Local Government Committee, 23 Oct 2001

Meeting date: Tuesday, October 23, 2001

Official Report 283KB pdf

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Community Care and Health (Scotland) Bill: Stage 1

The next item on the agenda is the committee's deliberations on the Community Care and Health (Scotland) Bill. Although we have been named as the secondary committee at stage 1, our report will be added to the lead committee's report. At stage 1, we simply consider the bill's general principles. After the committees' reports are complete, the matter is taken to Parliament, which agrees—or otherwise—to proceed on the basis of those principles. We then move on to stage 2.

This afternoon, we will hear evidence from two councils, the first of which is Perth and Kinross Council. I welcome its representatives to Edinburgh and to the Local Government Committee. Joyce Lewis is the head of social work services; George Harper is the legal manager; and Elaine Jones is the head of finance in the care together group. I believe that Joyce Lewis will make a few opening remarks. If anyone wants to add to her comments, they should feel free to signal to me. On a technical matter, I should point out to our witnesses that they do not need to switch microphones on and off; we are all automised—or whatever the word is.

I thank the committee for inviting us to attend today's meeting. I introduce my colleagues George Harper and Elaine Jones, who have been seconded to the care together project.

I have asked the clerk to distribute information about the project to the committee. However, I thought that committee members might be interested in hearing a bit more about it now. Care together is very much about the integration of health and social care services in Perth and Kinross; we are about to enter a two-year pilot period to test out the integrated model.

The project involves not only older people's services, but all community care client groups. When I refer to health and social care, I mean the elderly and mental health directorates within the primary care trust, the local health care co-operatives and the medicine for the elderly services within the acute trust joining in with all current social work community care services. The current organisational framework for care together has been agreed by the project's board, and interviews for all the new posts will take place in November.

My colleagues and I do not want to take up too much of the committee's time, which is why we are not doing a presentation. However, we are happy to answer questions or debate the bill.

Our submission does not make the point that there cannot be free personal care without national eligibility criteria. When the Convention of Scottish Local Authorities carries out its work on charging, it may address the issue of eligibility criteria. We believe that we will get away from the postcode lottery of service delivery only with eligibility criteria and that eligibility criteria go hand in hand with free nursing and personal care.

I want to ask about national charging, which links in with what you said. The bill will enable Scottish ministers to issue regulations providing for a national charging scheme. Is a national charging scheme feasible? If it is, would there be significant differences between Glasgow and Perth, for example? Many more people in Glasgow would seek residential care and I am not clear how a scheme would be worked out. Could a scheme be worked out so that there are no differences?

I believe that there must be a national charging scheme. There are great inequalities in Scotland because of the lack of a co-ordinated approach to charging.

It is difficult to believe that a national charging policy would create difficulties. Indeed, it would solve many difficulties, as currently there is no agreed way of charging for community care services. Some authorities charge fairly high amounts for services but some charge little or nothing. We must get away from a postcode lottery whereby people in one authority pay for a service but those in another do not.

Joyce Lewis said that the issue must be addressed on two fronts. Unless there are national eligibility criteria, we will not get away from the postcode lottery. If there are no agreed national eligibility criteria, one authority might decide that a service is a community care service whereas another authority might decide that it is not.

I cannot speak on behalf of a large local authority such as Glasgow City Council. Perth and Kinross Council has only around 1,400 clients who receive care in the community. Non-residential care income is around £900,000 per year. We are small compared with other local authorities and national charging is not as great an issue for us. However, if any changes greatly impact on councils and reduce their income, the best approach would probably be a phased introduction of the changes over three or four years.

That is what I meant. The approach must be considered and cannot be sudden.

The bill provides adult carers and carers of children with disabilities with an independent right to request their own assessment for services, irrespective of whether the person they care for is being assessed. Do the bill's provisions adequately legislate for carers?

Yes, the bill adequately represents and provides for carers. Carers currently have the right to an assessment when we assess the needs of the individual for whom they care. Under the bill, a carer will be able to ask for an assessment in their own right, which is proper. My only concern is what effect that might have on the carers, because the man in the street assumes, I think, that if he is given an assessment a service will follow, which might not necessarily be the case. I am a little concerned that we might be making carers think that they are going to get a whole raft of services when they might not be.

Has your authority done an assessment of that type of practical consideration? Have you done preparatory work on the implications of meeting the requirement of the new proposals to assess carers for those services?

Our only preparation is in being aware that the bill will obviously impact on our assessment and care management staffing ratios. For those who are not aware, I should explain that Perth and Kinross has a particularly high level of carers who care for vulnerable old and disabled people. The impact will be on the number of staff available, as they will have to carry out more assessments than are done at present. We are aware of that, but that is as far as we have taken the issue.

Perth and Kinross is already addressing the issue of eligibility criteria. We are putting together a system of banding that assigns individuals to particular categories according to the extent of the difficulties that they encounter in carrying out everyday tasks and the response that is needed for those difficulties. We will be introducing eligibility criteria, probably from April next year, which will help us to address the issue that Michael McMahon raises.

This question might be a bit unfair, then. Are you aware of other authorities doing similar work?

I am certainly aware of work happening in England, but I am not aware that such work is being undertaken in Scotland. Each authority in Scotland has eligibility criteria, but in general terms only. Perth and Kinross is trying to put together a banding system, consisting of perhaps four to six bands, that will allow social workers to determine whether someone qualifies for a service. It would also allow the patients, carers and users to identify with some ease whether they are likely to qualify. For instance, when a carer asks for an assessment, information will, I hope, have been provided to them beforehand indicating the likelihood of their qualifying, under the eligibility criteria, for a community care service.

On direct payments, you mention at the beginning of your written submission that you are in favour of promoting choice and flexibility for the service user. However, in the next paragraph, you say that you have great concerns about the uptake of direct payments and the effect that the uptake might have on the work force and on the ability successfully to undertake work force planning. Will you say a little more about that? Will you also say something about monitoring what might happen? If there is more flexibility and choice, it might be difficult to keep a handle on what is happening on the ground.

I will answer part of that, after which I will hand over to Elaine Jones.

One of the local authority's concerns in working with our health care colleagues is that, under a direct payment scheme, we must ensure that there is not only robust assessment and an on-going review process, but a clear monitoring process that ensures that individuals are getting the quality services that they continue to require. We know that people's needs might change, so we must constantly monitor services, asking, "Well, does Mrs So-and-so or Mr So-and-so still require that level of service?" That will ensure that best value and quality are continually addressed and that changing needs are met. We should not underestimate the number of administrative processes and the amount of professional reviewing and monitoring that will be part of that exercise.

I do not know the position in other Scottish local authorities, but I think that there is sometimes an assumption that an awful lot of voluntary and independent sector providers are out there just waiting to take on the mantle of providing services. In Perth and Kinross, we do not have a lot of opportunity for that. We will have to encourage potential service providers. We have a fairly healthy voluntary market and a sector within the independent sector is working with us. However, that will not be enough if the demand for direct payments is significant. We have business to do in encouraging service provision from those sectors.

The point that we are trying to make relates to cost structure in the council. In adult care, 50 per cent of our revenue budget is tied into staff costs. In the worst-case scenario, all our home care clients would decide that they wanted to take direct payments. As well as considering how we would administer that, we would still be paying our work force at the same time as making direct payments. That could be a double whammy. If the clients decided to take their direct payments and buy services from the voluntary or private sector, the third whammy would be that we would not recover any income. That is the worst-case scenario.

We thought that we ought to flag that up. If direct payments prove to be popular and the uptake is rapid, councils might find themselves under considerable pressure. Our no-redundancies policy might have to be reviewed in the light of that.

Before I call Iain Smith, I will ask about monitoring, which relates to Sylvia Jackson's question. Who employs the carer? Is it the local authority or the person who is receiving the service?

Are you asking who will employ the carer if the direct payments scheme is expanded?

Yes.

That is another issue for us. My understanding is that, once someone's needs have been assessed and it has been agreed that they require services, they have a choice. Either they can buy those services from the social work services' existing provision or we can give them money to buy the services elsewhere.

My concern is that the vast majority of carers have enough on their plates caring without having to be almost an employer of the people who provide services for them. I am concerned that we might have to set up something that is not necessarily part of social work services, but is almost like an employment agency to support carers by managing the buying of services for them. We will have to address that issue.

How would that link in with the form of independent living that we have at the moment, whereby someone can buy in a service and a voluntary organisation will deal with the payroll? Could that be linked in or do you see it as separate?

It could be linked in. My concern is that, depending on the uptake of direct payments, voluntary organisations in Perth and Kinross may not be able to take on the extra work.

Do you think that provision of monitoring should be included in the bill?

Yes.

May I ask a question?

I will take Iain Smith's question and then come back to you.

My question is about joint working arrangements under the bill. There are three parts to the question. The first is whether you think that the bill addresses adequately the financial barriers to joint working.

Secondly, you mention in your submission a problem with the disadvantageous position on VAT if the budgets are held within the health service rather than within local authorities. Will you expand on that so that those of us who are not intelligent can understand what you mean by it?

Thirdly, your local authority will work with a health board that deals with two other local authorities. Do you envisage any problems in working with that health board when it has to deal with other local authorities, particularly as one authority is larger than the others and could have a greater influence on the health board's thinking than the smaller authorities?

I will ask Elaine Jones to answer your first two questions.

Under the Value Added Tax Act 1994, local authorities have what we call section 33 status, which means that, in the ordinary course of providing services, we can recover the VAT that we pay when we buy in supplies, such as pencils and stationery.

Under the 1994 act, the health service is deemed to be a Government department, which, except in specific areas, cannot recover VAT. Health boards and trusts are automatically funded for that. The legislation will enable us genuinely to pool budgets, which we have not yet been able to do. That means taking resources from, say, the local authority, which is smaller—it has a smaller work force, for example—and hosting them within the financial system of the national health service. It makes sense to do that because of economies of scale in financial processing. However, when we do that, we have to accept that we will have to work with the VAT regime of the host. We would have to move from a favourable VAT regime under section 33 into—to us—an unfavourable VAT regime as the equivalent of being part of the NHS.

The cost to Perth and Kinross of losing section 33 status for our supplies and services would be £250,000 to £300,000 a year. If we put that into staff figures, it represents approximately 10 average D grade nurses or two nurses for each of our localities, year on year. The amount of money may not seem large, but we would be disadvantaged. That remains the one barrier to pooling budgets.

You asked whether the bill will promote joint working—the answer is yes. Everything that we have been saying to the Executive over the past couple of years has been addressed in the bill.

You asked about the relationship between the health boards and the local authorities, some of which are smaller than others. For those members who are not aware, Tayside Health Board takes in Angus, Dundee and Perth and Kinross. Perth and Kinross Council is very much at the forefront in Tayside—and perhaps in Scotland—in integrating health and social work services. Angus Council is also doing that, but in a different way. It has integrated its mental health services and some services for older people. Health is responsible for mental health services and social work is responsible for older people's services. Tayside has already started to integrate its services differently from previously. That will help to arrange fair share—if we want to talk about it in that way.

Our concern—like that, I am sure, of other local authorities—is that we have to ensure, as the smaller local authority, that our needs are well known and that we get the share of the moneys that we should be getting. I am sure that you are all aware that Tayside Health Board has had its difficulties. That has created delays in some negotiations that are under way. However, the Perth and Kinross equivalent of what the health board currently spends should be coming into the pot for the budget for care together. It will be the responsibility of the general manager in care together to manage that.

If there is a dispute, how is it resolved?

The care together board oversees the integrated model. If a dispute were to arise, the board would resolve it. A dispute has not occurred up to now, but there is a facility within the care together model in Perth and Kinross for disputes to be resolved. We also have a range of understandings through heads of agreement, financial regulations and standing orders, which would facilitate resolution of any disputes.

The representation on the care together board is drawn from what was Tayside Health Board and Tayside Primary Care NHS Trust and includes elected members from the local authorities. We hope to cover all interests. If there is a dispute, whether on the health side or the local authority side, those interests are all represented in that decision-making forum.

Sandra, do you want to ask your question now?

Not at the moment. I might come in later.

Before I ask my question, I will take the witnesses back to joint working, especially with Tayside Health Board. You are saying that in the future the three local authorities might all have their own joint working arrangements with the health board, so that the health board will have different arrangements with each local authority.

That applies not just to the arrangements with a local authority; the health sector and local authority in each of the local authority patches will also be involved. It is not just about having an agreement with each of the local authorities; it includes all our health colleagues. That is different from the current situation.

We have come to the realisation in discussion with ministers—this was touched on in relation to charging—that what works in Perth and Kinross might not work in Glasgow and what works in Angus might not work in Dundee. There must be flexibility so that there are horses for courses. Different models will be required across Scotland. There must be different models; we would not be able to have uniformity. It will be incumbent on the boards to have flexible partnership arrangements with local authorities and their health partners.

On the definition of personal care, the bill gives Scottish ministers powers to define by regulation social care for the purposes of separating the personal care element from the housing and living costs of residential care packages. Is there an argument that a definition of personal care is required in the bill, as opposed to within the regulations?

Yes. A definition should be in the bill.

The bill is an enabling piece of legislation. All the detail will emerge through regulations, conditions and guidance. There is an argument for defining personal care in the bill, but there is also a strong argument for including a lot of the other detail in it. The bill is little different from many other bills that are being introduced; it is an enabling bill. It does not include much detail; the detail comes through secondary legislation, regulations, conditions and guidance.

I understand the purpose of having regulations. The point that I am making is that, as the definition of personal care is so important, there is an argument that the definition should be in the bill, which would give us the opportunity to amend it, rather than giving ministers the power to come forward with regulations in the future. Would it not be to your advantage for the bill to contain a definition of personal care?

As head of social work services, I think that the definition needs to be in the bill. It must be clear so that we have balance and the equality of services that I mentioned.

A definition in the bill would also clarify your national eligibility assessment.

Absolutely. That is crucial.

I have one more point before we move on. Your submission states:

"The capital disregard of £18,500 differs from the Benefits Agency's capital threshold for income support."

That would necessitate two financial assessments per client within six weeks. Do you see any way round that? Can you make suggestions to limit that? Do you think there is any way that the bill can tighten that up so as not to put clients under even more pressure than they are already under?

We were discussing that this morning. We can understand why the threshold should be raised but, at the moment, there is still a £2,500 gap. The Benefits Agency capital disregard threshold for income support kicks in at £16,000. There is no way round that. As long as there are two different levels, there must be two financial assessments. Not only will we have to have two financial assessments, but we will have to keep monitoring clients to see whether they fall below the thresholds. That places an additional administrative burden on the client but, as long as there are two different sets of criteria, nothing can be done. It would be easier if everything was pegged at the same level.

I will pick up on the point about joint working and then go on to the funding of the proposals.

Your submission mentions joint working among the health board, the local authority and social services and the fact that resourcing will all go into one pot. Would you like that pot to get bigger or would you like to have more say about what goes into the pot, for example in relation to the selling-off of hospital sites? If a site is sold off, the money goes to the health board and not necessarily to the council or to the social work department. Would you like to see more of that money being used for care in the community and to alleviate some of the burden on local authorities and social work departments?

Absolutely. Clearly, members are aware of the rebalancing of care and, where possible, the move away from institutional forms of care. People will only go into hospital to become well again and will get the care that they need in their own homes. Increasingly, we provide services for a frailer public, which will no longer necessarily receive extensive hospital or institutional care or services. The fact that those frail people live in our communities makes it more important that we benefit from any capital resulting from a sale. The capital should be reinvested in the care and well-being of the public.

Thank you. I wanted that point to be clarified. I know that other authorities have raised the issue with other members as well as with me.

I will go on to the funding of the proposals. You will have read the care development group's report and will know about the £43 million gap. Does the council support the care development group's recommendation that all funding for older people's services should be the subject of a clear outcome agreement? Such services will obviously be closely monitored. It may not be within your remit to answer this, but there is a question about the recommendations with regard to, for example, attendance allowance not being paid. I know that that is a Westminster issue but it impinges on councils' budgets. If there is a shortfall, how do you envisage being able to make it up? Do you imagine that the Executive would make up any shortfall and that the money would be ring-fenced?

I should make it clear that funding is a matter for the Scottish Executive, not for the witnesses. I am anxious about asking the witnesses to answer a question that is not relevant to them. The £20 million will or will not be found by the Executive, but the Executive will fund the proposals. I rule the question on the £20 million out of order. It is not for the witnesses to answer. It is a question for the Executive and we can take it up later. I ask the witnesses to answer the other parts of Sandra White's question.

I retract that part of the question. We will have the deputy minister along to the committee, so I will ask him that question, if I may.

If there is a shortfall, and it is made up, would you like the money to be ring-fenced? Is that in order, convener?

Yes. That is fine.

Elaine Jones will probably say no because she is an accountant but I, being a social worker, say yes, so that the money would be used for the purposes for which it should be used.

We are split on the matter. Joyce Lewis would like the money to be ring-fenced. I will stick with the view of the Convention of Scottish Local Authorities and say no. I do not perceive a necessity for ring fencing.

Ms White asked about the local outcome agreements. The work that we have been doing in care together is partly about not what we put in, but what comes out the other side and about being able to evidence improvements in services. I know that in Perth and Kinross a local outcome agreement on daily discharges is in place with Tayside Health Board. We are also moving to a local outcome agreement for all older people's services as per the regulations.

We intended to do that anyway. We want to be able to achieve a local outcome agreement in each of the geographical localities. The agreement will cut across all community care groups. Which services people in local areas—not only health and social work professionals, but other organisations and, in particular, users, carers and patients—think they should have for their community will be recorded clearly in the agreement. Pinned to the agreements will be money if the service providers achieve the agreed levels of service.

We very much embrace the principle of local outcome agreements. That principle is about making local outcome agreements more than the community care plan that we currently have in social work. With all due respect, as George Harper said, you would need to have a wet towel round your head to read most community care plans. What sense do they make to Joe Public? Let us not make the same mistakes with local outcome agreements. Let us write them in plain English. Let us make them straightforward. Let us have everybody signed up to them so that everybody knows what they are about.

I have a short question about the second bullet point in the section of your submission that deals with accommodation. Will you take me through how clients might be

"charged different levels of top-up in the same home"?

Independent sector providers recently gave a presentation to council members. We were all aware of the problem. We have a good relationship with our providers in Perth and Kinross. I like to think that we do not just sit down to discuss fees, but that we sit down to discuss strategies, planning and partnership arrangements.

We talk about third-party top-ups. At present, the social work department might say that it would pay a certain amount for the care of an individual in a particular environment, but the provider may want more money. The provider can and does ask for the top-up to be paid by individuals or by their family members. To be frank, I do not think that service providers feel comfortable with that; it is difficult for them. Our concern is that there is the potential that somebody in a 40-bed residential unit or nursing home, for example, might pay a certain amount for a service for which somebody else pays £50 more.

We have to be mindful of the position into which we put not only families and individuals who receive care, but the care providers. The situation is not adequate from anybody's point of view.

Earlier, we talked about monitoring. Where in the system should monitoring take place to ensure that great discrepancies of the type that you mentioned do not arise?

The Regulation of Care (Scotland) Act 2001 is relevant in that regard. As well as monitoring direct payments for services to people in the community, there has to be a robust monitoring mechanism. It is important that the regulation of care is properly monitored and managed.

I understand that if a person who lives in Perth wishes to go into a residential home outwith your area, the council conducts an assessment and pays, in part because of the Social Work (Scotland) Act 1968, which talks about where people ordinarily reside, and in part because of the Community Care Act 1990. The Community Care and Health (Scotland) Bill is designed to ensure that clients have as much choice as possible. It is all right for someone who lives in Perth to go to a home in Aberdeen, but what if they want to live in another European Union country? Would your position be exactly the same or would it be different? The bill and the regulations are not specific about where people can and cannot go, but it is good on the issue of choice. I might choose to live in the south of Spain.

So might I. I do not know whether I will be able to answer your question. Our concern is that Perth and Kinross is an attractive retirement community—a vast number of people from the rest of the UK and from other European countries who have never lived in the area go there to retire. We are concerned that that trend might increase if people from the rest of the UK think that they will be able to access free personal care that they would not be entitled to south of the border.

I might be speaking out of turn, but my view is that, if a person's daughter lives in Spain and there is a care home down the road from where she lives, we should support the person staying in that home. There would be issues around monitoring that sort of arrangement. People would have to monitor the standard of care on our behalf.

Thank you for coming. That was interesting.

We will now move on to evidence from South Ayrshire Council. I welcome Elaine Noad, director of social work, housing and health—a rather larger remit than normal—David Sherlock, planning development manager, and Neil Beattie, chair of a local health care co-operative in the Ayrshire and Arran Primary Care NHS Trust area.

I know that you were here for the previous witnesses, so you will be familiar with the format. I believe that Elaine Noad will say a few words before I open it up to questions.

Thank you. In fact, I will hand over to David Sherlock and Dr Neil Beattie to make some opening comments.

Thank you for the opportunity to speak to the committee. I want to summarise the issues that we raise in our submission. We welcome the legislation and we support a principled approach to it. We have had the temerity to suggest some principles, which I am sure are familiar to the committee: empowerment of service users; integration of health and social care systems; recognition of the value of local government; an enhanced relationship between local and central Government; taking the work force with us; and equal partnerships.

On specifics, the administrative arrangements for free nursing and personal care need developed, particularly with regard to assessment, care management and resource control. There is room for tension between those elements and some time and training is required to deal with that. Further work is required on consistency and charging arrangements. We welcome the extension of direct payments, which should be based on an evaluation of current arrangements—our submission suggests evolution rather than a big bang. We thoroughly welcome the increased support for carers. We warmly welcome closer integration of health, social care and housing services based on rolling out good practices, rather than on the basis of one model fits all.

We would like to reiterate our support for stronger links between health and social services. We have some good examples of that. We welcome enhanced relationships between local and central Government. We think that agreements over resource issues and streamlining of planning of control systems would help that.

I would like to say how pleased I am to be here with my colleagues from the local authority—we are an example of joint working. It is behaviour—not structures—that is important. I was interested to hear Joyce Lewis talking about care together and how different models should be applied across Scotland. We do not have a formal arrangement like the one in Perth and Kinross, but social work and education are firmly embedded in the everyday workings of the local health care co-operative. There is not just a token consultation process at the end of a decision-making process; the LHCC is part of the process from the start.

A slight concern that we have is the increasing number of performance assessment frameworks. I might be on dangerous ground here, but we are worried that those frameworks provide comfort zones for politicians and organisers, rather than being based on clinical outcomes. If we go too far down that road an awful lot of energy will be diverted and expended on ticking boxes instead of concentrating on the benefits to the patient.

We asked Dr Neil Beattie to come with us today to demonstrate that we are truly integrated from the bottom up rather than from the top down. As members will see from our submission, we have representation on a range of committees, because we have tried to integrate throughout our planning, commissioning and delivery. That is the model that we wish to pursue for the purposes of the bill and the joint future recommendations.

Before I open the meeting to questions, I wish to ask a quick question on promoting choice. The bill includes provisions for a number of schemes to promote and, if possible, extend choice for clients in the provision of care. You say in your submission that you are concerned that

"personal allowance and personal savings are protected and that measures are in place to ensure that inappropriate service charges are not levied by care homes."

Could you outline further the basis of your concerns, and whether they could be addressed in the bill? I cannot remember what the protective measures are regarding personal allowance—which in my day used to be £13.75, but I guess it is slightly different now—so can you remind me what happens to that personal bit of the allowance when someone goes into a residential home? My memory is that it could be used up on such things as haircuts, newspapers and so on. How is that allowance protected? What did you mean by the statement that I have read out, with regard to tightening the protective measures? Should the issue be addressed in the bill?

David Sherlock will deal with the first part of your question, and I will finish off.

Our concerns came out of discussions that we had with some assessment and care management staff, who made similar points to yours, convener, about newspapers and other hotel-style extras, which in an objective light may or may not represent full value for money. We had some concerns when we spoke to assessment and care management staff that some people may be a little bit vulnerable to the type of charges that have been suggested as extras. Their personal allowances and savings could be vulnerable in that regard.

I corroborate that, because it has been our experience that sometimes the personal element has been bound up with top-up payments. Clarity is required about what are extras and what are not.

Clearly, we support the principle of choice. There is one issue about which we are concerned, which is causing concern elsewhere in the country, and that is the situation where someone in a so-called blocked bed wishes to go to a nursing home of their choice, but it is not available to them. At the moment, they remain in hospital until the place becomes available. We propose that it should be possible to move them to an interim establishment—the second choice—until the first choice becomes available, because that might contribute to better quality of care and free up hospital beds. I think that I have answered your question.

Yes, you have.

Thank you for your submission. It was interesting reading. I wish to discuss joint working with you and Neil Beattie, who I believe is from the health board—correct me if I am wrong. I will ask you the same question that I asked the representatives of Perth and Kinross Council. You have provided a full submission on capital resources. I wish to ask about the sell-off of hospital sites. You talk about joint working. Would it be advantageous to state in the Community Care and Health (Scotland) Bill that part of the money from the sell-off of hospital sites should be given to council social work departments to enable them to implement the legislation on care in the community?

I will start, then hand over to my colleagues. Yes, it would be helpful to state that in the bill. When we try to shift the balance of care to care in the community, one of the issues that we face is commissioning support and accommodation. I know from a previous life in a previous authority that pre-1995 there were financial penalties for health boards if they did not contribute some capital to commission services in the community.

I recollect that those penalties were removed in 1995, which changed the situation. To help to shift the balance of care to care in the community we need both the sharing of revenue resources and capital investment, which would come from the sale of a site. I know that health board members say that that cannot happen until the closure of a hospital, but the closure of a hospital might take two or three years at least. If together we are to shift the balance of care to care in the community, there must be capital investment and a shift of resources.

I want to add to that—I am delighted that that question has been asked. My background is in housing and for many years people with such a background have pointed out that there was a mechanism to transfer cash to meet the transfer responsibilities from what was called in the old days the Department of Social Security to local authorities—the care element transfer—and that there was a mechanism to deal with the transfer of health responsibilities to local authorities—the resource transfer for revenue-based services—but there was no equivalent mechanism for capital transfer; there was no capital resource transfer. That caused significant difficulties.

The moneys of the local authorities and Scottish Homes have been put to good use in financing community care, but they have been insufficient. In Ayrshire we have had experience of capital being made available through bridging finance in the old days of those schemes, which proved to be successful. A rigorous, independent monitoring exercise was carried out on mental health hospital discharges, which showed the value of capital resource transfer. We warmly welcome further arrangements to assist with capital transfer for housing, day care and joint-service delivery points.

We are trying to move from trusts to NHS Ayrshire and I would like the next move to be to care Ayrshire. Capital receipts from the sale of properties should be invested across the spectrum of care. For example, on the train today I discussed with David Sherlock where we can find some shared premises in Troon. We are sharing premises and we are getting together—developments now must have a strong social work element and a health element. The capital receipts that come from that should be invested for the good of the care community.

I have a question about a detail in the section on direct payments on page 12 of your submission. That section states that the cost of increasing by 10 each year the number of people who receive direct payments would be approximately £75,000. Will you expand on that? Is that an additional cost because of the operation of direct payments or would it be incurred in any case? If it is an additional cost, what is it for?

Those figures are an estimate, but we tried to ground them in our experience. They are based on the assumption that it would cost on average £144 a week per service user to introduce direct payments. That is less than the current average. We assume that along the way there will be some efficiency savings. We wanted to make the point that, although direct payments should be financed from current resources, we rightly have an emphasis on custom volume contracts to increase quality, which ties up our resources. Therefore, we must make provision for expansion in delivering new services.

The moneys that are involved in the estimate would be primarily for the purchase of care and it is not envisaged that we would finance elaborate additional administrative arrangements. We have tried to work with existing resources to purchase care, but that will become increasingly difficult over time and we will have to make additional expenditure on infrastructure costs.

I have an additional comment. We run a small direct payment scheme from which we have learned a lot. We have set the scheme in a fairly robust legal framework, not least to deal with financial audit and accountability for the local authority.

However, we are considering an increase in the start-up funding for each client to enter the direct payment scheme. Although we already provide money for people starting up to advertise for staff and so on, we now believe that they need additional start-up funding to take independent legal advice. That relates to an earlier question that was put to Perth and Kinross Council about its responsibilities as an employer in relation to payroll and other issues. There is an infrastructure requirement for individuals to receive money to cover start-up costs.

I want to discuss the joint working arrangements a little more, and ask you the same questions that I asked Perth and Kinross Council. Are you satisfied that the bill will deal with any remaining barriers to such arrangements? Do you see any particular problems in working with a health board that covers more than one local authority, or can any such problems be resolved without too much difficulty? Finally, your submission mentions a body to monitor the effectiveness of joint working and to deal with arbitration where such arrangements are not working. Would it be appropriate for the commission for the regulation of care to be responsible for that function?

That is a fairly meaty question. First, the bill provides for joint working arrangements, not least in its recognition of the need to take account of local circumstances. Our approach in south Ayrshire is more concerned with organic development, knitting in links between, and joint working across, LHCC committees and our own committees. The culture of joint working exists; as Dr Beattie said, the issue is behaviour, not structures. The bill proposes a framework that allows us to develop that aspect.

Turning to the second part of your question, I think that, like Tayside, we have done different things with or have reached different stages in some care group services, particularly in older people's services. That said, there are some very good examples of joint working in health across the three local authorities in Ayrshire. For example, we should be able to develop our partnership in practice agreement for people with learning disabilities across health and social work on a pan-Ayrshire basis. However, Kilmarnock has different needs from Ayr and we will have to ensure that some methods of joint working across other care groups—such as those dealing with old people's services—take place at a local level. To do that, we must link in with LHCCs, which is what we are doing.

I cannot remember your final question.

I asked about the reference in your submission to the need for a single body that would be charged with monitoring the effectiveness of joint working and arbitrating where any difficulties occur. Which body would most appropriately fulfil that function?

Instead of suggesting which body should take on that role, I would prefer to describe the elements that it would be useful to monitor. There should be a stronger focus on outcomes. People in local government believe that the principles of best value are very effective in that respect and, regardless of which organisation is responsible, we ask that those principles should be the subject of monitoring. I am told that clinical governance principles in the health service are very similar to best value, and perhaps there should be some melding of those frameworks.

Furthermore, there must be a thorough review of planning and control mechanisms. We recently had to work on a joint committee care plan, a local outcomes agreement, a performance management planning audit and an older people's joint strategy all at the same time. Although they were all worthy exercises in themselves, they covered similar ground and required information to be collated and presented in slightly different ways.

From the health side, joint working becomes more complicated because we are dealing with a three-tier structure. From "Designed to Care", which introduced LHCCs, right through to the latest document on the subject, called "LHCC Development: The Next Steps", we have seen LHCCs becoming more involved in planning and operational aspects.

The development of LHCCs has produced ownership on the part of the front-line workers in the process, who feel that they contribute to strategic planning and have a say in what happens. That has released a huge amount of energy. The NHS boards—I am also clinical adviser to Ayrshire and Arran Health Board—are getting going. They too have a new energy.

We have the problem of the third tier—the trusts. It is increasingly difficult to see what role the trusts have in the health service's planning and operational processes. The good work that has gone on has been at the level of LHCCs throughout Ayrshire—not just the work involving our LHCC in South Ayrshire—and has involved the local social work departments.

I know that this is not in its scope, but the bill will make things easier and will move the agenda further in the correct direction. The continuation of the trusts seems to be creating something of a block, rather than facilitating joint working and the planning process. The trusts have a role as facilitative powerhouses to get things going but, in my opinion, should not provide a controlling mechanism.

The Sutherland report took quite a long time to develop. There was then a substantial period during which academics, politicians, practitioners and others ruminated over the report. The care development group was established and took a few months to come up with proposals, which were published on 14 September. It then took only 11 days for the Executive to produce the bill to deliver on all that. Did that give rise to concern among your organisations? Do you think that the Scottish Executive has allowed enough time for consultation on the bill?

The bill's direction was well trailered and was the subject of discussion at local and national levels. We welcome its principles, which set up a framework to build on. The 11-day period was very quick, but there was a great deal of discussion in advance and the bill's aims were well defined among COSLA members in advance of its introduction.

Colleagues to whom I have spoken are not complaining about the direction of the proposed legislation. They are familiar and comfortable with it, although they have raised concerns about the speed with which it can be implemented. There are also concerns about how we move towards more direct payments, given the infrastructure requirements, and about how we move towards full joint assessments, given the need to train people thoroughly to give up their notions of how assessments may have been done in the past—they were done singly.

It takes time to build relationships and trust, which are necessary to implement the joint arrangements, but we found that the general direction of the bill was warmly welcomed.

Our previous group of witnesses said that we need national eligibility criteria, which would provide the only way to get away from the postcode lottery of care. First, do you agree with that? Secondly, given that the bill will allow ministers the power to define social care by regulation for the purposes of separating out the personal care element from the housing and living costs of residential care packages, do we need a definition of personal care in the bill, rather than leaving that to regulation?

On your first question, I would agree with my colleagues from Perth and Kinross Council that we need eligibility criteria that are equitable and transparent. That would be helpful.

My first reaction is that it would be helpful to have a definition of personal care in the bill. A caveat is that what we talked about four or five years ago as personal care bears no relation to what we talk about now. Many of us are dealing with aging populations and increasing dementia—the definition may be clarified as we move to joint working. If there were a definition of personal care in the bill it might have to be amended after a period.

You say that the definition from five years ago is unrecognisable. However, if there is no baseline definition of personal care in the bill—to allow for amendment if we are not happy about it—that will effectively allow ministers to change the definition by regulation rather than statute. Do you not foresee difficulty or danger in the fact that the definition that we understand at the moment will be unrecognisable in five years' time?

If there is a definition of personal care in the act we must be mindful of the fact that, in five years' time or whenever, we may have to revisit that definition and ask whether it has changed in the light of the changing demographics or needs of the population. However, I agree that there must be a baseline definition.

In section 2, where you consider the legislation, you talk about free nursing care and

"the potential for an undermining of needs led assessment and a danger of diversion away from care management."

Could you elaborate on that?

I am sorry to say that I am very hard of hearing, so could you speak up a little?

That statement comes from conversations with people in assessment and care management. The concern there is that their professional training in working with people's holistic needs—dealing with the whole person and working out all of their requirements—could be at odds with an expectation that people are arriving simply for an assessment of their eligibility to enter a nursing home. There is tension there. That probably needs to be dealt with in guidance and training as opposed to legislation.

I was going to ask about funding proposals, but I think someone has already touched on that. In your submission you mention monitoring in relation to an arbitration service. Do you support the care development group's recommendation that the funding for older people's services should be closely monitored and transparent, so that everyone can see how much money is going in and how much money is made up from other areas?

I will ask the same question that I asked Perth and Kinross Council but I will not be quite so provocative about it. What if there happened to be a shortfall in the moneys? I will not mention the attendance allowance part of it. However, if there were a shortfall, which had to be made up by the Executive or by other means, would you like those moneys to be ring fenced for a particular purpose? Could I have an answer from both witnesses from the council this time?

I will deal with ring fencing. The position that we would like to be in as a council is one where we have a director of finance and a director of health, housing and social work sitting next to each other, saying that they are happy with the structural arrangements for financing the local authority as a whole. I realise that that is not a simple thing, but if we got to that position the issue of ring fencing would be less difficult.

Very well answered.

If COSLA were here it would say that for local authorities to exercise their democratic mandate the money should not be ring fenced and that it is a matter for local determination. In fairness, I think that local elected members prioritise expenditure on social work as at national level—that is certainly our local authority's experience. Therefore, if moneys come through, they go where they are intended to go.

We welcome local outcome agreements on funding. The Scottish Executive wishes to proceed with those to show outcomes through particular streams of funding. However, we have said that we want clarity on the streams of funding. This year, for example, it took some time to determine exactly where the learning disability change fund moneys were in the settlement. To proceed with local outcome agreements—which we welcome—we need real transparency and clarity in respect of the pots of funding that underwrite the different local outcome agreements. I emphasise the point that was made earlier: we want streamlining in the performance and monitoring of expenditure as we are currently regulated in at least four different ways.

As there are no more questions, I thank the witnesses for attending. The exchange has been interesting. If we need to get in touch with the witnesses again, we will.

Meeting adjourned.

On resuming—