Official Report 260KB pdf
Item 2 is further evidence on the Regulation of Care (Scotland) Bill. First up this morning is Malcolm Chisholm from the Executive. Are you on your own?
I have a gang of officials somewhere, but they have gone missing—never mind, they will turn up. You should ask your easy questions before they arrive.
You look isolated there.
No. Everything in the opening statement that I made to the committee four weeks ago stands. I have been reading the Official Report of your discussions and I think that they are a very good example of our new procedures in action. I might not think so in an hour's time, but that is what I think at the moment.
There has been disappointment that the bill does not give a statement of principles and a full explanation of those principles. That disappointment should perhaps be taken in the context of the consultation paper going a bit further than the bill does on the principles of care. Some people from whom we took evidence felt that the principles in the introduction to the bill did not go as far as they been led to believe that they would. Will those principles be elaborated on in due course?
I will deal with that point—but first I will introduce my team. Liz Lewis is head of the regulation of care team, Lynda Towers is from the solicitor's office and Nikki Brown is from the local government finance department.
I take your point, but the bill has been compared with another—the Standards in Scotland's Schools etc Bill, which is now an act. People who gave evidence during the passage of that bill felt that it contained a number of principles, and they now feel that this bill falls a bit short. It is not that people are simply saying that they want more to be in the bill; they are basing their views on a previous example.
Clearly, some of those points are covered in the policy memorandum.
Yes—we pointed that out to witnesses.
Obviously, members will be able to introduce amendments. The reason we are keeping a statement of principle out of the bill is not that we do not believe in it; we are simply making a judgment on whether it is more appropriate to have something in a bill or in a policy memorandum. We have made our judgment, but this is probably an issue that we do not need to fall out over.
I would like to raise an issue that will be familiar to Malcolm Chisholm's ears—personal care. Has further consideration been given to the definition of personal care in the bill in light of recent developments to do with the Sutherland report? Section 2(20) talks about
Section 2(20) has a reference to personal care. To decide which services are regulated, it is necessary to define personal care. The subsection defines personal care and personal support and those services would be regulated. In a way, the purpose of the definitions is to distinguish those things from nursing care, which, of course, is not being regulated in the same way through the bill.
Can we assume that that definition will lead you through the development group?
In general, the definition is fine, but we must be more specific. Sir Stewart Sutherland accepted that he was giving only a general definition. In particular, when one talks about free personal care, one also needs an assessment tool, as a general definition does not solve the problems of assessment. The care development group will develop the work begun by the chief nursing officer on developing an assessment tool that will capture personal care. That is the particular problem, but there is no great gap—I know that Nicola Sturgeon will ask me about this on Thursday—between that understanding of personal care and the general understanding of personal care.
Given that this is such a controversial issue, would you advise the committee to be more specific and to lodge amendments to section 2(20) in order to cover items such as mobility, toilet functions and so on? Is the definition too loose? The last thing we want is for people to be haggling over the definition in five, 10 or 15 years' time. In order to make the provision totally clear, should not we be taking steps to ensure that the bill does not have only "as for example" and that it is more specific?
It is up to members of the committee if they want to improve—in their view—the definition. However, it is quite clear that "for example" means for example, rather than an exclusive definition. I am pretty happy with the definition in section 2(20), but I would consider with great interest an amendment that members regarded as an improvement.
I know that Mary Scanlon covered this point, but for the record, would you guarantee that the definition of personal care that the development group comes up with for the purpose of deciding what care will be free and what care will not be free will not be narrower than the definition that is in the bill? As Mary said, that definition reflects the Sutherland definition.
The key issue that the development group will have to tackle is the assessment of personal care needs. Given that the requirement for me to find a definition of personal care within six months is written into the group's remit, I would be foolish to say with absolute precision today what that definition will be. In general, I am comfortable with the bill's definition of personal care, which is in line with Sir Stewart Sutherland's definition and with our understanding of what personal care means. As I said, it would be foolish to shut down six months of deliberations by saying the last word on the subject now.
Do you agree that it is difficult to measure concepts such as "vulnerability or need", which apply to young people and to people with disabilities? I do not know how one could measure or assess vulnerability. Do you agree that those terms, which are in section 2(20), are rather vague?
You have moved on to a slightly different issue.
I am not talking about what I have in mind. The Regulation of Care (Scotland) Bill is the first to go through the Health and Community Care Committee and we already have problems over the definition of personal care. I am unsure how one could measure vulnerability on a scale of one to 10. What criteria would one use in order to assess vulnerability? Perhaps the committee should consider that further, but I am seeking a lead from you.
I should be interested to hear your suggestions. The bill covers a lot of territory, but we would be pleased to consider further suggestions from members.
Do you agree that those terms are a bit vague?
That had not occurred to me, but now that you have drawn the matter to my attention, I am prepared to reconsider it.
Thank you.
On registration, there are fit person checks. However, what you are referring to—the index of unsuitable adults—goes further than that. Some people have said that it would be better if that was included in the bill, but it will be done by separate legislation, partly because of the phasing. As you said, the consultation paper went out only in the second half of last year, so there is more work to be done on that. This is a good example of the fact that we take our time with legislation in the Scottish Parliament. The consultation will firm the matter up; however, on registration by the council, there will be fit person checks as well.
What is the progress on the consultation, which was to be with the Scottish Executive by the end of October? We are about five months down the line, and I would like to see the proposals included in the bill—it is an important issue.
A policy position paper will be issued once all the responses have been assessed and discussed. You know the process: we have a consultation paper, a policy position paper, then legislation. Unless we skip some stages, it will not be possible to get that issue into the bill. The result of the consultation will come quite soon; however, it is better to do it properly than to hurry it, to get it into the legislation.
As a minister, would you prefer the issue to be integrated into the bill? Would that be wise?
It will not make all that much difference if it comes a few months later.
Some of the organisations that have given evidence have expressed concern about the definition of a support service in section 2(2) of the bill. Is it intended to include home care services or day care? If so, why can it not specify that that is the case, rather than leaving it somewhat vague?
I read what Community Care Providers Scotland said about that. You are right—it refers to home care and day care, and not to the additional elements such as befriending advice, supported employment and vocational training that Community Care Providers Scotland discussed. Do you feel that that is not clear enough in the bill?
That is what the people who gave evidence felt. We feel that it could be a bit more specific.
It is to do with keeping options open. Although that is substantially what is meant, if we tied it down to those two types of care, it could not be anything else. That is the problem.
Should the hospice movement be covered?
The hospice movement would be included under "independent health care service".
So it would be covered by that paragraph?
Yes.
Since you were here last, further concerns have been raised by witnesses about the rather contrived method that you propose for funding the Scottish commission for the regulation of care. You tell us that you will increase funding to local authorities so that they can meet the increased charges levied by the providers because the providers have had to meet increased registration fees. Those fees will be used to fund the commission. Why not fund the commission directly? It is all the same public money.
There are two issues. As I said when I gave evidence to the committee before, we thought that there was an issue of principle. The view was taken that it was better that the costs of regulation should be explicit and transparent. It gives the providers a stake in the system.
At the moment, fees cover only 17 per cent of the costs of registration. You plan to move to a system that is funded 100 per cent by fees, which will not relate directly to the provision of services.
I know. However, there is more bureaucracy in the present system, which collects only 17 per cent of the costs, than in the new system, in which two finance officers at the commission might deal with everything. I take your point, but the important point for public expenditure is that the costs will be paid for, in one way or another. I sent you a letter clarifying the grant-aided expenditure arrangements. The cost of fees will be included in GAE in the next spending round. In addition, in this spending round, in the resource transfer that we are negotiating with the Convention of Scottish Local Authorities, we will take account not just of the fees that local authorities have to pay for their homes but of any increase in costs that will fall on local authorities because private providers raise their charges.
So you understand the argument, but you are not going to listen to it and do not propose to reconsider.
I have followed the argument with great interest, and I admit that it is a fine judgment. To some extent, one can say that the door is not entirely closed. We have said that we will subsidise the cost of regulating child care services, so the full cost will not be borne by providers. No doubt, similar arguments could be put forward for other services. In my role on the care development group, I will certainly consider the costs of residential and nursing home care, as they are clearly a fundamental issue.
The increases might not be enormous, but they are quite significant. You mentioned COSLA and said that you would cover the increased costs for local authorities. The financial memorandum says that the transfer of £6 million
We are very reasonable people and are still negotiating with COSLA. Nobody is saying that £6.1 million is the final figure.
You have argued that the private sector, in particular, should be seen to be paying. However, fees in the private sector will be passed on to the clients, the fees of 80 per cent of whom in nursing homes are paid for by the public sector. That money will then come out of local authorities' community care budget so, generally, it will not be the private sector that pays. Is that a good use of the community care pound?
It is explicit in the financial memorandum and in my letter to the committee that that will be taken into account in setting GAE for local authorities. If 80 per cent of nursing home places are paid for from public funds—in future, that figure may be less than 80 per cent, as more people own their own homes and so on—20 per cent of people are paying their own nursing and residential home care fees.
The concern is that there would be a loss of resources, because money would be recycled around administrators. That would not be the best use of the community care pound and would be a waste of resources that could be spent directly on service provision.
That is definitely the most persuasive part of the argument, but I am not sure how much it amounts to. The system that will be introduced will be less bureaucratic than the present one, which operates at the level of individual local authorities.
While you are being persuaded, I will ask about childminders.
I will stop Shona Robison there, as three other members want to ask about fees.
You mentioned GAE for local authorities. You will be aware that some local authorities have caused bed blocking problems because they do not allocate the full GAE equivalent. Could the proposals exacerbate the situation in local authorities, if the community care pound is continually recycled until it is worthless when it is finally divvied up?
That, too, is an interesting and important argument, which we have to address. The care development group needs to consider it, and it will be probably be raised in the debate this afternoon. The Executive said that services for the elderly were a priority; what do we do when local authorities spend substantially below GAE on services for the elderly? We could have an interesting discussion about that. However, I do not think that the logic of that argument is that everything should be funded centrally. Some people might argue that, but that is quite a drastic step.
Surely if we are in the game of providing equity of service throughout Scotland, irrespective of income or location, it is incumbent on us to ensure that we get best value for the community pound. Some local authorities say, "That may be the GAE that is allocated to this authority, but we will determine the levels of GAE that we spend in the other departments." That makes a mockery of what you are trying to do.
We ought to face that dilemma. The new arrangements that we are reaching with local authorities for new money in the first instance for the elderly mean that authorities will receive the money only on the basis of agreed outputs. That is a significant step. I have no doubt that people will say that we must go further than that in due course. I accept Margaret Jamieson's point, which leads into a major discussion about the relationship between central and local government.
Will you consider that aspect further?
Yes. I might even talk about it this afternoon.
I will make three points quickly. You said that you found the bureaucracy argument most persuasive but that you did not know what the cost would be. I suggest that an assessment of the costs of the bureaucracy of the system should be done, to give us some information on which to base our judgments.
I always listen. I will continue to consider the issues. As I said to Shona Robison, I think that, theoretically, the bureaucracy argument is strong. However, it is difficult to quantify. As I have said—I am throwing this back to the committee, and no one has responded yet—we will need a bureaucracy if we are to charge independent health care and people whom I imagine most committee members do not think should receive the regulation free. We cannot get rid of finance people dealing with those matters. I understand the argument that is being made, but payment concerns not just public expenditure.
May we have some comparative figures for the cost of the bureaucracy for each possible model? If we had hard information by which we could judge whether you are right or wrong, we would not have to talk in generalities.
We can consider that. It would be helpful to ask COSLA to give us some information about how much it thinks it will cost local authorities to deal with the system.
I apologise for being late—I had some train problems. I declare that I have an interest in a nursing home company that operates in England and Wales and that I am a member of the British Agencies for Adoption and Fostering. My wife works in child training and I apologise for anything else that I do not know about.
I think that the figure you quoted was used by Scottish Care last week. I do not recognise the figures it used.
The figure is based on percentages that you have given.
No one is talking about £600. Paragraph 214 of the financial memorandum refers to an increase of less than 1 per cent. If we were considering increasing fees to £600, I would ask for a subsidy, but no one is talking about such a range. As I have said, nothing shuts down the option of a subsidy in the future if the fee becomes an unrealistic burden. In fact, there will be a substantial subsidy over the first two years of the commission's operation.
You have heard the committee's views, so I will move us on. We will not go round in circles any more. Nicola Sturgeon has some questions on inspections.
We move from one concern to another. In the context of a system in which fees are about to increase, there has been widespread concern about the fact that the bill guarantees only one inspection a year, which is a reduction from the current situation. Almost every witness has given evidence that there should be a minimum of one announced and one unannounced inspection a year and that anything less would severely reduce the level of inspection and be unsatisfactory. Given the weight of that evidence, does the Executive intend to reconsider the relevant sections?
We should remember that we are talking about a statutory position. It is currently not statutory that care homes should have two inspections a year. The Accounts Commission recently drew to our attention the fact that a large number of councils do not conduct two inspections a year. We are proposing a statutory minimum. If you are proposing that the statutory minimum should be more than one, I must throw a question back to you—do you propose that that should apply to all the care services that will be regulated? As you know, only care homes are supposed—as it were—to receive two inspections at the moment, although that is not statutory. All the child care services that the bill covers require only one inspection currently. Are you suggesting that all services should be subject to a statutory minimum of two inspections? If you are, you are taking a great deal of flexibility out of the system.
What I am suggesting is that there is a persuasive argument that care homes should have a statutory minimum of one unannounced inspection and one announced inspection. That statutory minimum is necessary to ensure public confidence in the quality of care provided in care homes, given the vulnerability of the people who are in them. I think that the arguments that have been put to us for that are persuasive. I know that you are a minister who listens carefully to what people say. Are you prepared to look again at that argument, so that the intention behind the bill, which is to build public confidence and ensure quality, can be realised in practice?
Before you answer that, minister, I would like to pick up on what Nicola Sturgeon is saying. It is important to consider the residential nature of much of the care provision that is covered by the bill; that is not true of a childminder who may look after a child for two hours after school. We were talking about the residential elements of care. I picked up a little bit of practical knowledge about that last week, when Peter Cassidy and I visited a care home in Fife. The point that has been raised most often by the people we met then and by witnesses to the committee is that inspection is not just about finding out what might be wrong.
An inspection methodology group is currently looking at all those matters. It may well come forward with some further suggestions. However, I must repeat that there is not a statutory minimum of two inspections at the moment, so there is nothing in the bill that needs to change what happens at the moment. I will obviously pay great attention to any amendment along the lines that you have proposed and I understand where you are coming from, but a statutory minimum of two inspections would have an opportunity cost. I am sorry to use that phrase again, but it is one of the most important concepts in politics.
The last time you appeared before us, you said that by the time we get to stage 2 you might have a better idea of the number of inspectors who would conduct an inspection. Is that any clearer yet?
That is something that the inspection methodology group is considering at the moment. I hope that we will have a report on that by stage 2.
Has any further consideration been given to whether there will be five local offices or some other number? That is something that witnesses have expressed concern about for various reasons.
I have heard quite a lot of representations on that subject. When I started out, I could certainly understand the point of view that there should be more than five offices, but I have two comments to make. First, we are talking about those five, or possibly six, offices being complemented by local bases, which a lot of people could operate from when appropriate. That would be particularly appropriate in rural areas.
So you are basically saying that you are sticking with five centres?
That is the proposal. I asked people when I met the unions—
What about health board boundaries?
That is an interesting suggestion, which I have been attracted to myself. The problem with health board boundaries, as we know, is that they cut across local authority boundaries. If we had the same boundaries for inspection as we have for health boards, we would have 15 centres. I have given thought to that suggestion and, if that is what you are proposing, I shall certainly give it further consideration.
It is certainly a suggestion that we have heard. One of today's submissions highlights the fact that, when you add in the regulation and inspection people for each local authority and health board, there are about 44 or 46 bases. You said that we want to change a local service into a national service so that we can get continuity in standards. I do not think that any member of the committee disagrees with that and most of the people we have been hearing from are generally in favour of the principles of the bill, but we do not want to change a local service into a national service if that would mean losing some of the benefits of having local inspectors who are able to build up on-going rapport and a mutually helpful relationship at a local level. We must consider how we can go about involving local people—possibly through extensions of advisory committees—in ensuring that local links are retained in the new system and that the views of service users are listened to.
The whole point of the bill is to have more user focus, so the views of users and other stakeholders are obviously fundamental. It is entirely possible to have committees. They do not have to be area based, but they could be.
The ball is in your court on that one, minister.
You should be aware that, if there were five centres, the amount of travel for an individual—
People are not going to be travelling—
But there will be occasions when they will be required to visit one of those five centres. If, for example, the centre for the west of Scotland were based in Glasgow, it would be inappropriate to ask somebody from Stranraer to travel that road, given all the difficulties that that would entail. Logistically, it is unacceptable to move to five centres. We must try to maintain a local base, because the intelligence that those inspectors can pick up is invaluable. You risk losing that by pulling those services into a larger centre.
I entirely agree. Nobody is proposing that people should have to travel from Stranraer to Glasgow. I would certainly not support the proposal if that was what it would entail.
I take it that you are going to have something mid way?
I do not think that that is what the proposal is suggesting.
She is trying to sway you, minister.
Minister, I note the letter that you wrote to the convener on 9 February, in which you indicate that the Transfer of Undertakings (Protection of Employment) Regulations do not apply because
People had concerns about the limitations of TUPE. The intention is to improve on TUPE.
I have particular concerns about an employer saying that TUPE does not apply because a business is not being transferred, because I have been there and own the tee shirt. It is clear that individual employees and a service are being transferred. Staff organisations are concerned on behalf of local government employees and health service staff, who will transfer with different terms and conditions and salary levels. It is important that we ensure continuity in the work force. COSLA, the Scottish Trades Union Congress and Unison made the suggestion that there should be a body in place that replicates to some extent the staff commission that took part in local government reorganisation. Before I go any further, I should declare an interest as a member of Unison.
Perhaps I, too, should declare an interest as a member of Unison. I take your point about TUPE, but the purpose of the comment in the letter is not to suggest that we should have something less than TUPE, but that we should have something better. I met the unions this week and we discussed all those matters. The intention is that when people transfer, in the first instance they should do so with their current terms and conditions. The unions want to come to agreement about the terms and conditions of the whole work force, because at the moment we have 32 sets of terms and conditions—even more if we count all the health boards.
Okay.
The last time we questioned you, minister, we asked you to consider the parallel of the centralisation of general medical services to the Common Services Agency, which took place three years ago. Previously, the individual health boards administered those services. At a human resources level, there was a lot of anxiety among those staff who transferred. We asked you to talk to the people involved to find out whether lessons could be learned in respect of the transfer of staff to the commission. I accept that there is not an exact parallel because an element of the work force will still be dispersed, but there are two points: the anxiety that was caused to staff in the transfer process and the loss of effectiveness, local contact and understanding that has resulted from the centralisation process. Clearly, that should be avoided.
That is true. I am sorry, but I have no recollection of undertaking to do that. However, if I gave such an undertaking I shall certainly do that. If you could provide a note of when I promised to do that it would be helpful. I re-read the minutes last night and I do not remember that. However, I do not have a problem with it in principle.
I will check that.
We certainly had a discussion on the matter, although I cannot say categorically that you gave us that undertaking.
I remember that it was a very cold day in the Hub.
I have never been in the Hub, so it must have been somebody else.
Perhaps it was your officials.
If it was in the Hub it might have been an informal briefing.
I apologise, minister: it may have been your officials who gave such an undertaking.
Before anyone gets the wrong idea, it was not an informal briefing over a few jars in the Hub, but an informal meeting with officials.
That issue has been addressed by the Audit Committee in the budget overview.
We would be happy to accept any further points on that in writing.
Staff seminars on such matters are taking place in Inverness this very day.
Is there any prospect of establishing a commissioner for children? Several people have raised that issue with us.
That issue has come up in relation to the bill because part of it is about children and because the Care Standards Act 2000 set up the children's commissioner for Wales. I am sure that members understand the point, but for the benefit of people outside the Parliament I should say that although the Health and Community Care Committee is the lead committee and I am the lead minister on the bill, decisions about some elements of the bill are not made by the health department. A commissioner for children would fall under the work of the education department. Clearly, the establishment of such a role would not be for me to decide. Consideration has been given to those matters, but as it does not come under my remit, I cannot say any more than that.
Do you believe that the establishment of a children's commissioner could be accommodated within the bill or would further legislation be required should the Executive be persuaded that a commissioner would be appropriate?
It would be dangerous for me to stray into someone else's portfolio. I would merely observe that the children's commissioner for Wales was set up under the Westminster legislation with a relatively narrow remit, because the work of the commissioner was governed by the overall parameters of the bill, which referred to certain groups of children. I believe that the Education, Culture and Sport Committee is looking into the matter. However, I should end there before I get myself into deep water.
So you cannot tell us whether we will have such a commissioner.
Is it intended that a specialist division within the commission will regulate the independent health sector? Are there staffing implications in that?
It is the intention that there should be a specialist division and that would have staffing implications. However, we are not talking about many staff because the independent health care sector in Scotland is relatively small.
Thank you, minister. We allowed the minister a little more time because several people have raised some of the issues that we have discussed and we will want to include those in our stage 1 report.
Whatever would make best use of the committee's time. I could certainly make some opening remarks.
I think that we will move straight to questions, if that is acceptable.
Okay.
Do your organisations agree with the bill's provisions in general?
Yes. We welcome the bill and its provisions for national care standards, a regulatory body and an inspection service.
What are your views on the consultation arrangements?
We welcome the fact that there has been wide and useful consultation, as the legislation will be very wide-ranging and involve many interested parties.
It is quite difficult for the committee to question you, as the bill's implications for adoption and fostering will be considered at stage 2. Given the fact that we have an opportunity to change things, I draw your attention to a television report last night claiming that there was much red tape in the system. Your submission also raises concerns about
Mary, perhaps you could leave the question there. You can come back in after the witnesses have answered.
I will address our concerns about assessment, and Lexy Plumtree, our legal consultant, will say something more about your other detailed points.
It would be very helpful if you could send us a submission outlining such concerns. At the moment we have nothing to compare with the bill's provisions. Your present submission mentions past failures concerning the quality of assessment and services without being totally specific about them. Although I understand that you have been part of the consultation process, perhaps you could tell us at stage 2 whether the bill is addressing those concerns.
Perhaps Lexy Plumtree could answer that question.
Excuse me. I have a terrible cold.
I am glad that you are at the other end of the room.
I think that I am past the infectious stage. I just have this husky, interesting voice with some squeaky notes.
My supplementary links two elements that Mary Scanlon mentioned. You have talked about the consultation on the national care standards, and you have raised concerns about compliance with those standards and the sanctions that might apply to any local authority that fails to comply. Those aspects seem to be linked. How can appropriate standards be rigorously applied across the board?
When I was drafting our submission, I included something about sanctions. As Mary Scanlon said, the bill does not yet include adoption and fostering, so it was a bit difficult for me to deal with everything. The idea of the bill is to allow registration, inspection and deregistration. If a service provided is unsatisfactory, the provider is to be deregistered. However, deregistration is not feasible for local authorities, which have statutory duties to provide not only child care services but community care and a range of other services. We cannot just say that such-and-such a local authority did not do its adoption work properly and must therefore be deregistered. That is not feasible, practically or legally.
The reports that have been provided by the SSI south of the border, where people are being measured against explicit standards, have resulted in things such as this document—"Framework for the Assessment of Children in Need and their Families". That is extremely helpful in assisting local authorities that may be failing. I like to think that that kind of document, rather than sanctions, would be a way of improving matters.
Section 55(1) of the bill gives a definition of "child". You say in your submission that:
You will appreciate that, because the bill contains nothing about adoption and fostering services, I do not know what Government amendments will be introduced at the next stage. Those amendments may deal with this point.
So this is an issue that you want to highlight, but it will depend on what the Government does.
Yes. If a Government amendment defines a child, for the services that we are interested in, to be a person under the age of 18, that should be satisfactory, subject to the actual terms of the amendment.
Would you expand on your proposal on curators and safeguarders on page 5 of your submission? You say that there may
Again, this is obviously not a key area in the bill with regard to direct regulation and inspection. However, a provision in the bill amends the Children (Scotland) Act 1995 in relation to the regulations for safeguarders and curators. We have no dispute with that provision, but we hope that the Executive will undertake—when it has the new section in the Children (Scotland) Act 1995 and it brings in up-to-date regulations for safeguarders and curators—to consider not only safeguarders, who deal with the children's hearings system, but statutory curators in adoption.
We are in a bit of a vacuum because we are not sure what will be in the bill. We could go into all sorts of expansions on adoption and fostering and then find that we had to come back to you in the future.
What is in the bill is probably all we need. However, we want to say to the Executive that, although it has consulted on safeguarders, it must also consider curators.
In your written submission, you express concern about the costs to your members that are likely to arise from the proposal that the commission be self-financing through fees. What could be the implications for child care services?
We have been in here for about half an hour and I was interested to hear your questions to the minister about what I presumed were the cost implications for day care and health care services. You will appreciate that I am not terribly familiar with those services.
You probably heard the minister claim at one point that the sums involved to pay for registration are small compared with free care for the elderly, for example. In your submission, you say that if fieldwork, adoption and fostering services are to be registered for the first time, the fees charged would come out of local authority child care budgets. Is that your view?
It is not so much our view as my fear. It is another expense for the local authority. Where will the money come from? Will it decrease further the money that is spent on child care services?
So your fear is that the complex system that the minister proposes to fund registration and inspection through increased GAE and that kind of thing may not be sufficient, and that the resources may come out of core budgets?
I do not know enough about the financial arrangements. I am not a very good financial person, but it is a fear.
It is a fear.
You also say that there should be a mixed form of funding to support the Scottish commission for the regulation of care. You say that
We do not have a formal BAAF view. We do not want to be controversial about this.
Oh, go on.
I do not want to get the sack. We have fears about the financial implications of the cost of registration and inspection for our members, which are voluntary agencies. All the voluntary adoption agencies in Scotland are small, with one exception. We also have fears about fees for local authorities—will their child care budgets be reduced? It would not be unreasonable to require a reasonable management fee from run-for-profit organisations, but no organisation should have to pay through the nose for what should be a central Government body with high standards, and which should be funded publicly.
I have a point for clarification, because we do not want to misrepresent your views. The proposal is that the Executive will increase GAE to local authorities, which will then pass the money on to the Scottish commission for the regulation of care, but that seems to be a cumbersome way of doing it. Do you agree that if that is what is envisaged, a better way of funding would be direct financing, thereby cutting out the middleman?
I think so. It seems to be more sensible that instead of giving local authorities extra money to pay back, it should be paid directly to the Scottish commission for the regulation of care. There will have to be some central funding for the commission. It cannot be funded solely from registration and inspection fees. It is not a subject on which I have much knowledge, and being a lawyer I never like to commit myself.
As a fellow lawyer, I never like to commit myself either.
Generally, we welcome that. In relation to the council, the notion of having a body to register and regulate social work practitioners, which has wide powers to require, for example, continuing professional development, and can deal with situations in which people might be struck off in the worst-case scenario, is attractive. It is welcome that there will be a body that has that oversight role with regard to social work training and keeping up the standards of practitioners. I do not know whether we have given any thought to whether there should be two separate bodies, but the notion as presented is attractive, and is on a par with what happens elsewhere.
Ian Millar is right that we do not have a strong view on this. I know that the question of whether we have too many quangos is a big issue. I question whether having one quango instead of two is appropriate, because the proposed quangos have such different functions. Also, the commission will be involved in inspecting and registering a huge range of services—health care, community care and matters that do not directly involve social work professionals—so it is probably fair to social work professionals that their registration and possible removal is dealt with by a separate body.
I wish to turn to another subject. In your written submission you welcome the fact that there is to be an extension of inspections into the fields that you represent. What are your views on the bill's provisions on the nature and frequency of inspections?
We heard part of the earlier debate. There are resource implications. We do not envisage frequent inspections. If there are to be inspections of fieldwork services and the entire adoption and fostering service, the nature of the inspections will be different from the inspections of establishments. It may be that a single large-scale inspection on a regular basis will be more effective.
You heard some of the earlier discussions. Are you saying that you would favour one announced and thorough annual inspection? What are your views on an unannounced inspection during the intervening period?
The answer to the first question is yes. I am not sure about impromptu inspections for such a huge service, because I am not sure what they would achieve. In an establishment one could do some quick cosmetic work to bring about immediate improvements, but if something is not working terribly well in such a huge service, you will not be able to tidy it up quickly just because you think that the inspectors are coming.
In your written submission you welcomed a separate care services complaints procedure. Could you elaborate on that with regard to the current proposals?
We do not have strong views on or worries about what is in the bill. It is important to have a complaints procedure. We welcome the clear way in which section 6 is written, and the fact that the complaints procedures are separate from, and can also be used along with, local authorities' existing complaints procedures, which are the relevant procedures for our service. That is important.
Thank you very much for your written submission and for your responses to our questions. As I and committee colleagues have said, we are in a difficult situation as we do not have anything in the bill in front of us on adoption and fostering. We may, if it is acceptable to you, come back to you to ask you for a further written or oral submission—more likely to be written—once we see the adoption and fostering element of the bill. We will then know what we are working with and will be able to go into more of the detail. No doubt you will have comments and suggestions for amendments at that later stage. For the time being, thanks very much. We will be in touch.
I would just like to say that our three organisations represent major providers of child care in Scotland and that the basis of our submission is the welfare and safety of the children who use our services.
At stage 1 of our legislative process, we are meant to do two things: first, to consider the bill in general, to decide whether the bill is necessary and to decide whether we agree with it; secondly, to say whether we believe that the arrangements that have been made for consultation have been adequate. I put those two questions to you: what are your general views on the bill and what comments do you have about the consultation that has been undertaken to date?
Our organisations are well aware of the risks to vulnerable children and young people, both those living in the community and looked-after children. We strongly welcome the measures to register and set standards for those who work with children and with other vulnerable people.
And the consultation—
We wondered whether there could have been more contact with the vulnerable young people and with other users themselves, but we welcome the fairly extensive consultation process.
What do you believe to be the main implications of the bill for looked-after children?
We hope that looked-after children, as well as the people looking after them and the public, will be able to rely on a good system of regulation of the services that they receive. There should be much less chance of hearing about the disturbing abuse of children in public care that has been regularly reported. We seek a regulation of both the services and the work force, to make a repeat of such abuse much less likely and to engender public confidence.
Events in Dunblane probably started off some of the discussions around what is now covered by the bill. We welcome the bill as it highlights the risk to children in certain settings.
Do you have concerns about how projects might be regulated?
Do you mean individual services that we run in partnership with local authorities?
Yes.
We hope that most services will be covered by the proposed regulation, as they all involve working with vulnerable children. We view our services, like other services, as being subject to registration and inspection. If they formed part of a larger local authority service, I suppose that they might come under a general registration.
Our organisations employ qualified social workers, teachers and community education workers. We hope that the system of regulation will be integrated and will, at some stage, include all our staff.
I would like to turn to the proposal for the Scottish commission for the regulation of care to be self-financing through fees. In your written submission, you discuss the impact on some "valuable and needed services". You suggest that
We are concerned that the bill suggests that the proposed commission and council will be partly, if not wholly, self-funding. Without figures, nobody is too clear about what that will eventually mean. We wish to highlight our view that a clear balance needs to be struck: we need to ensure that high standards are met through quality inspection and regulation, but that that is not to the detriment of service provision. If voluntary organisations have to pay an increasing sum for inspections, registration and reporting mechanisms, that could take away from the much-needed resources used to provide the services. It should not get too bureaucratic and financially tied up. That is the note of caution that we want to sound.
You say that a balance has to be struck. Does that mean that inspections and registration should not be 100 per cent financed through fees?
Ideally, registration and inspection should be paid for by the new commission and council. If voluntary bodies have to start finding funds from their own resources or if they have to approach the statutory services with which we are in partnership, that means trying to get more money from local authorities to pay for our own fees and registrations. That could have a detrimental effect on the provision of services. Voluntary sector funding is increasingly hard to get. For many of us, our arrangements with local authorities form part of a financial and professional partnership. Such partnerships with statutory services are increasingly difficult to secure. That could be an additional ingredient in making complex arrangements even more difficult.
Is that the view of all three agencies represented here?
Wherever the money comes from, it will be from funds that are devoted to care services or to public services in general. Given that there is a limited pot, we are concerned that there needs to be a balance in regard to registration and inspection. They should be rigorous and should cover all the services that vulnerable people receive, but what society or people want to spend on services and the amount of money spent on regulation have to be taken into account sensibly. We are concerned about there being an enormous edifice of registration and inspection, with no account being taken of the actual amount of money that is available for all services.
I do not want to make assumptions, but I think that the committee is saying that we want to avoid bureaucracy in the system. Is it likely that there will be one charge level or variable charge levels? Those levels will change every year, so you will have to renegotiate every year. Are your organisations comfortable with the fact that you will have to add that into your negotiations every year with your local authorities, if that is your purchasing organisation?
One of our concerns is that the bill suggests that some fees could be waived, but is not clear what those will be and whether the fees will be raised annually.
They will be.
We do not want there to be any additional expenses on the voluntary sector or on child care organisations at the expense of their being able to provide services.
We expect that local authorities will start to negotiate three-year contracts with voluntary organisations now that they have three-year funding, but if what we read in the financial memorandum about the care commission is right, the charges are going up every year. Even on a set contract you will have to anticipate charges, as you do not know what will happen beyond the 10 per cent increase in the first two years. You will have to take a guess in your three-year contract or you will need to have a clause that allows you to renegotiate every year, especially in the third year when the increase might be 200 or 300 per cent.
The proper balance must be struck between regulation and provision of services from the outset, so that we do not end up with 50 per cent of an organisation's service costs being spent on regulation and inspection. That could happen unless regulation costs are limited.
Were you consulted on this?
I do not know whether the self-financing proposal was in the original consultation papers.
We certainly submitted our concern about the fees and the implications for the voluntary sector during the consultation process.
How do you see the regulation of child protection services being undertaken? You make a point in your submission about the need
Parts of the bill are about reassuring the public that children in those settings are safe. Public awareness of those issues is high following the Sarah Payne and Anna Climbie cases. The public would expect that child protection field services be regulated. If they are not, the public might be reassured that something was happening when it was not. We therefore want to see child protection fieldwork services included in the bill.
You mentioned the Orkney case, which was more than 10 years ago. Have the lessons that were learned from Orkney not come into the system? Is that still an example of bad practice that we must address in the bill?
There is more knowledge and information about the real risks to children. We are increasingly aware that children are at risk. If they are at risk of sexual abuse, they tend to be at risk from adults whom they know and trust but who are not their parents. They can be at risk from neighbours and in places in the community such as sports clubs. A job has to be done to reassure parents that their children will be safe in all sorts of settings. We want an integrated system where no child falls through the net and where the work force is as well regulated as possible.
We mentioned the index for sex offenders to the minister. He said that there is a consultation process and that a policy paper will be produced. Have you been part of that process? Are you satisfied with the progress on that?
A range of measures are proposed for the protection of children in various settings. We are keen that the system that emerges is integrated and coherent, so that there are no gaps and children are not more at risk in an informal club than they would be receiving a social work service in their home. All children must be covered by the measures.
Have your concerns been addressed? Can you assure us that the concerns that you have raised in the submission are being addressed in the bill, or should this committee be doing more to help protect children? We are asking for your advice.
We do not think that the bill as it stands will address those concerns. In regard to the Orkney case, we do not want a situation whereby after children are removed their care is inspected and regulated, but the decision about whether to remove children is not subject to any standards.
Convener, can I ask that the organisations before us suggest to the committee any amendments that they see fit to cover those serious concerns? It would be a lost opportunity if we did not take advantage of the bill to cover vulnerable children.
We voiced concern, during informal briefings at the start of the process, about the fact that the index of unsuitable adults would not be available to be considered with this bill. The minister has told us today that it will follow. Presumably, as long as you feel that all the pieces fit together properly, you are relaxed about the fact that the index is not in the bill but will follow.
There is an issue of timing and coherence, but if the end result is a coherent system that means that no child falls through the net, that is what we want to see.
I was struck by one comment in your submission. Although it is a sensible point, some expansion on it would be useful. You say, on page 4, that it is important that a sensible balance is struck between standards and their costs. That is an important issue. Can you tell us a bit more about where you see that sensible balance being?
There are a number of issues to do with cost. As I have already mentioned, the voluntary sector is concerned that fees for registration and inspection would reduce the money available for service provision. There are a number of concerns about resource implications; even the implications of the voluntary sector's having to spend time tracking what is happening to the bill.
My next question is slightly separate from what we have been discussing. Should there be one body or two? Differing views on that have been expressed. Are you comfortable with the creation of two separate bodies or do you think that there is an argument for having one body?
We are aware that some evidence has been given on the subject and we have discussed the matter. I do not want to appear to be sitting on the fence, but we have no particularly strong views about whether there should be one or two bodies. We are concerned that the functions are carried out effectively and efficiently and that the guiding principle should be the protection of the vulnerable people in our communities, whether that is done by the private or the voluntary sector. Whether there are two bureaucracies or one is not important at the end of the day.
What are your views on the provision of national standards?
In what regard? Are you talking about the setting of standards?
Yes.
Again, that takes us back to the point of principle. We think that unless something in the bill says that the main aim is to secure a good quality of life and high level of safety for service users, anyone who is involved in the setting of standards will not have a guiding compass and will be subject to whoever happens to be appointed by the Executive to be on the bodies. If we had a principle similar to the one that was outlined in the original vision statement—that the services should be built around the needs of the service users, who should be involved in the planning and delivery—people would have a clear understanding of the kind of standards that we want to achieve and would not end up producing long lists to do with fuses in plugs and so on, as everything that they did would have to pass the test of whether it made the situation better for the service user.
If we keep the interests of children and other vulnerable users at the heart of any standards, that will obviously be positive.
What are your views on the nature and frequency of inspections as laid out in the bill?
We had understood that some of the regulation would be around self- assessment. All our organisations have processes for quality assurance.
The provision in the bill is for one announced—and, presumably, thorough—inspection a year. I take it that you are happy enough with that as well as with unannounced inspections.
I think that the commission would have to keep the power to carry out unannounced inspections.
What are your views on the complaints procedures?
It is important that whatever complaints procedures are available are easily understood and easily accessible. Complaints procedures are often criticised for not being user friendly. To enable children and young people—particularly the most disadvantaged, who lack confidence and have low self-esteem—to make a complaint, the procedure must be accessible and easily understood.
On the subject of omissions from the bill, you have talked about child protection issues, fieldwork services and the fact that you would have liked principles and values to be written in to the bill. Your written submission says that you want nanny agencies to be covered by the legislation and gives us more information about fieldwork services. It also gives us an interesting take on the commissioner for children in Scotland. Many of us on this committee are keen on that idea but you suggest that including the commissioner in this bill might make their remit too narrow.
We were keen to speak about the commissioner for children today. Some of our organisations have been campaigning for such a commissioner for 25 years. The Scotland for children campaign is made up of a large number of bodies, including the Association of Directors of Social Work's children and families forum, COSLA and most of the major children's organisations, as well as the Association of Directors of Education in Scotland. There is widespread support for the notion of a commissioner whose remit would encompass all children, not simply those who are looked after or who are involved in the care system. We are concerned that a remit that was based on the provisions in this bill would exclude the majority of children, including some who face great adversity.
On the voices of users, schedule 1 to the bill says that there should be representation from
Thank you for answering our questions and for your written submission. I found that useful, especially on the commissioner issue. We can end up going down a particular alley on an issue without recognising that it is not necessarily the best way to go.
Thank you and good morning. I have with me our press and information officer, Richard Baker, who will chip in when you get bored listening to me.
We are conscious of time because we want to get to our draft report, but if you speak to those matters it may knock out some of the questions that members were going to ask.
National care standards is an issue that relates to the representation of older people. Section 5(2) states that the Scottish ministers
That may go beyond what is provided for in the bill, but we would expect that those would be the likely outcomes of misconduct—depending on the level of such misconduct—given that a professional body is to be established with the remit of examining the conduct of professionals.
If I may, I would like to make a couple of points about day care services and home care services at the end.
That would be fine.
I have no firm opinion about the creation of two separate bodies. As long as they work well together, co-ordinate their work and advise each other, their creation raises no problems for us.
You wanted to make a couple of points about day care services.
If I may.
Could you be specific about day care services as they are affected by the bill, rather than talk about the generality of day care services?
My point is that as far as I can make out, the bill mentions those services in passing and states that they will be subject to inspection and regulation. The definitions are rather unclear. The provision of day care services is not a statutory requirement, but such services are perceived to be local authority services: it is nice for people to receive them if they can get them.
Are you calling for greater clarity of what is covered by the term
The notes refer to "adults"—I must presume that such references include day care services for older people, which make up a substantial number of the services provided in that sector.
That was my point. I was quite surprised that you had no concerns about the financial implications of the bill. The financial memorandum estimates that registration for a large adult day care centre will cost between £1,400 and £1,800 and between £1,200 and £1,800 for a home care service. Given the amount of services that Help the Aged provides, I am surprised that you are not concerned about those fees.
I did not say that I had no concerns; rather that it would be difficult for me to comment on behalf of private or independent home care agencies or local authority home help services and so on.
I presume that the bill is trying to achieve standardisation through the introduction of national care standards in all sectors of care provision.
If those standards are going to be introduced, the financing will have to be examined closely. At present, most of the day care centres that we work with and help to maintain must fundraise to keep going. There will be implications for those centres if they are hit suddenly with a fee of £1,200 to £1,800, given that they are struggling to maintain services, whether they are funded through grants or—wholly or in part—through a service contract. That is a bit worrying. In many cases, those centres have received no increase in funding over the past six years. The financial implications should not be borne by the day care centres—they should be borne by the service contractors.
We attended a meeting of the cross-party group on older people, age and aging. While I will not go into the issue too deeply, we empathised with the concerns that were expressed about self-financing through fees and about how unrealistic that is. We are seeking views on a direct grant.
Could Elizabeth Duncan send us a copy of the Help the Aged report on malnutrition in care settings, to which she referred?
That report was part of our dignity in the ward campaign.
You should send it to the committee clerk.
I am happy to do that.
Thank you.
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