirmative SSIs. I invite the minister to move motion S4M-11458.
Motion moved,
That the Health and Sport Committee recommends that the Public Bodies (Joint Working) (Integration Scheme) (Scotland) Regulations 2014 [draft] be approved.—[Alex Neil.]
Motion agreed to.
Item 6 is our fifth and final formal debate on the affirmative SSIs. I invite the minister to move motion S4M-11459.
Motion moved,
That the Health and Sport Committee recommends that the Public Bodies (Joint Working) (Scotland) Act 2014 (Modifications) Order 2014 [draft] be approved.—[Alex Neil.]
Motion agreed to.
That concludes our consideration of subordinate legislation. I thank the cabinet secretary for giving his time this morning, formally and informally, and for the officials’ attendance. It is all very much appreciated.
10:20 Meeting suspended.Previous
Attendance