The next item on our agenda is the financial memorandum to the Adult Support and Protection (Scotland) Bill. As members will recall, we agreed that the bill should be subject to level 3 scrutiny, which involves inviting written evidence from bodies on which costs will fall. Last week, we took evidence from the Convention of Scottish Local Authorities. This week, we will take evidence from Executive officials.
I do not know whether levity is allowed, but Diane Strachan and I feel that we are in need of some adult protection today as I am recovering from an eye condition and Diane recently broke her elbow. We are the walking wounded. However, we are here to provide a briefing and to answer any queries that members might have on part 1 of the bill.
The committee has decided that the lead on this bill will be taken by Derek Brownlee and John Swinney. I invite one of them to start us off.
I appreciate what Jean MacLellan says about the work that has been done on costs and about the feedback to consultation. However, when Convention of Scottish Local Authorities witnesses were here last week, they did not speak about £13 million or £14 million but about an amount that would be perhaps double that. When I suggested that the national figure, if it was worked out proportionally from the Borders figure, would be even higher, the witnesses did not demur. If we assume that COSLA has done detailed work as well, the range of estimates—between the Executive's and COSLA's—is broad. Why is that? Why should the committee regard £14 million as a better figure than £26 million or higher?
I will highlight a couple of points. We would all acknowledge that the Borders inquiry showed that some poor practice had to be rectified. COSLA said that an additional £1 million had been spent in the Borders. We argue that the local authority had to spend that money to take its services to the level that existed in other local authorities.
I presume that there is potential for the bill to be demand led. COSLA's figure last week was that one in eight of the elderly population is vulnerable to abuse—I forget the precise phrase that was used, but that was the gist of the argument. A very large pool of people could be affected by the bill.
The first thing that I should say is that the figure of one in eight elderly people being vulnerable to abuse is a prevalence rate, not an incidence rate—no one can say exactly what the incidence is. The bill will not be implemented until 2008 and there are specific pieces of research that will help with finessing the calculations. Important research is being undertaken in the Department of Health to try to track incidence—we are working with one of the researchers to ensure that our bill is, ultimately, based on what is learned from that research.
Our incidence figures are based on the Borders figures, because we feel that they are more evidence based than the one-in-eight figure that Jean MacLellan mentioned. We know, for example, that people in the Borders have a greater awareness of the issue and that there is therefore a greater number of referrals there, so we anticipate that that will be the case in other local authority areas once the bill is enacted and awareness of adult protection increases across Scotland. We thought that that was a reasonable place to start, and we have estimated the figure at one referral per 1,000 of the population.
Whether we go with your figures or the COSLA figures, additional costs will clearly be associated with the bill. Is it intended that those costs will simply be met from budgets of local authorities, health boards and police forces?
Which costs do you have in mind, beyond care management costs?
When you talk about a total cost of £14 million for the legislation, do you mean in addition to existing resources or that it would be met within those resources?
There is an upcoming spending review. The Health Department will be bidding for the £14 million as part of the spending review, so we hope to secure that funding.
So the funding might come from additional resources, but that is not yet clear.
People are at different points on the learning curve. There are some areas of Scotland that have had their own procedures in place from about 2000. One example is the Lothian and Borders training consortium, which is pretty well advanced. Provision in the Borders is satisfactory, but other areas have yet to reach the point that it has reached. However, most local authorities at least have embryonic adult protection committee structures—although they may not call them that—with information, awareness raising and training at different levels and for different categories of staff.
One of the concerns is that if the spending review bid was not successful and no additional funding was forthcoming, that would result in pressure to reallocate resources within all the respective organisations. Let us suppose that there was no new money. What impact would that have on other services?
My understanding is that the current figure for community care work is £1.1 billion and that factored into that is a proportion for unmet need, which I understand is in the region of £100 million.
So, the cost could be managed from within the existing resource.
In our view, that is possible, but, as Diane Strachan has made clear, our intention is that there should be a spending review bid, and our senior management is committed to that.
Has the upheaval in the Borders been covered by existing resource?
Yes.
So, one set of authorities has demonstrated that costs could be covered within existing resources if necessary.
Yes.
You said that most of the disparity in costs was to do with case load. That does not explain everything. There are a number of areas in which COSLA seems to be looking at higher costs than those that were indicated in the financial memorandum. In those other areas, is COSLA out on a limb? Perhaps that is not the most delicate way of putting it. Is COSLA simply out of line with most other consultees and organisations?
COSLA responded to our consultation on our regulatory impact assessment. Its main issue was to do with multiplying adult protection units by 32—that is, one for each local authority—because that did not take into account geographic distribution and the fact that although Scottish Borders Council might have three members of staff, Glasgow City Council might require two adult protection officers, given that it is a much larger authority. We took that on board, which is why we changed the calculation so that we multiplied the Borders figure by 50. At that time, COSLA did not give any indication of significant extra costs. Twelve local authorities responded to us, and COSLA and three authorities raised the adult protection unit figure. However, none of them was concerned about significant additional costs.
Multiplying the figure by 50, rather than 32, took you to £7.5 million, did it not?
Yes, from an original cost of £4.8 million.
COSLA seems to have identified an extra £2 million on top of that, without which it reckons that the officers could not have a dual function.
That was not in our original costings, which we changed as a result of COSLA's feedback on the regulatory impact assessment. We take on board the fact that there might be variations. For example, Glasgow might need more officers, as might the Highlands and Islands, given the dispersed population.
I want to move away from this area of detail to fundamental questions. As I understand the genesis of the bill, it comes out of the particular case in the Borders—such a reason is almost always a bad reason for legislating, but that is the way in which it has been presented to us. Will you say a bit more about why we need the structure that the legislation puts in place, bearing in mind some of the comments that we have had from COSLA and others about what is required?
The Borders case is only one factor. The genesis of the bill goes back to the late 1990s, when the Scottish Law Commission published its report on vulnerable adults. There have been changes since then through the Adults with Incapacity (Scotland) Act 2000 and the Mental Health (Care and Treatment) (Scotland) Act 2003, but there is still a gap. For example, someone who has dementia that has not yet been diagnosed might deteriorate and reach the point at which they become an adult with incapacity. There are people with mental health conditions who have been treated but are still vulnerable. There are people who leave care and lead chaotic lifestyles and who might be at risk. At present, there is no statute that allows inquiries in such circumstances when allegations of abuse are made, and there is no common-law power. That is why the bill is necessary.
Can you precisely quantify the group of people to whom the bill will apply, in terms that do not become elastic?
No.
Why not?
Because we do not know what the demand will be, given the hidden nature of the problem. When we make it clear that there is the possibility of investigating people's circumstances, that will create additional demand. We cannot quantify what that additional demand will be.
That is where I have a problem. You said that the reason for the legislation is that local authorities have identified a number of cases for which there is a lack of legislation. It should be relatively straightforward to quantify that. Presumably, the local authorities already know the people who are involved in those cases and has identified them as people to whom the current legislation does not apply. However, you say that we do not know how widely the legislation will be used. There is an unknown number of other people to whom it will apply.
That is right. As you say, there are two elements. There is a known population but there is also an unknown population: people who, due to the new legislation, might disclose situations and who will need the measures that the bill proposes. At present, some people do not come forward. Those who are subject to elder abuse do not disclose.
That means that you cannot quantify the—
That is what I said at the outset. There are imponderables with which we have to grapple.
The structure that the legislation proposes is quite expensive. The adult protection units will cost £10 million.
Yes.
You have produced a precise quantification of the amount of money that is needed, but you say that you cannot quantify the number of people to whom the bill will apply.
Yes. However, we are saying that we think that the proposed structure is sufficient to meet the known demand. We are talking about the set-up cost. Under the bill, there will be an annual report to the Parliament and the numbers of people will be quantified in that report when they become clear.
The spectre that is always before us is free personal care. There were plenty of warnings about that. I do not think that the Parliament should adopt procedures that cannot be precisely quantified. You have given us precise figures for what you say is the known population—
As far as we are able to, yes.
However, you are unable to give us the figures for the unknown population, which could be the same number of people, or it could be twice as many people. You cannot give us any quantification of that.
The bill is essentially about inquiry and investigation. It does not necessarily equate with an escalation of care costs. Part of what we are trying to do is stop abuse; investigation will stop a proportion of abuse. That does not necessarily translate into expensive care packages.
So the quantification that you gave us is purely for the investigation and identification of people in this category.
Yes. The staff involved will undertake those tasks.
And any future monitoring or care required for those people would be an additional cost.
Not necessarily for the known population, although that might be the case for the unknown population, and we cannot know what that cost will be. Research evidence about adult protection from other countries tells us that their policies and procedures are at a more advanced stage, but there is only a small amount of research that defines what works in adult protection.
When we spoke to Val de Souza last week—she represented COSLA but was from West Lothian community health and care partnership—she emphasised the importance of training and said that it was the top priority and more important than the structures to which the costs identified in the bill relate.
Val de Souza is a training manager in West Lothian and that is her particular expertise. As I said in my opening comments, a lot of training that is already happening is being absorbed in local authorities—for example, in the Lothian and Borders area, where Val de Souza works.
Practitioners tell us that training is the key issue. Given the considerable cost associated with training in caring for the known population and your suggestion that the plight of further individuals might come to people's attention through the operation of the legislation, how would you justify the cost of the adult protection committees? They would be expensive committees to set up. One could argue that all formal hearings at committees in local authorities are expensive when one counts up the cost of the time of the people around the table. In each of the cases covered by the bill, do you require to stipulate within legislation a formal committee hearing?
We think that we do. We know from a number of cases that strategic planning has not taken place across the disciplines in an ideal way to serve those who are being abused. The only additional cost would be that of the independent chair. We are simply asking those who have a strategic overview in their remit to come together possibly six times a year to review how well they operate together.
Does that require to be put in legislation? You identify good practice that might operate under guidance and could be applied flexibly in each individual case, but your legislative proposals require that scale of hearing for every case that is identified. Is that a reasonable use of resources compared with other priorities, such as training?
We think that it is a legitimate cost, given the number of cases in which such a strategic overview has not been taken, such as the Borders case, a number of deficiency in care reports or some of the issues that the Scottish Law Commission highlighted nearly a decade ago. We need the structure to ensure good practice.
Child protection committees exist at the moment, but they are not statutory, so our third consultation on the bill specifically asked whether adult protection committees should be made statutory. Seventy per cent of the respondents said that that should be the case to provide consistency in adult protection throughout Scotland.
That all adds up to quite an indictment of the way in which such services have been planned over the years. Is that a central part of the bill?
Yes. We are trying to improve practice.
I will move on to a couple of other costs that have been highlighted to the committee as being underestimated. The Association of Chief Police Officers in Scotland says that the estimate of the cost of police officers' input into implementing the bill would be not £644,000, as set out in the financial memorandum, but £1.16 million. What are your thoughts on that difference?
Dumfries and Galloway constabulary did the original calculations for us. When ACPOS's figures came in, they nudged the cost up. For example, we had costed for additional police officers at £30,000 per officer and ACPOS's figure was, I think, £40,000. That is the difference.
ACPOS responded to our consultation on the partial regulatory impact assessment but did not raise the additional costs with us at that point. If it had done so, we could have considered them, but it has subsequently sent additional costs to the committee.
Have you reflected on those?
As Jean MacLellan said, we based our calculations on Dumfries and Galloway constabulary's costings of £30,000 per annum for particular grades of officers, which ACPOS has calculated as £40,000. We will consider that point with ACPOS.
We used those costings because Dumfries and Galloway is a rural area and is working towards putting an adult protection committee structure in place.
Another major cost issue on which we have not touched so far is general practitioners' input into the process. Last week, a representative of COSLA, speaking for wider public authorities, suggested that it was important to have GP input, which would involve locum costs. Is that in any way factored into the costings that you have put together so far?
So far, we have factored in the key individuals who are involved in inquiry and investigation. GPs are included, but the role that they undertake varies. For example, at the hard end, they would make an assessment, a medical examination and a detailed report, whereas, at the other end of the scale, they may not be involved at all and, somewhere in between, it might be necessary to get an extract from a GP's case notes, so there is a range of possibilities for GP involvement.
It is possible that that input may have been underestimated but, from what has been said, it sounds likely that that will be a demand-led cost rather than an across-the-board per capita cost.
That is right. In many instances, the GP might have no role other than to say, "I know this individual and this is what I have done for them to date." In the scenario that I described earlier, in which someone's partner has dementia, the GP may not need to be involved in an examination if that could be unsettling for the couple. The GP's involvement might have no obvious benefit if the person's condition is already known but the abuse was not known.
My final question is on the issue of additional care managers, which seems to be where the biggest gap arises. It was mentioned that the case load figure of 23 cases per capita was based on particular research. For the record, what was that research and how was it carried out?
The Executive published the research in 2002 in the "Review of Care Management in Scotland". The research was carried out by Kirsten Stalker. I do not have any more details, but I could find the report for the committee.
We can find the report from that reference. For information, were COSLA and local authorities involved in that research exercise?
I understand that to be the case.
I think that five local authorities were used as case studies in the research.
We have no further questions, so I thank both Jean MacLellan and Diane Strachan for coming along to answer our questions today. We actually have a wee bit of time for our consideration of the bill, as it will not be considered by the lead committee until September, but we will publish our report in good time so that the lead committee can use it in its evidence taking.