Social Care (Charges) (PE1533)
Good morning. I remind everyone to switch off mobile phones and electronic devices, as they interfere with the sound system. We have received apologies from Hanzala Malik.
Agenda item 1 is an evidence-taking session with the Scottish Government as part of the committee’s consideration of PE1533 by Jeff Adamson on behalf of Scotland against the care tax, on the abolition of non-residential social care charges for older and disabled people. Members have a note by the clerk and the various submissions. I point out that at the initial stage NHS Scotland’s view was not sought, on the basis that the questions that had been identified were more properly a matter for the Cabinet Secretary for Health, Wellbeing and Sport in the first instance. Following today’s evidence session, the committee might wish to follow up issues specifically with NHS Scotland.
I welcome to the meeting Shona Robison, the Cabinet Secretary for Health, Wellbeing and Sport, and Scottish Government officials David Fotheringham and Mike Liddle from the integration and reshaping care division. I invite the cabinet secretary to make a brief opening statement, after which we will move to questions.
Thank you very much, convener. I welcome the opportunity to speak to the committee about this issue.
I certainly recognise the concerns that have been raised by people who face a range of challenging disabilities and conditions, their carers and the organisations that work with them, and I am determined that the Scottish Government will continue to work with our local authority and, indeed, health partners to improve the consistency and fairness of the current approach to charging for non-residential care.
It is important to consider charging as part of the wider social care system. We need to ensure that resources are in place so that we have the quantity and quality of social care that people require and that any charges are affordable and reasonable. With that in mind, I announced on 20 January a further £100 million investment over three years to increase social care capacity and help reduce the number of people who are waiting to be discharged from hospital. Charges for social care allow local authorities to recoup a small part of their expenditure on social care, but we must ensure that charges, where necessary, are fair and affordable.
My predecessor, Alex Neil, and I have taken a close interest in the issue of charging for social care, and I am determined that there should be a fair system for service users. That is why we are working in partnership with the Convention of Scottish Local Authorities and have ensured that, for example, no one under 65 and in the last six months of a terminal illness should be charged for the care that they receive at home. We will set that out in legislation, if necessary. I am happy to explore with the committee and others what more can be done, and we are in continuing discussions with COSLA about what further action can be taken to create a fairer care-charging system.
I am happy to take questions, convener.
Thank you for those opening comments, cabinet secretary. I should note that Jeff Adamson, the petitioner, is in the gallery.
In your letter to the committee on this petition, you say that you were “sympathetic” to it. However, much of your response is about ensuring greater consistency across local authorities rather than moves to abolish care charges. Do you have any views on the principle of abolishing such charges?
As I said in my opening remarks, we need to look at charging in the round, and we are in discussions with COSLA about what more can be done. We need to ensure that we have the capacity in social care; after all, a lot of the debate at the moment is about how we prevent people from being delayed in hospital and, indeed, how we ensure that people are not admitted to hospital when they do not have to be. All that requires us to build capacity in the social care sector.
I guess that that is part of the debate about and the considerations that we need to give to this matter. Because resources are finite, we need to decide on the best way of deploying them. However, as well as having that bigger debate about the balance that needs to be struck, we must resolve certain issues, which is why, as I pointed out in my opening remarks, we have looked at the issue of people in the last six months of life, why COSLA is working on a new financial assessment that will lead to more continuity and consistency across local authority boundaries and why we are talking to COSLA about what more we can do to create a fairer charging system.
I certainly acknowledge that there are inconsistencies and that systems can differ from one local authority to the next. While we have that bigger debate about what is affordable, and in the context of having to consider the important issue of the growth of social care, we need to make the current charging system fairer for those who are paying charges, and that is the focus of our current discussion with COSLA.
Given the variance in charging across the 32 local authorities, has the Scottish Government done any assessment of the cost of abolishing care charges?
We have, but obviously there are some unknown quantities in that. We looked at the current income from charges, which was around £50 million, but there are certain unknowns such as how much costs would grow by if charges were to be removed. It is hard to estimate something like that completely, but I think that, as we will acknowledge, there would be a growth in demand and therefore a growth in costs.
Although £50 million might not seem to be a huge amount when we look at the bigger picture, if it is spent on abolishing care charges, it cannot be spent on growing capacity. I guess that we could equate that to £100 million that could be put into growing social care capacity but would not be. Those are the debates and dilemmas that we have in the current financial climate. Given the challenges of the need to grow social care, delayed discharges, or a growing ageing population, for example, we need to decide on the best place to invest our finite resources.
As I said, we are having discussions about such issues with local government and the national health service. The problems are not easy to resolve and, when charges are levied, it is important that they are fairer than they are at the moment; I am keen to progress that. We have to make some challenging choices about investment in social care otherwise we will continue to face other challenges around not being able to keep people out of hospital or to get them out of hospital as quickly as we need to. We have to ensure that we provide adequate care for people who need it.
The petition is about the unfairness of the current charging regimes, particularly the inconsistency between local authority areas and the charges that they make. Cabinet secretary, you have made a couple of references to delayed discharges. Health board boundaries are not coterminous with local authority boundaries and there is inconsistency in charging across local authority areas. For example, NHS Lanarkshire covers three or four different local authority areas that have different systems for care charging. Do you not see the potential for some individuals to pursue a delayed discharge because they cannot afford the charges that apply in their local authority, while in other areas there might be greater scope for discharge because the care system does not charge as much?
You make a fair point. Part of the complexity of delayed discharges is that some local authorities have greater social care capacity, some are more able than others to recruit staff, some have more care homes, some have greater provision of home care services and some have more intermediate care beds. Each area faces different challenges from the others. That might be a part of the problem, but there are other issues that lead to some of the differences and particular challenges of delayed discharges being worse in one area than they are in another. Having said that, I have made it clear that delayed discharges are a problem throughout the system and we are focused on resolving that problem.
Your point about inconsistencies is fair. That is why COSLA has been working on a new financial assessment framework so that there will be more consistency around what income is taken into account and what is disregarded. However, as I said in my opening remarks, we are in discussions with COSLA about what more can be done. There are issues around the income level at which people start to pay charges, for example, and they are important issues for tackling inequalities. There is also the issue of people who have complex needs.
To summarise, the discussions that we are having with COSLA are a work in progress and I am sure that the committee will understand that those discussions are difficult, challenging and complex. We need to ensure that, if we do one thing, it does not have a knock-on effect on something else. We need to consider in the round what more we can do to create a fairer system, address some of the inequalities that exist in the charging system and bring more consistency to address some of the issues that you raise.
With integration come 1 April, those issues of consistency will have even more importance. Therefore, you can be assured that we are in the middle of discussions with COSLA about what more we can do to move the matter forward positively.
10:45
Cabinet secretary, I accept your response. However the issue is the length of time that it is taking us to reach a conclusion. The working group has existed for three years and the last paragraph of COSLA’s response indicates that the group will be working on a number of issues over the next year. Do you have a timescale in your mind for when you would like all those issues to be wrapped up so that we get some consistency and co-ordination of service delivery for people who require care services?
I note from COSLA’s response that one of the issues is the consideration not only of household incomes but partners’ incomes, which might be worrying for some households. In the past, when partners’ incomes have been included in other areas, it has ended up with separations and divorces because people felt that they were being financially undermined because of the care charges that were applied and the disproportionate charges on someone who lived in the household.
I understand the committee’s frustration at the length of time, but I suppose that it is a reflection of the complexity of the issue. A couple of things that have happened over that time were referred to earlier. There has been progress on charging for under-65s with a terminal illness. It is right that that was resolved. It was not fair that someone be charged for end-of-life care. The other issue that is about to be finalised is the new financial assessment framework, which will help with some of the issues with what one local authority or another disregards.
We are making incremental steps of progress rather than something quicker. However, on the future timeframe, we are in some detailed discussions with COSLA about what more can be done. Obviously, we want to bring those discussions to a conclusion as quickly as possible, but we are keen to get the conclusion right, because the issue keeps surfacing. If we are going to do more on fairer charging, we want to agree something that will be sustainable and see us into the long term rather than have to come back and revisit the issue time and again, as we have done in the past.
I hope that you will forgive us for taking a bit more time, but, as soon as those detailed discussions with COSLA are reaching any conclusion, I will be happy to come back to the committee with the detailed information.
You indicated that discussions with COSLA are coming to a conclusion. Do you have any timescale in mind? I note the incremental steps that have been taken but many individuals and households want answers sooner rather than later to the questions that have been raised about the charging regimes that apply. I am interested to know whether you have a timescale towards which you and your department are working to try to get a conclusion to the issue.
I guess that it is always as soon as possible. If I put a timeframe on it and that timeframe slipped because we had not reached conclusions in those discussions, I am not sure how helpful that would be. I certainly want to try to bring the discussions to agreement and conclusion as quickly as we can. I would be more than happy to ensure that the committee gets early notification of that once we are in a position to do that.
You are aware that under the Community Care and Health (Scotland) Act 2002 the Scottish Government could, if it so wished, set charges if it felt that it was not getting support from COSLA members. Has that been part of the deliberations and discussions not with COSLA, but in the department and with you?
We and COSLA are well aware of that. Obviously, we have said in relation to six-month end-of-life care and the fact that councils should not charge for that that, if required, we would enact the 2002 provisions. We are all aware of the power that we have.
We are trying to take matters forward in the spirit of partnership. The new integrated partnerships will start on 1 April. We all recognise that resources are challenging and that we need to ensure that where we spend the money will have the biggest impact and will be the biggest help so that social care delivers in the way that we need it to deliver. We need to be cautious about the decisions that we make. They have to be made in consultation and negotiation rather than in any other way. However, we are, of course, aware of the power that we have.
Thank you very much, cabinet secretary.
I note from the evidence that much of the income that has been generated from social care services has not been put back into those services. Will you comment on that?
To be fair to councils, I know from my discussions with them that they are certainly spending their social work budgets. I do not think that there is a case of a council not spending the resource that it has on social care. They are doing that. In the main, councils are doing what they can to meet increasing demands.
One of the challenges is in how we can make better use of our collective resources, which is why integration is so important. The benefits from ensuring that the integrated teams work more closely together will mean that social-care spend will have more impact than it currently has. However, I do not get the sense, from the evidence that we have, that local authorities are holding money back in the social care arena.
From our analysis of the cost of collecting the charges, we think it likely that about 15 per cent of the income that is generated from charging would be releasable. That would be the cost of administering the charges. The figure is comparatively small; we think that the amount is likely to be about half what the evidence from Scotland against the care tax suggests.
I am sorry, convener, but I understood your question to be about whether the income that councils get from charging goes back into services. We have no information to suggest otherwise. When we consider what councils are spending on social care, we do not get the impression that they are holding money back from it. In fact, in the discussions that we have had with partnerships over the winter, when there have been heightened issues to do with delayed discharge, local authorities have been pretty up front in coming up with additional resource through the tripartite arrangement in which we, health boards and councils put in money. I do not get a sense that they are holding any moneys back.
Good morning, cabinet secretary. We have had a few changes in the committee since the petition was lodged.
I will give voice to a sentiment that I think underpinned part of what the petitioners were trying to say to us. Given that the power exists under the 2002 act, they are concerned that although trying to negotiate an arrangement seemed to be the sensible thing to do, that has taken considerable time and, as they see it, nothing of substance has been forthcoming—although I note what the cabinet secretary has said to us in evidence. You are right to seek a voluntary agreement, but is there any justification for the petitioners’ sense that COSLA has shown a lack of rigour in pursuing the issue about the timescale? The petitioners’ feeling was that not an awful lot had been happening and that perhaps, given that ultimately you had a power, the Government should have been encouraging some sort of resolution of the issue a little more actively. Will you respond to their suspicion that there had been a lack of initiative and drive?
COSLA has made some progress, I am sure, although I understand the frustrations of people who want faster progress. We are trying to get 32 local authorities to agree to a new financial assessment framework, which has taken time because it involves talking about what should and what should not be disregarded. That is not without its challenges.
To be fair to COSLA, in the midst of looking at that issue it has also been looking at integration. We have been working on the national indicators to agree what the £100 million for delayed discharge will deliver and what integrated partnerships will deliver regarding the 72-hour discharge standard and keeping people out of hospital. It is a huge agenda. The people in COSLA who have been working on that have also been considering fairer charging. They have had a lot on their plate and have been trying to keep all those balls in the air and to make progress on all of them.
I can understand that people might be frustrated and feel that the pace has been too slow. The issues are complex and have required detailed discussions on each aspect, which is why progress has been a bit slower than people would like.
Is consistency ultimately achievable? Argyll and Bute Council suggests in its evidence that the geography of its area is such that it will always be difficult to achieve the degree of consistency that some people might regard as reasonable, based on how easily they could access services elsewhere. Is geography an insurmountable obstacle or can the concern about the geography of the area that the council represents be overcome?
There will always be differences around the edges. There is a host of challenges in delivering services, including the requirement for travel. The ability to access services in remote and rural areas is different from the challenge in an urban environment.
However, the financial assessment framework will be helpful. Why is something disregarded as income in one local authority when it is not disregarded in another? If you move from one local authority to another, the variations between what is disregarded in financial assessments are considerable. COSLA accepted that the variations are too large. If we can marshal those variations and create more consistency on what is disregarded or not disregarded, the differences will be more about issues such as rurality and the nature of the local authority area. We will get to a better place through the financial assessment framework. It will probably not eradicate every difference, but it will be a much fairer financial assessment than we have at the moment. We will look at that very closely as it emerges for approval from COSLA’s structures.
11:00
Inclusion Scotland has raised a specific caveat and the Equality and Human Rights Commission put forward a more general caveat and warning regarding compliance with the United Nations Convention on the Rights of Persons with Disabilities—in particular, article 19. Does the Scottish Government think that the framework is compliant and what has been done to ensure that it is compliant?
Yes. We have looked at the evidence that has been provided to the committee on the matter to date, and we do not consider that the general charging framework is incompatible with the acts and conventions that have been highlighted. We have also ensured that it is consistent with equality legislation. Obviously, we will review the position if more evidence comes forward. However, that does not mean that improvements cannot be made with regard to fairness. The framework might not be incompatible with the UN convention or whatever, but that does not mean that there is no scope for improving its fairness. That is where we are focusing our attention at the moment.
You said that you have taken the same view through the equality impact assessment.
Yes. As the committee is probably aware, the Equality Act 2010 places a general duty and a specific duty on local authorities: both duties are relevant in development of charging policies. Local authorities are required to have a policy to
“eliminate discrimination, harassment, victimisation ... advance equality of opportunity ... foster good relations between persons who share a relevant protected characteristic and persons who do not share it.”
COSLA’s charging guidance states:
“As a result of the general duty local authorities must consider how to promote equality and ensure that no group are put at a disadvantage by their charging policy.”
The guidance also states that local authorities should
“carry out Equality Impact Assessments on their non-residential care charging policy”
to ensure that they have no
“disproportionate impact on people of a protected characteristic.”
That is all about considering whether a policy is fairer to one section of the community than to another and whether people feel that existing charging policies are fair. I do not think that that means that any particular group is necessarily being penalised. It is about a local authority’s charging policy being different from that of another local authority, rather than it being about the policy varying within a local authority.
All that said, it does not mean—as I have said throughout this evidence session—that more cannot be done to make the policy fairer. It is one thing for there to be requirements under the law but it is quite another to consider whether something can be made fairer, which is the territory that we are in.
Can I conclude on the issue of fairness? Ian Hood, the co-ordinator of the Learning Disability Alliance Scotland, made a very forceful and reasoned contribution to our discussion in relation to what has changed in recent times in that the income tax allowance has increased significantly. Councils were able to charge £6,000 to £8,000 for over-65s, which used to be consistent with the income tax threshold. However, that threshold is now £10,000 and is set to go higher. So, there are individuals who are no longer regarded as being subject to income tax but who, because the charging threshold has not increased, find that they are regarded as being capable of meeting charging costs. I wonder whether—en route to abolition as a principle, which we have touched on—the issue of fairness is rather exposed by that discrepancy, which has arisen even over the period during which the review has been under way. Might it not be a route to alleviate matters for those who are least able to afford the charging?
We are having such discussions with COSLA—we are looking at inequalities and people who are on lower incomes and how we could do more to make charging costs fairer. You will forgive me for not going into too much detail, but there is recognition that we need more debate about the people who are on the lowest incomes.
I will take comfort from that.
There are no further questions. Does the committee agree to reflect on the evidence and to consider a paper by the clerk at the next meeting before deciding what action to take?
Members indicated agreement.
I thank the cabinet secretary for attending. I now allow you to go.
Thanks very much, convener.
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