We continue our inquiry into free personal care for the elderly. Today we will take evidence on that subject from individuals who have made written submissions to us about specific sets of circumstances that have affected them or their families. From right to left, the witnesses are Alan Lawson, Anne Logue, Frank—[Interruption.] Frank Bardgett is not here.
I am over here.
Oh, right. You are not sitting in the right order because you are over on the left. The remaining witnesses are Kate Thuillier, Scott Rae and Sylvia Denton. I welcome you all and invite you to make very brief opening statements. Given that there are six of you, you will appreciate the need for brevity. If we take up too much time with opening statements, there will not be sufficient time to have a discussion, which is the most important part of this afternoon's proceedings.
I and a number of colleagues were involved in a particularly appalling case that threw up three general issues relating to the care commission that will be of interest to the committee. The case concerned a care home in Dundee, where the invoices with which we were issued had been fiddled in such a way that everyone was being overcharged. We discovered that a variety of techniques had been used with a significant number of people over a considerable number of years—three, at least.
I will talk mainly about the personal nursing and care allowance. As far as I know, all other benefits are index linked in some way, but that allowance is not. At the same time, so many costs are increasing that fees are now horrendous in my mother's nursing home. My mother entered the nursing home with motor neurone disease on 5 May 2003. Since then, costs have risen by an average of 6 per cent each year. The most recent rise was 7 per cent, which is crippling. However, the personal and nursing care allowance has not increased. Wage and utility costs have risen so that operational costs at the nursing home have gone up in some cases by 100 per cent. Training costs have risen enormously; that is largely to do with the Commission for Social Care Inspection, which is an excellent body, but it has knock-on effects on costs and fees, as indeed has the care commission.
For the past three years, I have been involved in a battle with Renfrewshire Council over its charging policy. It is charging my mother, who has dementia, for her care. My father, who is now dead but who was physically disabled, did not pay anything for his care. We are going round in circles. We have had appeals hearings and so on, but I am here today because nothing has changed. The only light at the end of the tunnel comes from the on-going meetings with the Convention of Scottish Local Authorities and the Executive.
My case was submitted by a charitable organisation and I was not aware that it was coming to the Scottish Parliament. You have my report on my dealings with the various organisations and the problems that I have had over my mother's care. I have prepared a brief statement that I would like to read out about how I feel about the health care system. Would that be in order?
As long as it is not too long.
There is much controversy about the accuracy of a quotation attributed to the British politician and philosopher Edmund Burke, yet it continues to challenge politicians on the issue of falling standards in our society. The quotation is:
Actually, could we go straight to the actual case? I appreciate that you want to do this sort of—
I cannot do that, because I have not been briefed sufficiently.
But it must deal with circumstances that are personal to you.
I am trying to tell you how people are lulled into a false sense of security with regard to the health care system and into thinking that everything is fine. However, it is not.
The purpose of this session is to hear about individual cases. If there is an issue that has been personal to your family that has given rise to difficulties, we would like to hear about that specific issue.
There are two issues, but I see no reason to go over them, because they are in the report that has been submitted.
Okay, if there is no need, we will move on to hear from Scott Rae. We will ask questions directly on the written submission.
I am here because I have submitted some feedback about my experiences with regard to my mother's care. She is physically disabled with multiple sclerosis.
My father is in a nursing home. He has a constricted artery in his neck on which a surgeon declined to operate. The artery has led to multi-infarct dementia and a series of small strokes that have left him largely incapacitated, without memory or speech, and incontinent. He needs to be in a nursing home. My two parents-in-law are also in a nursing home. My wife and I, who are only children, are therefore well aware of the importance of nursing home care.
Thank you. We shall proceed to questions on the written submissions that we have received.
I have a question for Sylvia Denton. To whom did you go for advice on and support for the people whom your submission mentions?
Do you mean for advice on personal care allowances?
Yes.
I went to the Scottish Executive and a citizens advice bureau and I rang the social services, but getting answers was difficult.
Did you approach the care commission?
I am in contact with the care commission about another complaint, but I have not approached it about personal care allowances.
So is one of your issues the fact that there are no agencies on the ground to support you?
Yes.
What was the reaction when you went to Citizens Advice Scotland?
There did not seem to be sufficient information to confirm whether there would be entitlement to nursing care or a personal care allowance. I was referred to the social services, which—to be frank—did not know the answers either. People can be told that there is entitlement in one case but no entitlement in another, similar case. There are no definite guidelines.
Have you approached the Department for Work and Pensions for a benefits check and advice and support?
No.
Did the social services supply any literature or leaflets?
I got more help directly from the Scottish Executive than from any other source.
What local authority covers the area in which you reside?
Highland Council in Inverness.
I have some questions for Mr Lawson, whose evidence is more about the role of the care commission. Mr Lawson, you say that the care commission lacks the powers to deal with financial issues. Will you say a little more about that? You also mention publicity about the findings of investigations into complaints. Should care home owners be responsible for informing residents of such findings, or should that be the care commission's duty? How much information should residents and their families be given? Finally, you outline the problems that you and others have faced, but how can complainants be better supported and who should provide that support?
On the financial issues, the care commission does not examine paperwork on financial transactions between customers and homes, although I think that it is to start doing spot checks to make sure that there are no unfortunate irregularities. However, my point is not so much about financial issues. It is about the serious question of whether the care commission has the powers and the attitude to take someone's licence away in cases of gross exploitation, which our case was. The care commission is cautious and timid about doing that. Perhaps you need to speak again to the chief executive and chair of the care commission and raise those points.
Before you move on, Duncan McNeil has a question on publicity.
I think that we would all agree that, when there is wrongdoing and a complaint is upheld, that should be made public. However, the committee has taken evidence from care home owners and others who complain that the reports that are published on the care commission's website are available for too long, even when the home has responded to the criticisms and corrected things. I do not know whether there is an issue in your particular case, but our understanding is—
I think that those witnesses were talking about inspection reports.
Was it just inspection reports?
I think so.
Not complaints?
No.
That is interesting.
That is correct. It is important that you do not allow people to tell you otherwise.
To be fair, it may have been my misunderstanding.
Eventually, a further inspection will take place—at present, they take place twice a year. The new inspection report, which will go on to the website eventually, will refer back to any requirements or conditions that were imposed on the licence. It is important to understand that there is a huge difference between putting something on a website—one needs a code number to get into it, by the way—and making a public statement. Putting something into the public domain is a nice phrase, but we should be clear that it means making a public statement rather than hiding it on a website.
Do you want to move on to the next point?
My next question was about how complainants could be better supported.
I think that Mr Lawson was about to come on to that.
Complainants have to be protected by the care commission. Who else is going to do the job? Hopefully, there will not be many cases in which home owners really have a go at complainants, but there are bound to be tensions. It is almost impossible for complainants to have anonymity. Either they will have discussed their complaint with the home owner or manager beforehand, or the complaint will be about a particular individual. People will know who the complainant is. The care commission will anonymise complaints, but that is bolting the stable door after the horse is out in the open—or something like that.
Did you get itemised billing? I have been made aware that when people get their bills, they show extra costs as "sundries", which vary. A bill should be itemised, no matter whose it is: one should know exactly what the extras are.
In our case, the sundries were a very minor element of the bill. The home is now being required to produce invoices in a particular way, listing the extras, showing dates and putting numbers on them. They now show to what dates free personal care payments—which the home receives and then credits us with—apply. There was a fiddle going on with that, too. The care commission might now be tightening up what it requires care home owners to do in relation to pro formas and invoices. I know that many care homes are private businesses, so they probably cannot be told exactly what to do in that respect.
You said that the social work department was overworked, that there was therefore a delay in getting an assessment and that there were no back payments. There seems to be a difference between assessments for those who have money and assessments for those who probably do not have money. There seems to be a feeling that people who have money are being overcharged. There is a different price for people who have extra cash that can dwindle while they are in a home.
Are you directing your questions to particular individuals?
The question is for any of the witnesses. I cannot remember who raised the issue of powers of attorney.
My mother's power of attorney was taken out in England. Recently, she was admitted to hospital and when she came out she was not allowed to go back to the nursing home that she had been in. I said that I had power of attorney and that she could not just go anywhere. The hospital wanted her out because it needed her bed, so I was told that unless I had medical power of attorney, the hospital could more or less send her where it wanted. I now have the worry of having no medical power of attorney over a lady who has dementia.
Was that in England?
I am sorry, it is not called medical power of attorney; it is called welfare power of attorney. It is new; it applies to Scotland.
The committee will have to examine the matter; the issue is new to us, so we will pursue it on your behalf. Do you want to come in at this point, Anne?
No. I was just agreeing with what was being said.
There are differences between the legal systems in England and Scotland. However, if someone has the power of attorney, they have it.
Off the top of my head, I am not sure whether a power of attorney that was granted in England would prevail in Scotland. That is not the issue that Sylvia Denton raised, however; she is concerned that many people do not know about the separate welfare power of attorney.
Absolutely.
Okay. We are clear on that. If no one else wants to come in, Dr Turner has a question on another issue.
People who have money feel that they are being charged more for a space in a home than are people who technically do not have money. That has been raised with me more than once, so what was said on the subject in the submissions rings true.
That happens in the Renfrewshire Council area. My mum went into a home recently; I think she is paying £495 a week for her place. Before she officially became a resident, she was in the home for respite care. She had to go there in an emergency; we were told that the charge was £495. We found out later that the cost would have been £81 if she had been referred through the council's social work department. The care, food, bedding—everything—would have been the same, but we did not know about the referral system. My mum pays for everything. She also had to do that when she was at home; she paid for everything, including her food preparation.
Did anyone give you an explanation for that?
No. That is why we ended up at loggerheads with the council. By way of explanation, we were sent leaflets on the free personal care profile, but that does not apply to my mum, who has dementia. Verbal explanations simply referred us to the Executive guidance, which the council has told us it is following. We are still at that stage.
Before she was admitted to hospital, my mother was in a home in which she was paying about £550 a month for care. Another lady in the same home was paying £440 a week. It was a Church of Scotland home and, having decided to renovate the building, the Church of Scotland home put up that lady's costs to £570 a week to cover the cost of the renovations. Because my mother was getting help from social services, she was not asked to pay more. I asked the Church of Scotland whether everyone in the home would have to pay for the renovations. The answer was that they would—I have a letter to that effect. Is that right and proper? I do not know whether it is. If a care home is being renovated, does the local council have to pay an increased charge for the residents whom it supports, or do only residents who have money have to pay by way of an increase in their charges? That should be looked into.
It should be made clear whether that is the case. It was not, in the past. Costs are not always made clear upfront when someone goes into a home. Is that your experience?
There is a significant difference between the many homes that were formerly council-owned and council-run—in which case, the council would have done all this—but which are now private care homes. In the past, such issues would probably not have impacted on the inmates, residents or whatever of council-owned and council-run homes. I suppose whether one feels like an inmate or a resident depends on the quality of the care home.
Whether it was a private home or not, increases would depend on who—the person or the local authority—was paying the costs of the person living in that home. One would think that any rising costs would be spread among all the residents, which would include those who are paid for by the local authority, although I sometimes get the impression that that is not necessarily the case. That is an added worry on top of all the other worries that have been described.
I have a question for Kate Thuillier about her written submission. You say that when a resident is moved from home to hospital, the free personal care allowance may be withdrawn. Is that something of which you have personal experience?
I do not have personal experience of that, but I am always nervous about the subject because I have heard of other people who do.
So, you know that that actually happens.
I believe that it has happened. I have heard stories about that.
That would mean that one would have to pay the full component while in hospital.
One might have to do that. Apparently, the nursing home has to make it known that the resident has gone into hospital, after which the allowance can be withdrawn. The retainer to keep one's place in a home is steep, so one will still have to pay a lot of money with no help, if the local authority money is taken away.
Have you been notified of that by the home in which your relative lives?
I have not, but I understand that a nursing home must notify whoever pays the fees if a resident goes into hospital.
Your written submission refers to backdating because of delays caused by the social work department. You refer specifically to payments being backdated to the start of the need for care, which might not coincide with the first approach to the social work department. I would like to get a clearer understanding of what you mean. In your mother's case, which you cite, the disease was diagnosed in 2002, but a need for more care was identified in 2003; I presume that a later approach was made to the social work department. I can quite see the point of saying to the social work department, "It has taken you nine or 10 months to deal with this, so I want to go back to the first notification," but did you mean that, or did you mean going back to 2002 or 2003?
I phrased that badly. I meant that payment should be backdated to the date of entry to the nursing home. Before that, we had attendance allowance and were managing to cope with my mother's care.
The payments should be backdated not to diagnosis and not necessarily to the point at which you notified the social work department, but to the date of entry to the nursing home.
In our case, yes.
It appears from your written submission that you are under the impression that assessment for free personal care can be made only once the applicant is in a nursing home. That is what you have said in the submission, but that is simply not the case. One can be assessed for free personal care in one's home, in hospital or in a residential home. Assessment for free personal care is not dependent on the person's geographical location.
I knew a month beforehand that my mother would be going to the nursing home, so I thought that it would be a good idea to get her assessed so that, as we hoped, the allowance would be paid from 5 May. I was told that we could not do that.
What is your local authority?
Our local authority is the City of Edinburgh Council, whose social work department told us that we could not have the assessment.
That is not the case—an assessment for free personal care can be made anywhere. The hope is that it will often be made in the home, in order to allow people to stay at home. Free personal care is not triggered simply on entry to a nursing home.
I would like to say something about getting the assessment. We had incredible trouble getting the assessment on my mum done. It took between 10 and 14 months for her to be assessed by the social work department.
We have received evidence that there is considerable variation between councils in respect of the time between the first approach and assessment. We are aware that in some areas there may well be a problem—we will consider that carefully.
My mother's assigned social worker was well aware of her care needs, and a care assessment was done well before her 65th birthday, but there seemed to be no impetus whatever from the council to start the application process for free personal care. Through our efforts, the process started, but that was months after her 65th birthday. However, as I said, we have still not received a single penny. There seems to be a breakdown—the process does not happen automatically, so the public have to make the effort.
My father was admitted to a nursing home because he had a sudden debilitating stroke. The consultant advised us that it was in my father's best interests to be out of hospital and into permanent care as soon as possible. We found him a place in a nursing home in Perth and immediately applied for free personal care. By the time a place in a nursing home that was closer to us became available, which was six weeks later, Perth and Kinross Council had not been able to action the assessment. My father went back to the bottom of the queue, because he had moved to the area of a different local authority, which was the City of Edinburgh Council. The process then took more time. Obviously, the payments are not backdated. I simply raise, in a rather less dramatic form, an issue that others have raised.
Anne Logue would regard a six-week wait for assessment as being just short of miraculous. There clearly is an enormous variation throughout the country in the length of waits for assessment.
I have a question for Scott Rae. This might sound a bit strange, but when was your mother's 65th birthday?
Her birthday was on 23 August last year.
I suspect that some delays might be associated with the end of the financial year for local authorities, although obviously not in your case.
That is all well and good, but my mum is paying thousands of pounds every month for her care.
I am not making excuses for the council; I was just thinking of possible reasons for the extension of the period.
One of the fundamental points about access to free personal care is the informal, or formal, waiting times that now seem to apply for various reasons.
My question has been answered, to an extent. Most of the witnesses have talked about delays in getting an assessment of needs, but I am picking up that, even once assessment has been done, further delays occur in producing the care package. Is that correct?
Yes.
So we have delays in assessment and a failure to backdate payments. When would be the appropriate point to which payments should be backdated? Should it be the assessment date—although people might have to wait for a long time for that—or the date on which the request was made?
The payments should be backdated to the date of entry to the nursing home, if the care is residential.
We cannot consider the entry into the nursing home, although that may trigger the request for an assessment for free personal care. Do you think that payments should be backdated to the date when the request or application is made?
No, because people who apply before they are 65 would not be entitled to payments at the time of application.
That is a fair point. So to when should payments be backdated?
They should be backdated to when the person first needed and was entitled to be paid for personal care.
In the real world, the payments should be backdated to the 65th birthday but, ideally, they should be made from when the need for care arises.
Not everybody will need care at 65. The vast majority of people aged 65 do not.
My mum has needed the same level of care for several years.
That was an on-going situation.
Yes.
In the case of the friend whose case I have mentioned, there were three appeals. After the first appeal, everyone who made the assessment agreed that she should have personal care. However, she has only just got it. It took two years and five months. That is the problem.
My mum was diagnosed as having dementia in 2003, but the social work department completed its assessment only recently. I am not sure whether the start of payments should date back to the psychiatric consultant's assessment or to the social work department's assessment.
Or to when you put in the request.
The requests were ignored. We were told by several people in the care manager's offices that my mum did not qualify for free care, because she was continent and mobile. That illustrates the situation in Renfrewshire.
Payment should be applied from the date when the need for personal and nursing care arises.
The discussion has been useful. It has confirmed some issues that had already been presented to us in evidence, which gives us a feel for what is happening on the ground. You have all dealt with different local authorities; some of the problems are clearly being experienced right across the local authority spectrum. They occur to greater or lesser extents, but they exist nonetheless.
Previous
Item in Private