Agenda item 3 is our final evidence session on the Carers (Scotland) Bill at stage 1. The Minister for Sport, Health Improvement and Mental Health has been joined by a new set of officials, who support him in this policy area. They are Dr Maureen Bruce, deputy director, and Moira Oliphant, team leader, care, support and rights division, population health improvement directorate; and Ruth Lunny, principal legal officer. Welcome to you all.
Before we begin, I express the committee’s thanks to a group of young carers who spent time with us last Thursday, to share their experiences of their caring roles and their views on the bill. Their experience has allowed us to reflect on the reality of caring as a young person. That experience was quite varied, and the evidence was very good.
If the minister does not mind, I ask Bob Doris whether he wants to say anything about that session.
I will be very brief. I am sure that the minister will be interested to know how much the young carers value the support of the Princess Royal Trust for Carers centre in Falkirk. Many of them had a complete lack of information about the support that is available for young carers until they found that vital resource.
I will mention two issues that the young carers raised that are relevant to the bill. They are absolutely convinced that short breaks are vital in supporting them to be not just carers, but normal young people getting on with their lives, separate from their caring responsibilities. They also want greater status in relation to the healthcare system in order that they can deal with situations such as the cared-for person being taken into hospital unexpectedly. I am sure that those matters will be teased out, but given that that is what the young people told us, it is nice to mention them at the start of the session. Thank you for giving me the opportunity to do that, convener.
Thank you. The session may come up later. Minister, you wish to give an opening statement.
Thank you for the opportunity to say a few words about the Carers (Scotland) Bill and why I believe it is important.
Both adult and young carers are integral to our society. They provide vital care and support to their families, friends and neighbours. I thank the committee for its scrutiny of the bill; it was very positive to hear about the committee’s productive session with young carers, and I know that there have been other evidence sessions as well. I thank the committee for the work that it has undertaken so far.
We have seen much progress in supporting carers. I hear directly from carers about how their lives have changed for the better and the personal outcomes that they have achieved as a result of the support that they receive. The Scottish Government has invested over £114 million between 2007 and 2015 on a range of programmes and initiatives to support carers, and it is investing further in this financial year. However, some carers are not being supported and that can have a adverse impact on their physical, emotional and financial wellbeing. That is a concern for us all. Another concern is that carers can experience very challenging circumstances, including economic and social disadvantage. Sometimes young carers do not have the best childhood.
A crucial role for the bill is to complement important policies and drivers such as the integration of health and social care and the roll-out of self-directed support. Integration of health and social care with the progressive roll-out of integrated joint boards is vital in providing seamless services and empowering local communities to take charge of their own health and wellbeing in innovative ways.
There is a key role for new legislation to accelerate and sustain the progress that has already been made to bring about a step change in the way that services support carers and to inspire renewed ambition about supporting carers. This is within a wider context, which is really important. As we all know, Scotland has a growing population of older people who are successfully living longer, but often doing so with a range of complex and multiple physical and mental healthcare needs. There are more children with complex health needs or disabilities.
We need to support Scotland’s carers so that they in turn can support the many people with illnesses and disabilities or who are frail, many with dementia. Of those carers, 47 per cent live in the most deprived areas, caring for 35 hours a week or more. It is striking that that is almost double the level found in the least deprived areas. We need to support carers who experience considerable disadvantage, especially if the impact of caring is taking its toll. Therefore, our wider work to tackle health inequalities within the even wider context of tackling economic disadvantage is crucial.
The Carers (Scotland) Bill is a fundamental part of delivering the wider strategy to tackle inequalities and the work that we are doing to deliver the Scottish Government’s vision for carers. Our vision is that carers, whatever their circumstances, should enjoy the same opportunities in life as people without caring responsibilities. It is my intention that Scotland’s carers should be better supported on a more consistent basis, so that they can continue to care, if they so wish, in good health and to have a life alongside caring.
The objective of the bill is to make real that ambition by furthering the rights of both adult and young carers. The bill is designed to deliver on fundamentals such as carer involvement and participation, comprehensive yet person-centred support planning, preventive and community-based approaches to supporting carers, a strategic overview, and development through the local carer strategies. I believe that the bill strikes the right balance between making the necessary requirements on local authorities and health boards to deliver support for carers and providing the flexibility to ensure a personalised approach to support.
In reviewing the evidence from a wide range of interests, it is clear that there is broad support for the bill’s principles. We have listened carefully to carers and carer organisations in developing the bill’s provisions, and I hope that carers will be able to recognise their voices in the bill as it stands. As I said in Rhoda Grant’s members’ business debate on carers in the Parliament on 10 June, I welcome any suggestions that seek to improve the bill and the lives of carers and young carers across Scotland.
We are engaging with important stakeholder interests to consider their views further, and we will give full consideration to all good suggestions as we take the legislation forward. I hope that we have been able to demonstrate that willingness with the Mental Health (Scotland) Bill, which will be debated at stage 3 tomorrow. It is my intention to proceed on that basis with this bill, too.
I look forward to the committee’s continued consideration of the Carers (Scotland) Bill and the contribution that scrutiny and consideration can make to the bill’s improvement. I also look forward to the discussion that we are about to have, and to any questions that members may have.
Thank you, minister. The first question is from Dennis Robertson.
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Minister, you will be aware that we have taken evidence from a number of carers and carers organisations, and one issue that has been raised concerns the criteria for eligibility. Local authorities state that it is necessary for them to set the criteria so that they can reflect local need, but carers and carers organisations would like some certainty and stability. If those criteria are set by local authorities, there is a concern that many carers may not meet them, and that would not reflect your aim of ensuring that carers have a life outwith their caring role. How will you reassure carers and carers organisations that have raised those concerns?
Thank you for that question. We need a balance between ensuring a more consistent approach and recognising that each local authority is a body corporate in its own right and has democratic accountability, given that councils are ultimately accountable to their electorate. The intention behind the bill is to ensure better support for carers across the board. The bill also contains a duty for each local authority to publish the local eligibility criteria that are to apply in its area, and those must be reviewed every three years. We decided that the criteria should be set locally to ensure local decision making, but that is overlaid by national guidance. In that regard, the bill refers to
“such matters as the Scottish Ministers may by regulations specify.”
When each local authority sets its local eligibility criteria, it must have regard to that national direction, and we will consult on those regulations.
That is essentially a balance between the bill’s intention to ensure a better, more consistent level of support for carers and recognising that local authorities are ultimately democratically elected bodies.
If you feel that the criteria have been set such that many carers will not be eligible for support, will you intervene?
We will monitor the implementation of the bill, as Parliament would expect, and we will pay particular attention to the efficacy of the provision and how it is being rolled out on the ground. We have retained the ability to set national criteria in regulations, should that be determined necessary. My clear preference is for us not to get to that stage, and to have the national direction as set out in the bill. As I have said, the local eligibility criteria will be overlaid by national guidance. That is my preferred approach, but should it be necessary at some point down the line, we could introduce national eligibility criteria.
So if individual carers or organisations feel that the eligibility criteria for support have been set too low, if you like, they can approach the local authority. If they do not get a satisfactory outcome, they could come back to the Government and say, “We are not being treated fairly. The provision is not meeting the objectives and outcomes set by the Government in order to give people a life outside of caring”, and you would intervene.
Even if I wanted to say to national carers organisations, “You can’t raise this issue with me as the minister responsible”, they would raise it with me anyway. We are in regular contact with national carers organisations on a range of issues, not least the bill. If people have concerns, I expect them to raise them with me.
We want to get this right at the outset. Under the bill, it is necessary for carers and carers organisations to be involved in local carer strategies. They should also be involved in drafting what the application of local eligibility criteria should mean. It is about empowering carers. They must be involved in the process.
However, you can understand some of the concerns. If a family moved from one local authority area to another, the eligibility criteria might be different, so they might drop out of support.
I can understand that perspective. The key point for me is that the eligibility criteria in a local authority area have to be clear to people in that area. If, by their nature, the criteria are local, there might be differences from one local authority area to another but, as I said, any local eligibility criteria have to be informed by the matters that we set out in regulations.
The bill also includes a more general power to support carers who do not meet eligibility criteria. The bill is writ through with an approach that is designed to support carers.
There is general support for the integration of health and social care in all sections of society, but there will be a greater emphasis on local authorities meeting need as we move people from acute services to primary care services. Therefore, local authorities suggest that there will be a greater burden on them. Does that not mean that care and support for carers could be diluted to an extent, because authorities will prioritise people who move from acute services to primary care services?
No, I do not think that there is evidence to suggest that that will be the case. We are all supportive of the integration agenda, which is about trying to ensure a more seamless interaction between the health service and social care. I cannot envisage the particular challenge that you refer to. It is true that we want to get more folk out of acute care and into primary care and community settings. The bill could be a significant advance in achieving that, because one of the barriers might be that carers do not feel particularly well supported in their caring role, which could cause delays in that transfer.
Surely the challenge is a resource one.
We have set out a significant resource in the financial memorandum over the lifetime of the forecast. We will resource the bill’s provisions.
I am a wee bit surprised by you saying that you were not aware of any concerns. Dennis Robertson was referring to evidence to the committee that indicates that, although many people—including many members—support the bill, there will be challenges in delivering on increased expectations. Those challenges have been well rehearsed by the Convention of Scottish Local Authorities.
Various professional organisations told us that if we go beyond the regular and substantial test to a universal position, the numbers will be greater than the estimate in the financial memorandum. That relates to the producer side of the story, if you like—the people who are paid to deliver the support.
However, we heard the same from the other side of the story in a couple of the evidence-taking sessions with carers. We found ourselves explaining the position and why it would be a good idea to extend support and to identify carers at an earlier stage. The carers had their own experiences of difficulties in being assessed appropriately and in getting appropriate help. Young carers asked us last week about the impact on them, and the older carers we met in Glasgow said that things were difficult enough already. They were concerned that, if we broadened the measures out and increased expectations, they might lose out.
Does Nanette Milne want to supplement that point?
I wanted to raise a slightly different topic—I can wait.
I will let the minister answer the point first, then.
Of course I recognise that, in any demand-led process, which is ultimately what we are instituting, there are forecasting difficulties. We are confident that our forecast is appropriate, although I know that COSLA has expressed concerns about it and that the matter was explored with the Finance Committee recently.
The removal of the regular and substantial test is a positive step. It is sensible to broaden out the scope of the bill to cover carers who should be eligible for assessment and, potentially, for support. I think that the removal of the test will not in itself result in a large increase in the number of carers requesting an adult carer support plan, because, as we know, the majority of councils do not use that test just now. Indeed, we have supportive quotations from councils about removing that barrier to assessment. Aberdeenshire Council, for example, says that it will “improve equity and consistency”.
Those who decline a carer’s assessment now might not want the new adult carer support plan—perhaps those who feel that the current assessment is stigmatising. Others might decline the assessment because they are content to be involved with the community care assessment of the cared-for person, because they do not feel that they are a carer—that is an issue in itself that we might touch on—or because they feel supported already. We know that about carers who do not come forward for support quickly—again, this is an issue in itself for carers as a group. The carers allowance is a case in point.
We are dealing with a low baseline, and the forecast for demand is not unreasonable. I accept that it is difficult to come up with an absolute or certain figure when we are dealing with a demand-led process.
Yes. I am not arguing over the principle; I am trying to articulate the concerns of carers who have told us in evidence that there can sometimes be a long wait for assessment and for a package to be put in place. If people with a low level of need are going to be assessed, what will that do to carers who need assessment quickly? Carers say that resources are scarce when it comes to getting access to social workers and having on-going and changing needs addressed. In practice, we are searching for assurances that what is a worthwhile measure will not impact on those who are in more urgent need of care, and that regular, on-going care will be provided.
Of course, it will be for each local authority to manage the case load. It will be a question of how authorities handle the cases that they deem more urgent. Some of that could be determined by the processes that are set out locally.
In the financial memorandum, we have set out substantial additional resource. By the financial year 2021-22, there will be more than £63 million for support for carers, which I think we would all agree is a considerable sum. We are proposing to resource the recognition that, over time, a rising number of people will come forward. I hope that that takes care of people’s concerns. We are going to resource the measures properly.
COSLA said that another issue will arise over time. It made the case that making the support available would result not just in a greater number of people coming forward but in people being likely to take up support. There are examples from England of where such processes have not been as slow as people thought they would be. COSLA argued that in England there was take-up in the short term, over a three-year period, rather than a slow build-up in demand. It said that there was a surge at the beginning. I do not know whether that has been taken care of.
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We will assess any evidence that is available; in fact, we have done that as part of the process. A comparison has been made with free personal care, on which the take-up rate has been higher. I do not necessarily think that that is comparing apples with apples. We would expect the take-up rate for free personal care to be higher, because most of the people who are entitled to it are already known to local authorities. We will take on board any evidence that is available, but there is plenty of evidence to suggest that the take-up rate will rise steadily on an incremental basis.
If there is a short-term surge, how will the Scottish Government cope with that? What would your reaction be if there was a surge in the early weeks and months of implementation? We are dealing with vulnerable people, and we cannot necessarily deal with them retrospectively. What contingencies are in place to ensure that, if there is a surge, you can respond to it?
We are in dialogue with COSLA. We have set up a finance group to look at the issue in further detail. You alluded to the concerns that have been expressed by COSLA about the resourcing of the bill. We have made an offer to look at any different forecasts based on COSLA’s evidence. Thus far, it has provided no such evidence. We have set up a finance group to look at such matters in greater detail, and COSLA will be represented on that group. We will continue to explore those matters in detail with COSLA.
You mentioned that there has been a surge in England, but I am not convinced that there has been anything that could be described as a surge per se. Officials are in dialogue with colleagues down south, and they are not talking of a surge per se. Of course, we will continue to—
Has there not been a significant increase in demand in England?
Perhaps I can invite—
Maybe my use of language is poor—maybe it cannot be described as a surge. What can we learn from the experience in England? Has it affected your thinking?
I have no doubt that there has been increased demand in England, and we are forecasting an increase in demand as a result of the Carers (Scotland) Bill. Maybe it comes down to a matter of language; I would not necessarily describe that as a surge.
I accept that it is recognised that the bill will result in increased demand over time. I used the word “surge”—you can choose any word you like.
Well, I would describe it as increased demand.
The experience in England is that that has happened in the shorter term rather than the longer term. Does that give you any cause for concern?
I invite Moira Oliphant to say a bit more about the contact that she has had with colleagues down south. I think that the use of the term “surge” is probably unhelpful.
I am not here to argue over words. A point has been made about an increase in demand in the shorter term. I ask Ms Oliphant to tell us about the experience in England and whether it should give us concern. If it should not give us concern, I will have my answer—that is fine.
The experience in England is that there has not been a surge in demand in the first few months of operation of the Care Act 2014 down south.
There has not been a surge, so COSLA is wrong.
We have spoken to officials down south and they have said that the demand that they might have anticipated has not emerged, but the act has been in operation for only a few months, so we will have to look at the situation again.
So COSLA is wrong to use that as part of its argument. The committee can discount that.
Ultimately, the committee will have to come to its own position. I suggest that the use of the word “surge” does not reflect reality. We are confident in the figures that we have set out.
What is your view of the evidence that has been put to the committee by COSLA, which represents the people you will be putting in charge of delivering the policy?
We have established—I do not know why it took us 10 minutes to do so—that we should not take into serious consideration COSLA’s claim that there will be a surge or unpredicted demand in the early implementation period. We have been told that we should not worry about that and we can discount that view when we are producing our report.
If you want to put it that way, that is the way you want to put it. The point that I am making is that we are confident in the figures that we have set out in the financial and policy memorandums. We are confident in our methodology. We invited COSLA to provide us with its methodology, and it has not done so thus far. We will continue to work with COSLA, and that is a reasonable position to take.
Good. Thank you.
I will not explore the idea of a surge any further, but I want to mop up one or two other aspects of the very relevant points that the convener made.
The first was the comparison with free personal care, which I thought was interesting. In Glasgow, for example, there is a time period within which someone who would qualify for free personal care is assessed. Once the person has been assessed, there is a time period that he or she has to wait before the package is delivered. I am not sure whether that is the case for carers who are getting assessments currently across local authorities.
To what extent will the decisions on acceptable waiting periods for assessment and delivery be for the discretion of local authorities? I would feel more comfortable, not with the Government dictating what the time periods should be but perhaps with it giving some guidance on carer’s assessments to which local authorities should operate. Some information on that would be helpful.
That is likely to be the space that we will occupy on that issue. There is a spectrum of people involved in caring responsibilities dealing with a spectrum of different conditions. I accept that there could be some circumstances in which the assessment would need to be done very urgently. I am thinking of those who have caring responsibilities for people who are perhaps near the end of their lives, who might have a greater need than others to be dealt with on an expedited basis. There is nothing in the bill at this point about timescales. We are only at stage 1 and we are open to hearing arguments as to why there should be. The argument for them might be particularly persuasive in the circumstances that I have just set out. That is something that we can deal with as we move forward into stage 2.
Just to follow up very briefly, because you gave more information than I thought you might—
I like to be helpful.
I am not sure how I feel about the information, but it was interesting, because this committee is at the stage of considering what should or should not be in the bill.
What I was considering was not so much prioritised cases but the generic, routine carer’s assessments. Any gaps between identifying someone who needs an assessment, getting that assessment done, identifying a package and delivering that package are unfortunate. Gaps happen in other aspects of local authority delivery at the moment. Some guidance from the Government would be helpful—we can deal later with whether that should be in the bill or elsewhere.
You moved on to my second point, which the convener made well, about the carers who are already in the system and getting a reasonable service—not a superb service, but everything is relative—from local authorities. They have concerns that their service might be diminished somehow. I am sure that that will not be the case for them, but what about those new carers coming into the system who should get priority? Will any guidance be given to local authorities to make sure that there is a fast-track process via social work departments or integrated health and social care boards?
To finesse it slightly, there are two issues here. The first is to make sure that there is no gatekeeping or other undue delay in the routine carer’s assessments, which will take place universally now. Can that be dealt with in regulations? Secondly, can regulations deal with the need to prioritise?
You might want to comment further on those points and I wanted to be clear that I saw them as two separate issues.
That is the point that I was trying to make in response to your initial question, which was about whether this issue will be dealt with in guidance. As I have said, that is the space that we are occupying right now. Of course, that guidance has not been written or bottomed out, and I will be very happy to take on board any perspective that the committee might have on the matter. Equally, if it emerges that this issue should be covered in the bill itself, I am open to hearing that case, too. We are just at the start of the process, and I am not going to be taking an overly prescriptive approach; instead, I want to do whatever is most effective to support carers. I suppose that, in my previous response, I was simply highlighting a particular subset of carers—for example, those providing palliative care to the cared-for person at the end of their life—for whom the process might need to be expedited.
There are a number of supplementary questions.
Minister, you said that the finance-led group had been established. Who are the members of that group, and when do you expect it to report?
We have invited a number of organisations to join the group. COSLA has been invited to send two representatives. When I gave evidence to the Finance Committee, I was asked whether COSLA had responded positively to my invitation; at that stage, it had not, but I can now confirm that it will participate.
Other members of the group include, from the Scottish Government, the deputy director for finance, health and wellbeing; the head of internal financial performance; the team leader for local government finance; the deputy director of the care, support and rights division; the team leader for the carers policy; and two representatives from analytical services. There are also the two representatives from COSLA I have just mentioned; a representative from Social Work Scotland; three policy reps from councils; two local authority directors of finance; one representative from a national health service board; and, crucially, two representatives from the national carers organisations.
As for timescale, we want the group to meet and report to me as soon as possible.
COSLA continually says that the Scottish Government does not fully fund the legislation that it passes. What if a local authority comes back to you and says, “We have spent more than you have given us?”
At this stage, we are trying to bottom out any concerns that COSLA might have; indeed, that is—in part—why the group has been established. As I have pointed out to the convener, we invited COSLA to provide an alternative figure and an alternative methodology, but it has not been forthcoming. I am very willing to receive that information from COSLA and to let my officials have a look at it.
In his reply to Bob Doris, the minister touched on the issue that I wanted to raise in my substantive question; basically, it was about those who provide what one might describe as terminal care. Clearly, those people need to be identified quickly. For a start, a lot of them do not recognise themselves as carers in the first place, because they are just husbands, wives and so on. They also need to have their care plan reviewed quite quickly and, indeed, quite frequently, given that their circumstances will change regularly and in a fairly significant way as time moves on.
The minister will not be surprised to hear that I have been speaking to Marie Curie Cancer Care about this issue, given that I have raised it before. It feels that a care support plan for these carers should be in place within seven days of their being identified as carers and then, as I have said, reviewed regularly. It also feels that the stipulation in the policy memorandum that
“local authorities must set out their plans for identifying carers within the context of the ... carer strategy”
could be strengthened either in the bill itself or in guidance if general practitioners and primary care were included. After all, an awful lot of these people will come to light via their GPs and the primary care team rather than through local authorities.
The final point in that context is the need for short breaks for respite and for local authorities to be in a position to offer them.
Those issues can be covered either in the bill or in guidance. I would like to have them on the record and hope that consideration will be taken of them.
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I have touched on that issue with Mr Doris, and I recognise that it is important. We are committed to looking at the provisions in the bill that might relate to those who are caring for people who are at the end of life. The point is well made that, if it is identified that they need a support plan, they will need it pretty quickly, as is the point that the support plan may need to be reviewed fairly regularly—almost on an on-going basis.
We are happy to hear any concerns that may be expressed by Marie Curie or any other organisation about how we can get that right; at the end of the day, that is what I want to do through this bill process. We will continue to look at that issue. We are not a million miles apart on it.
I recognise that carers not self-identifying as carers is a challenge. People may not always think of themselves as such; you made the point that they think of themselves as the parents or the children of the person that they are caring for. We recognise that it is important to encourage carers to come forward to seek assistance, which is why we are trying to widen the scope of people who can be eligible for the assessment process. I am not convinced that it is necessary for us to do anything on a legislative basis to improve carer identification, but I am open to hearing any perspective that should be set out by the committee members as we assess the bill’s provisions.
The bill contains three provisions that relate specifically to short breaks. The first is that local authorities,
“in determining which support to provide to a carer ... must consider in particular whether the support should take the form of ... a break from caring.”
There is also a duty on local authorities to
“prepare and publish a short breaks services statement.”
Another provision is that the adult carer support plan and young carer statement must contain
“information about whether support should be provided in the form of a break from caring”.
Breaks from caring are part of the process as it is set out in the bill.
I want to ask a few more questions about costs. In their evidence, the councils raised the costs of preparing the support plan. They said that the amount of money that is given in the financial memorandum as a maximum is what they calculated as being the mid-range of costs for the preparation of a support plan.
There were also concerns about the cost of a short break. It might be useful to put on record what you see a short break as consisting of. You were at the cross-party group meeting at which carers said that it would cost more than £1,000 to replace them for a week to allow them to have a short break for that time. That sum is vastly higher than what the financial memorandum identifies.
Those are two cases in which we have heard specific evidence that the actual costs are not reflected in the financial memorandum.
I am aware that COSLA has expressed concerns about the unit costs of the adult carer support plan and the young carer statement. The method of establishing the unit cost was very much steered by COSLA, which was concerned about league tables of unit costs appearing. COSLA wanted instead to ask local authorities for the total number of carer assessments carried out in a year and the total costs, and then for Scottish Government officials to work out the unit costs, which it has done.
It was COSLA that wanted the average unit cost worked out, and not the median. That was not a particular problem from our perspective. The £176 unit cost for the adult carer support plan is the average based on questionnaire returns from 14 local authorities, and I think that it compares favourably with the median unit cost of £116 in England. That is a similar picture to the unit cost for the young carer statement.
On the unit cost of support for short breaks, we are taking short breaks seriously. We have included a short breaks enhancement of £2.36 million in the financial memorandum because we recognise the importance of short breaks. We have also committed in the financial memorandum—the spending review permitting—to continue the short breaks fund. We take short breaks seriously and we provide substantial financial resources for them.
Are you saying that short breaks are dependent on the amount of money in the fund rather than on an entitlement for each carer to have short breaks?
No. I am saying that that is what we are providing towards it. Of course it is to be person centred and based on the assessed needs of the individual carer who comes forward seeking that assistance. However, I am making the point that we are providing a substantial amount of resource towards that area.
Carers are telling us that the cost is greater than is allowed for in the financial memorandum. Will that cost fall on councils or will the Scottish Government top up the fund?
I go back to the finance group that we have established. These are matters that we will continue to discuss with COSLA. Our perspective is that we have set out in the financial memorandum that we will provide a substantial amount towards the support of short breaks. I think that £2.36 million per year could fairly be described as substantial. There is also the short breaks carers fund, which we want to continue as well.
Will the Government fully fund the costs of the bill? I think that that is the question. Financial provisions are being made, but it is not clear whether the cost of the bill will fall on local authorities or whether it will be fully funded by the Scottish Government.
We are funding the provisions of the bill and we have set that out in the financial memorandum.
If there are additional costs that the financial memorandum has got wrong, will you fully fund them as well?
We will continue to maintain dialogue with local authorities. We have to fund local authorities on an annual basis through the budget settlement, so there will always be that process of dialogue with local authorities as part of setting any Scottish Government budget.
So you are not going to guarantee fully funding the costs of the bill.
When we have that annual dialogue and discussion with local government about each budget settlement, that is us committing to funding any provisions that we legislate for.
I think that that is where councils are concerned, because they feel that the costs of the bill will be greater than the Scottish Government has estimated. If that comes out of their existing resources, which are declining, it means that the services that they provide to other people—including, indeed, cared-for people—may be put on hold because they are obliged to fund the carer support primarily.
I have made the point a couple of times now, Ms Grant, that if COSLA wants to make an alternative estimate and bring forward its methodology for how it came to that estimate, we will receive that and analyse it. We have not received that.
Would you fund it? That is the question.
The first point is that we would like to receive it and see what it is. We have not seen it thus far.
I realise that Dennis Robertson is still waiting to ask his supplementary, but as Bob Doris is seeking further clarity on the short breaks issue, I will bring him in first.
I will really try to be brief, convener.
As I was listening to the dialogue between Ms Grant and Mr Hepburn, I sensed a disconnect in what was being discussed, which brings us back to the need to define what a short break is for the individual, for the local authority and under national criteria. For some of the people whom I and other committee members spoke to, a short break might be an evening off to go to the cinema with friends so that they can continue to be a young adult and do what young adults do. For others, it might mean a week away. Some local authorities will invest significantly in short breaks while, in other local authorities, what looks like a short break might be a little bit different.
I am not sure how any group can resource short breaks fully, given that the process is based on individual circumstances, on each local authority’s individual strategy or, indeed, on what is defined as a short break under this bill, which I hope will soon be an act. The disconnect relates to how we can ever cost short breaks, and I must repeat the minister’s view in that respect. Is this more about local authorities having strategies for extending short breaks to those most in need, which would be based on individual circumstances? The definition of a short break is quite important.
To see if we can get some clarity here, I will come in at this point with a question that brings us back to Rhoda Grant’s comment. The minister mentioned a number of duties that will be placed on local authorities to consider and whatever, but the carers organisations have expressed disappointment at the absence in the bill of a right or an entitlement to a short break, which is something that you have fallen short of providing. Is it the case that the bill places no duty on local authorities to provide a short break?
That is correct, convener. At this stage, the bill includes no such duty; it is not the case that local authorities have to provide a short break. I can go over the details again if you want, but in any assessment of an individual carer’s needs, authorities must ensure that they assess whether a short break should be part of the package of support. That gets to the heart of Mr Doris’s point. It has become very difficult for us to be overly prescriptive and definitive about what constitutes a short break, because it can mean very different things to different individuals.
As a result, I think that the approach should be led by the assessment process. We should remember that we are removing the “regular and substantial” test, which means that someone who provides one or two hours of care a week could be entitled to an assessment—and rightly so, in my opinion. Now that those carers are encompassed by the assessment process, there is even more of a need for the decision on whether short breaks should be part of the package of support to be assessment-led.
That said, convener, I have already made the point that we are at the start of this process and that if a compelling case can be made for a statutory right of all carers to a short break and if that is something that we can accommodate, we will of course look to do that. The national carers organisations have told my officials that they believe that they have come up with some mechanism and have undertaken to provide us with information on that. I do not think that they have done so thus far, but when they do, we will of course take their submission seriously.
We appreciate that answer.
Dennis Robertson’s supplementary might take us back a wee bit, but it is only a one-off. We will then move on.
I will try to be very brief, convener. My point goes back to Mr Doris’s questions. We have established that we can prioritise for end of life, and I suspect that, for end of life, the referral route to provide support for the carer will come from the health profession. I am trying to understand how we prioritise who gets the assessments and who carries them out, given that we cannot establish priority until the assessment has been carried out. A fundamental issue about the provision of care is that the care plan can be established only after we have gone in and carried out an assessment. How do we prioritise who gets the assessments in the first place, and how do we decide who carries them out?
With the removal of the “regular and substantial” test, someone who is a carer is now entitled to seek an assessment. I recognise that there is also an issue about how quickly that assessment should be undertaken, but I think that Mr Doris’s point was about how quickly the package of support can be put in place after the assessment is carried out. I merely observed that there might be particular circumstances in which that could be felt to be particularly urgent. I recognise that any carer who comes forward for assistance, who is assessed and whose assessment leads to their being entitled to a certain amount of support will want that support to be put in place as quickly as possible.
10:00
I think that you are missing my point altogether, minister.
Okay. Why do you not explain your point to me, Mr Robertson, and let us see whether or not I can get it?
I shall endeavour to do my best, minister.
My point is that the amount of care that a person requires cannot be established until an assessment has been carried out, which means that a difficulty for providers is prioritising who requires assessment. How do we enable providers to prioritise? It could be about the referral and whether it is the carer or whoever who makes the referral, but someone needs to be able to establish where the priority lies. The end-of-life example is a fairly easy one, but in general terms, I am simply saying to you that what is required to meet need cannot be established until the assessment has been carried out.
I accept that. My point was that anyone who meets the broad criteria for being a carer will be entitled to that assessment. Obviously, we need a system that is finessed to deal with how they are prioritised; we are at the start of this process, and I am open to suggestions about how we can do that most effectively. The point that I was making was that we want to ensure that the process is as seamless and expedited as possible for everyone who goes through the system. Indeed, that is my ambition. However, I recognise that there are particular groups of carers—I have offered one example, and I am willing to hear others—who should be expedited further.
I hope that I have understood Dennis Robertson’s point.
The issue of priority that has been raised could be another layer or barrier in addition to the contentious issue of whether people have actually been assessed properly that we continually get in our case work and, indeed, hear about in evidence. When the person gets their assessment is another process that has to be gone through. It is all very challenging.
The broader question is: has there been any discussion with other professional bodies about a standard assessment process across local authorities? We could easily make a presumption in respect of a person who is near death or has cancer—although cancers are progressive and can build up, which leads to an urgent need at the end—but we can also take a preventative approach to support carers dealing with someone who, although not at the end of their life, might nevertheless be in an urgent situation. If the carer collapses, that will leave two people in hospital. How can we deal with the whole issue of prioritisation with limited resources? Surely it is not going to be left to politicians.
No. Not to put too fine a point on it, I hope that a degree of common sense will kick in. If someone is in the circumstances that you have set out—if they have collapsed and are in hospital, and the carer needs an urgent assessment—that situation can be taken care of. My point to Mr Robertson is that we have not necessarily been overly prescriptive about the issue of prioritisation at this stage, and I am open to hearing other suggestions.
Nanette Milne mentioned Marie Curie Cancer Care’s particular concerns. We have heard those concerns, and we are committed to looking at the particular case that the organisation is making. If it becomes clear that other subsets of carers need to be prioritised, we will be happy to look at such matters as we progress the bill.
I presume that your officials and organisations are discussing what a prioritisation model would look like. Was your comment about end-of-life care a casual one? Is that an obvious area for priority?
No, my comment was not casual. I was simply observing that those dealing with end of life present themselves as an obvious group.
And that view is not based on any work that you have carried out.
It is based on our awareness of groups that have raised particular issues, which we will respond to. I will bring in Moira Oliphant at this point.
Given that we are meeting the national carers organisations soon, we will be able to discuss the issue further with them. I note that looking at the impact of caring is important in helping with prioritisation, once a carer has received an adult carer support plan, but we will certainly pursue the matter.
The fact is that carers are worried. If there is a universal right to a carer’s assessment for non-urgent matters, it raises questions about the diversion of resources, and people want to be reassured that if an assessment is urgently required, it will, as the minister has said, be put in place. Common sense will prevail in 90 per cent of cases, but it is important that we reflect some of the questions that have been put to us in the evidence that we have received.
That is the virtue of this process: questions are raised with you, you gather the evidence and we respond to that evidence. You have my commitment that we will do so.
I want to ask about carers’ right to refuse to care. Carers’ assessments are always carried out on the basis that the carer will care, and assistance is then put in place to allow them to do that. A number of carers have told me that it is assumed that they will care. That is particularly the case for couples in which one partner is caring for the other. If the relationship should end, there is no way out of that for the carer—they cannot walk away. When a relationship is at an end and someone wants to make a new life elsewhere, it is still assumed that their caring role will continue. Should there be in the bill a right for the carer to decide whether they will care and for how long?
First, the words in the bill are “able and willing” to care, so people’s willingness to care is part of the process. The impact on young carers’ lives could be particularly acute. Part of the young carer statement process will deal with whether it is appropriate for the young person to undertake caring responsibilities and whether they want to continue caring.
We would not want to compel people to undertake caring responsibilities: people must want to continue that caring responsibility. The bill is designed to support those who want to do that, but who also want to have a life beyond that caring responsibility.
A carer could, for example, say that they are, as part of their carer support plan, willing to care between the hours of six and midnight, but that they need a night’s sleep because they need to go out to work. Their local authority must then provide the care outwith that.
The ambition is to have a person-centred focus in which it would be incumbent on the local authority to respond to and to take seriously points that are made about an individual carer’s circumstances. If the carer has other commitments or needs that must be met, that has to be part of the assessment process.
The bottom line is that we cannot compel people to care for people. We would not want to do that.
I think that that happens at the moment; in fact, I know that it does. A constituent of mine was sent home in the middle of the night with someone who could no longer walk or talk, and all they had been given was a Post-it note with the name and phone number of a person who might have been able to help. It turned out that that person could not help, but the assumption on discharge was that the person in question would give up their own life to care for someone without any support or assessment.
That brings me on to discharge planning—
I am happy to talk about discharge planning, but I have to say that it is hard for me to talk about the particular case that you have just highlighted. If you want to contact me about it, I will be happy to respond. On the face of it, however, I think that that case speaks to the need for the bill; after all, it sounds from what you are saying as though the person in question had not had any form of assessment.
As I said, that case leads me on to discharge planning, because the individual was discharged from hospital in the middle of the night without any reference having been made to support that might be available. Should the bill contain a right for carers to be consulted, on discharge, about the support that they might need, before the person to be cared for is discharged from hospital? It did not happen in the case that I highlighted, and has not happened for many other carers to whom I have spoken.
I start by making the general point that I have already made a few times to the convener, which is that we are happy to take on board any amendments to the bill that might be suggested. I know that some organisations that have provided evidence to the committee have stated that they would like the bill to include specific provisions on the role of carers, and on admission and—crucially—subsequent discharge of the people for whom they are caring. My commitment is that I will take seriously any suggestion that might be made as we move into stage 2.
It has already been mentioned that COSLA has said that it is not going to get enough money for this. I note that a number of concerns have been raised about the bill, and I have to say that I am particularly concerned about the waiving of charges. At present, regulations state that a local authority must waive charges for support services that are provided to carers under section 3 of the Social Care (Self-directed Support) (Scotland) Act 2013. I was a member of the committee during the passage of that bill. However, the bill will repeal that section, which means that the services that will be provided to carers under the bill could be charged for, unless ministers regulate otherwise. Why do we need to do this? A number of years ago, we made a promise to carers, which we seem—from looking at that provision—to be going back on. Some organisations have expressed concern that it will mean that the commitment to waive charges will be reneged on. Surely we are not going to do that.
That is correct; there are no plans to renege on any commitment that has been made.
In that case, can you explain to me why the bill will repeal section 3 of the 2013 act, thereby making services that are provided to carers subject to charges, unless ministers regulate otherwise? Are you going to take that provision out of the bill? If you were to do that, it would assure me and others that what you have just said is the case.
What I have said is the case. I am not quite clear what part of the bill you are referring to, Mr Lyle, but I can tell you that we are working with local government colleagues on the waiving of charges. Our commitment is as it has been set out, and we have no plans to move away from it.
There will be no charges at all.
That is our commitment.
That is good enough for me, minister.
I am glad to hear that.
10:15
This might be a slight fly in the ointment, minister, or it might be that I have not understood the situation, in which case please accept my apologies in advance.
A local authority might wish to provide a subsidised service for carers or cared-for people outwith the assessed needs that are being met in a package. For example, a local authority might decide that it wants to provide subsidised day trips that are separate from any short-break commitment, care package or whatever; and it might say that carers and so on can have the subsidised activity for £5, otherwise it will not exist. Would such provision be allowed under the bill? I think that it is allowed at the moment.
Again, maybe I am just floating something that I do not fully understand. I have just heard chat at local authority level about providing additional opportunities at subsidised rates, so I want to make sure that waiving of charges would not prevent that.
I need you to write to me on that specific example, about which I am not sure. However, we certainly do not want to do anything that would curb any available activities and support.
I appreciate that. Thank you.
You have no other comments on that point just now, minister, but you might want to respond on it at a later point.
If we try to discuss it without knowing the specific circumstances, we would just end up talking ourselves into a guddle. I would much rather know the circumstances and how they interact with waived charges, and respond in writing on that.
On reflection, perhaps I should have written to you about the matter because I am not sure about the specific example. I had heard of it and thought that I would take the opportunity to raise it with you. However, I will write to you about it.
That would be helpful.
Dennis Robertson, very quickly.
I have a quick question on young carers, whom we mentioned at the beginning. How do we identify our young carers? What process can we put in place? Is putting information in schools being considered? Young carers have suggested to the committee that there could be posters or whatever in school nurses’ rooms or their libraries. We need a process to help young carers to identify themselves and/or to be identified by teachers and so on. What can you do to help in that?
I accept that identification of young carers is important, but we do not necessarily need to legislate for it. It strikes me as being something that we should probably just get on with.
The bill has provision for information services and so on.
Indeed. Those information services will exist, but the point is that carers need to self-identify. We know from carers’ own experiences that there is a problem in respect of people not identifying themselves as carers, which we already touched on. I suppose that people would have to be at the stage of self-identifying before they would access information services.
In terms of how we support carer identification better, that is something that we just need to get on with. A variety of national policy initiatives support identification of carers by professionals. There are other initiatives that support it: for example, there is the Scottish Government’s funding of NHS Education for Scotland, the Scottish Social Services Council and the college development network for workforce development. However, if there are good ideas that we can help to roll out by sharing best practice or by providing some other form of assistance, I am willing to listen to them so that we can take them forward.
An important point that was made earlier about young carers generally in terms of our engagement with them was that local authorities, rather than independent organisations, could provide advice and information for them, although I realise that that would have challenges. However, it was interesting to note that the young carers who visited Parliament last week said that the information that they get at different points in their caring varies widely. Some of them related their stories about having been carers for two or more years before any help for them kicked in. Sometimes the help came from the school and in other cases it came from a GP. There seems to be a real opportunity to do something in that regard through the bill.
Of course, not all carers want other people to know that they are carers. Unfortunately, they might be stigmatised by other young people because they are caring for people who have addiction or mental health problems. However, there seems to be an opportunity with the bill to have greater co-ordination around identifying and supporting carers in all their interactions.
One place that has not been mentioned is the business workplace, where appropriate support can have a dramatic impact.
On that last point, the Scottish Government has supported the carer positive kite-mark initiative that is designed to work with businesses to support carers better. A number of businesses and public sector bodies are involved in that. We are committed to working with businesses across Scotland to encourage better take-up of the scheme so that we can identify businesses that are carer friendly and which support carers who work for them.
The convener mentioned the duty on local authorities to provide carer information services, and concern has been expressed about the impact of that duty on existing services. We are implementing a statutory duty on every local authority to provide a carer information service, but they do not necessarily have to provide that service directly or in-house. There are many positive examples of the third sector providing such services; local authorities can work with the third sector to provide local services. Some people have called for the bill to be amended, and we will listen to any arguments that are made. We should seek to amend the bill in a way that reflects the existence of such third sector organisations in parts of the country. I am not convinced that we can include that in the bill, but it is common sense that where a well-established local carers centre already provides carers with information, the local authority could discharge its statutory function through pre-existing services.
Let me follow on from the point that was raised by Dennis Robertson about identifying young carers, which is a major difficulty. May I invite the minister to look at the drug and alcohol information system that is being established, and ensure that young carers are part of the data collection so that it is possible to identify the young carers of people who have drug or alcohol problems? Can we link the system to the named person under the getting it right for every child initiative? The named person is supposed to be responsible for ensuring that children are adequately cared for and so on, so that is another route by which young carers could be clearly identified without massive interference.
The first question is fair and the point was well made. I will readily commit to considering that. The bill includes a named person for young carers, and that named person must be informed that the young person has a young carer’s statement, and about specific provision, so that they can ensure that support is provided. Concerns have been raised about that process, so I am willing to consider how we can finesse it, if need be. I do not want to do anything that would reduce the likelihood of a young carer coming forward for assistance, so if we need to finesse that provision we will. Dr Simpson’s point was that there could be a role for a named person if they are aware of a young person who has not yet received a young carers statement, although I suppose the fact that the named person is already involved in the process will make them more aware of such matters. If we need to look at any form of revision or guidance to make that clearer, I commit the Government to doing that.
As there are no further questions, I thank the minister and his officials for their attendance this morning and for the evidence that they have provided.
10:25 Meeting suspended.Previous
Subordinate Legislation