Good afternoon. I welcome everyone to this meeting of the Health Committee. We continue to take evidence on free personal care as part of our care inquiry. The Deputy Minister for Health and Community Care, Lewis Macdonald, is with us and is accompanied by officials from the Scottish Executive: Adam Rennie, Donald Carmichael, Jean MacLellan and Paul Gray. I invite the minister to make a brief statement before we go to members' questions. I have allocated roughly an hour for this part of the meeting.
I welcome the committee's post-legislative inquiry and am grateful for the opportunity to give evidence to the committee. I will make brief remarks on the three main areas on which the inquiry has focused.
You will be aware that we have commissioned external research on direct payments and have therefore not taken evidence on them thus far, although we might come back to you to ask about specific issues.
As far as I can see, the big issue is the implementation of free personal care throughout Scotland. The committee has been given clear evidence that councils are implementing the policy differently. Some have even instituted waiting lists for elderly people who have already been assessed as being in need of personal care.
You put that point to me in the Parliament last week, and heard my answer then. The requirement on the local authority is to make an assessment of a person's need for services and, if it assesses those services as being required, to deliver them and to deliver without charge the services that are free of charge. That is an absolute description.
So there should be no waiting lists.
That is one of the areas on which confusion arises. People may be required to wait for different reasons. For example, when somebody is coming up for discharge from a hospital, and the local authority, the national health service and the other partners are looking to put in place a package of care to allow that person to leave hospital and go into a home—
I understand that.
Let me finish the point. The good practice that we look to partnerships to achieve for a delayed discharge involves putting the services in place within six weeks.
I understand that, but that did not answer my question. My question is clear and specific, as was my question to the First Minister on 18 September 2003. The individual who is assessed by a council as being in need of free personal care is entitled, from the date of that assessment, to that money. The First Minister made it clear on 18 September 2003 that that was the case. My question to you is simple. It has been made clear that any individual is entitled to that money from the date of their assessment. We understand the point about the circumstances of those who are in hospital, but that cannot be used by a council to say that an individual is not entitled to support from the date of their assessment.
What the person is assessed for is not a cash payment.
Indeed not. It is for services.
Yes, it is for a service, and they are entitled to that service—
From that date.
From that point. Clearly, however, putting the service in place will not be possible overnight in some cases. I gave an example of somebody who is just leaving a hospital. The service required might be complex. It is the same for somebody who leaves their own home to go into a care home or who requires to receive services in their own home. A complex package could be required to be put in place before the person can receive the service. The council should proceed accordingly. The way in which the council delivers the service is a matter for it. We do not try to micromanage that. Once the council has assessed somebody as being in need of a service, it should put its best efforts behind putting the service in place as quickly as it can.
Forgive me, but that is quite different from what the First Minister said to me on 18 September 2003. This is the nub of the whole issue. An individual elderly person is assessed as being in need of care. The law says that they should get that care. What you seem to be saying is that it is up to the councils to decide when they deliver the care.
It is not up to them to decide when they deliver the care; it is up to them to provide the service as quickly as they can. That is a slightly different—
So going on to a waiting list is okay, is it?
It depends what you mean by a waiting list. There are a number of reasons why a person might wait. For example, a person might wait for admission to a care home. A council might assess a person as being in need of certain community care services that are best delivered in the context of a care home.
But that is not the issue.
Let me finish the point. The council should then endeavour to provide those services. It might be that, for reasons outwith the council's control, it is not able to provide a care home place straight away. In that case, it should deliver to the person the services that can meet their needs in their own home.
I understand what you are saying entirely and I agree with it, but that is not the issue. A council, following an assessment, may write to the individual concerned and, while confirming that they have been assessed as being in need of certain services, may say to them that they must go on a waiting list. In one case, a person had to go on a list for 90 days. I have no idea where the council got the 90 days from, but it issued a letter to an individual, putting them on a waiting list not because it had to repackage their care or sort out their individual arrangements, but simply because it did not have the money to pay for the service. That is the point that I am getting at. I am trying to get you to acknowledge that surely that is not the right interpretation of what the Executive is asking councils to do.
Once a local authority has made an assessment, it should deliver the service that is assessed as being required.
So people should not have to wait for a service for—
The 90 days to which you referred is certainly not something that we have given councils guidance on.
The problem exists because of your lack of clarity and the lack of clarity in the consolidated guidance, which says that
The consolidated guidance is, as it says, guidance; it indicates how councils should proceed in carrying out the law. However, the Social Work (Scotland) Act 1968 and the Community Care and Health (Scotland) Act 2002 make it quite clear that councils should assess and then meet a person's care needs.
Can you make it absolutely clear that Dundee City Council is breaching its statutory duties in the example that I gave? Although the person has been assessed, the council has said that it will not backdate the payment to the date of admission and that the person will not receive any payment for 90 days.
In some cases, councils might well have misunderstood their obligations or have prioritised their resources inappropriately. We acknowledge that councils, like everyone else, operate in the real world and must put in place what they have assessed is required. However, in order to meet their statutory obligations, they should make services available as promptly as they can.
But that is not good enough. You have said very clearly that services should be provided once assessment has been carried out and that, although getting those services in place might take a while in some complex cases, that is not a matter of funding or lack of money. However, the issue that I have highlighted is driven purely by funding. Dundee City Council has told us that it does not have the money to implement free personal care as per your guidance. You have not made it clear how you will resolve that situation.
As I said in my opening remarks, my officials are working with councils that appear to have introduced waiting lists for reasons other than practical ones and are drawing their attention to the circumstances under which they must operate.
But Dundee City Council has said:
I will not comment on the specific circumstances of the Dundee case, because I do not have the documentation.
Well, I will give it to you.
That is very kind of you. As for my officials, they will endeavour to ensure that all councils are aware of their obligations and prioritise their resources in line with the current legal requirements.
If we leave aside specific examples—and I believe that we have heard clear evidence of such cases today—do you have any general powers to deal with waiting lists for care without having to revisit the legislation?
Government always has powers to direct local authorities, but, for good and obvious reasons, we do not make a habit of using them. Instead, we expect to continue our work with individual councils—and, indeed, with COSLA as the representative of the majority of councils—to address those points and ensure that we have the consistent practice throughout Scotland that we all want.
During our evidence taking, it became clear that the practice of operating waiting lists must be dealt with, as it is becoming widespread among councils. Are you or your officials aware of how many councils are in this situation?
After raising the point recently with councils, we believe that 15 councils operate waiting lists of one form or another. In addition, a couple of councils operate some form of waiting list for assessment.
What is the scale of the problem? How many people are waiting for their care packages?
We are seeking to bottom out such matters. Some 1,690 people are waiting for assessment in two authorities—the City of Edinburgh Council and Scottish Borders Council. Those figures are pretty clear. However, the situation varies among councils that operate other forms of waiting, and part of the difficulty is that we are not simply dealing with one variant. My officials are currently exploring such matters with councils.
When you talk about "other forms of waiting", I assume that the people who are on such waiting lists have already been assessed as needing free personal care.
Yes.
The committee heard that councils are delaying assessments because they know that care packages are unlikely to be available. According to witnesses, the delay can be considerable. Are you aware of the problem?
As I said, we are aware that the problem has arisen in two local authority areas. We are continuing to explore a range of issues with councils as part of our evaluation of the overall policy. There are provisional figures from councils on the number of people who are waiting for services, but we are in the process of compiling that information.
Moneys come from various sources, but the most important matter is that people should be well looked after at home. Until the committee's inquiry began, I had not particularly considered the people who entered sheltered housing—perhaps around 1985—and have grown old in that environment. Such people might need a care package, for example if they have just come out of hospital, but the package might be delayed. Funding from the supporting people programme could help in such situations. Sheltered housing complexes that provide care used to have managers who provided 24-hour cover, which helped other services to go in—primary care services, such as general practitioners, or ambulance services—to look after people who were waiting for care packages to be put in place. Most people who enter sheltered housing want to live independent lives—that is what it is all about. Are you aware that the loss of the supporting people grant is being blamed for problems? For example, organisations cannot afford to employ managers overnight or full time during the day. In addition, sheltered housing services are paying increased fees to the care commission. You might not think that such issues matter or relate to the policy on free personal care, but they are all related.
All the issues that you raise matter, and I am aware of them principally from a constituency perspective. Arrangements for the supporting people programme come under the portfolio of Malcolm Chisholm, the Minister for Communities. I understand the importance of joining up different aspects of policy. When a person is assessed as being in need of care, the assessment should be acted on, so that the person can move to the place where they will receive the best care or at least receive services in situ as an interim measure.
A doctor might decide that someone needs care, but then there is a delay because a social worker must make an assessment. Another, hidden delay arises between the decision being made that someone needs an assessment for a care package and the assessment being carried out. Not only might some local authorities be stalling, to avoid paying the money, but there is a shortage of social workers to carry out assessments.
I have ministerial responsibility for the joint future agenda, which seeks to encourage and enable health and social care staff to work together on matters such as single shared assessments, to ensure that there is the minimum delay in situations such as you describe. The approach ensures better sharing of the criteria for assessment as well as the assessment process itself. I acknowledge the importance of the issues that you describe, but the work that is being done to encourage closer working between health and social services is beginning to deliver benefits.
The convener invited the Minister for Finance and Public Service Reform to come before the committee to answer questions on the financing of free personal care, but we were assured that you would be able to handle such questions. I am sure that you are able to do so.
On community care services in general and free personal care costs in particular, the short answer is that we responded to the COSLA bid. Local government estimated the costs and we funded the estimate in full.
That brings us to the nub of the issue. The Scottish Executive asked COSLA for an estimate of the cost and funded that estimate. The Scottish Executive and COSLA were happy with the agreement, but people throughout Scotland are being affected because some councils, such as Dundee City Council and Aberdeenshire Council, are not happy with the agreement and say that the Scottish Executive's money is not reaching them. Waiting lists for care are operating in Dundee and other services have had to be cut to fund free personal care in Aberdeenshire. Did the Executive accept COSLA's general estimate without considering the need in each local authority area?
Since the agreement was reached with COSLA, we have monitored how the money that we provided has been spent, to ascertain whether it has been used as it was intended to be used. I do not think that there is a question of the money not reaching councils, but perhaps not all councils are choosing to spend all the money that is allocated for older people's services on such services. The 2004-05 figures, which are a matter of public record, show that the grant-aided expenditure for older people's services and other community care services amounted to some £1.5 billion, but spend in the same period was £1.4 billion—so there is a difference. In global terms, the allocation under GAE is not inadequate and falling short of the spend; the spend is falling short of the allocation.
Which local authorities are choosing not to spend the amount on personal care that they should be spending and are diverting money to other areas? The committee would be grateful if you could give an indication of that.
I am not sure of the status of individual councils, but Paul Gray might advise us.
The minister referred to the research that we are undertaking, which we hope will help us to get a better handle on the matter. It is clearly the case—I say this neutrally and not critically—that local authorities record their expenditure against services in different ways, so it is difficult to make a like-for-like assessment of the situation across local authorities. We are doing all that we can do to secure a common basis of understanding among local authorities of what is encapsulated in the services that we are talking about and how authorities account for such services.
The councils that responded to our call for evidence made the situation clear. Aberdeenshire Council states that its allocation is £7.2 million but it has spent £8.76 million. The figures are down in black and white. That information must be given to the Scottish Executive. The matter is straightforward. The Executive has allocated funding for the implementation of the new policy. Surely you should be able to tell us how much money the 32 local authorities have been allocated and what their spend is.
You will be aware of the usual rules that apply to local authority spend. Those rules apply also to implementation of this policy.
Can you provide us with information on the specific allocation to each local authority in the past financial year? The committee could pursue with each local authority how much they have spent in comparison with the allocation. That would help us to clarify the situation.
I am happy to do that.
On the point about the original assessment, there has been no increase in the level of assistance for free personal care since it was introduced. Obviously the numbers go up every year, as do costs. Will the minister comment on the fact that the one thing that has not gone up is the amount allocated to each individual? Does he have any intention of reconsidering that allocation?
A specific sum was allocated. The payment of £210 is meant to cover a specific part of the service, although a degree of estimation was involved at the time. Essentially, the figure reflects a judgment about what the market rate would be. In England, the equivalent payments range considerably, from £80 to £190 a week, and equivalent payments in Wales are at a different level from those in Scotland.
I believe that the fancy term is "fiscal drag". An absolute figure is put in and is not shifted. As each year goes by, in effect the Government saves money by not increasing the figure. Is not that what has happened? The allocation will have to be reconsidered; otherwise, it will increasingly become an issue.
That is one of the matters that we expect to examine as part of the evaluation.
My question follows on from Mike Rumbles's points. When you reconsider the financing for either councils or individuals, do you intend to calculate the allocations based on whether communities, such as Dundee and Greenock, have a greater need because there is a declining population and a higher percentage of elderly people in the population? Is it necessary to take into account the greater need in some areas?
There is no doubt that overall demographic trends are among the issues that will inform the next stage in the development of the policy. Relating funding to geographical variation is a more difficult proposition. I am not sure whether you are suggesting that.
Mike Rumbles made the point that, in some respects, there is greater demand in places such as Dundee. There is a fixed allocation per head of population, as is the case for much local authority funding.
Yes. Allocations in local government are based on a range of different formulas. It is important to bear it in mind that the payments that we are discussing are for old people who receive services in care homes, which account for only a proportion of total funding, which includes services to people in their homes and in sheltered housing.
I was thinking about services across the board and the proportion of elderly people who would be in need of them. You have indicated that the money is not ring fenced and that local authorities can use it for other purposes. It should be spent on meeting the needs of elderly people in other areas.
One of the criteria for allocation ought to be the percentage of people in each local authority area who are elderly. We know that the percentage is higher in some areas than in others.
Yes.
We also know the areas that have a higher proportion of elderly people.
We will want to see the evidence on the matter and to take it into account.
We move on to the vexed question of meal preparation, although I hope that we will not have to spend terribly long on it.
Have the Executive and COSLA reached an agreement on the issue yet?
Not quite, I am afraid.
Can you assure the committee that any agreement will not involve a dilution of the clear position that was finally reached in the Executive guidance, which stated that meal preparation should be included? That point was clear in the public information that was issued.
I cannot give a blanket assurance. I am not familiar with the detail of what is provided in every local authority, which is important, but we are seeking to reach a commonsense understanding of what the guidance means, what it ought to mean and what the policy intention was. Clearly, the policy intention was that people should receive assistance with the preparation of food free of charge, where that is one of their assessed needs. However, we recognise that there is not an open-ended requirement for local authorities to provide assistance with any preparation of any food that comes into the user's imagination. The commonsense objective that we are seeking to agree is to enable people to receive the services that they require.
I want to be absolutely clear about what you are saying. Your interpretation of the policy intention is that, where meal preparation is an assessed need, the service should be included in free personal care. That is my understanding of what the guidance said.
The law refers to
So the point is to ensure that all local authorities understand that.
It is important that all local authorities should have a common understanding of the law. The law does not say—and our guidance does not require—that the preparation of food should always be a free service. It says that there should be assistance with the preparation of food where that is an assessed need. Cooking the meal and providing the food for it are not explicitly covered by the provision, which covers assistance with the preparation of food, where that is assessed as something with which a person requires assistance.
You have answered the question that I was about to ask, which concerned something that was raised with me just before I came into the meeting. The issue relates to people who have not yet had an assessment for free personal care but whose home support worker has perceived that there is a need for help with the preparation of food and whether that is chargeable.
I am sorry, do you mean—
Given what you have just said, I presume that if a person has not had a formal assessment for free personal care but needs help in relation to the preparation of food and the home carer has realised that the person needs help and gives that help, that is chargeable.
That would be chargeable. Any service that is provided prior to an assessment is provided at the discretion of the local authority and whether it charges or not will be at its discretion. The law does not require the local authority to provide for free any service for which a need has not yet been assessed.
Clearly, there is a great deal of misunderstanding about this issue. It is an area that badly needs to be clarified.
I completely agree. Local authorities first flagged up the issue towards the end of last year. Since September last year, we have been actively working with them to reach a commonsense understanding that reflects the intention of the law. The difficulty arises from the fact that the legislation does not define in detail
We were all struck by Stewart Sutherland's evidence. In his view, what was important was what was required by an individual at the time of their assessment. Basically, any aspect of food preparation with which they needed assistance could come into free personal care if they were assessed as needing assistance with that particular part of the food preparation. His view was that it should be dealt with on that individual basis rather than under an umbrella policy that was applied by a council. Do you broadly agree with that?
Broadly. However, it is important to emphasise the word "required". In other words, any required need should be covered.
Right. I think that that is clear.
It has not come across my desk particularly. I see that none of the officials around the table is conscious of those points either.
Will you consider the evidence that has been placed before us, which suggests that that practice is taking place? Will you consider what action you can take to ensure that it does not continue?
I would be happy to consider the evidence and act accordingly.
You are aware that free personal care applies to people in residential care and people in their own homes. There is a ceiling on the amount that people in residential care can receive for care but there is no such limit for people in their own homes. Someone who remains in their own home could have a complex package of care that is far more expensive than that which is received by someone who is in residential care. I am not suggesting for a minute that that should not be funded but I would like to know what the reasons are for having a ceiling on the amount that people in residential care can receive but not on the amount that people in their own homes can receive.
The difference is a practical one. Where services are provided in a care home, we simply set a tariff that says that level of funding will be provided. That comes back to the point that was raised earlier about why the amount is the same now as it was a couple of years ago. We have made a best estimate—which we think is pretty accurate—of what the market rate for those services would be. Clearly, people in their own homes do not have such ready access to the level of service that might reasonably be provided.
At the risk of sounding trite, I would say that the question is a fair one and we are examining it in the context of the review, which will be finished at the end of this year. It will take us a year to carry out the review because the issue is complex. We will have to be clear about the underpinning rationale for the various forms of payment that are made. I do not have anything to say on facts in addition to what the minister said, save to point out that we are considering the matter actively.
Anybody can be cared for in their home, if the level of care that they need can be provided. As no ceiling has been set, who decides whether a person is allowed to have a care package at home? Is the decision made by the local authority? Does the Scottish Executive set no cut-off point at all?
The local authority makes that judgment, exercising the autonomy and discretion that we think local authorities should exercise in delivering the policy.
But work is being done on the matter, so there will be a response on it.
We are considering the policy in the round. We will consider all the aspects and ensure that the funding that we put in is used equitably and to deliver the objectives that we have set.
I move on to affordability and sustainability. We have heard evidence that the policy is discriminatory, in that under-65s who require care packages are not entitled to free personal care. Does the Executive have proposals to extend free personal care to other groups such as under-65s with Alzheimer's disease? I come to the $1 million question. Research by David Bell and others at the University of Stirling indicates that the cost of free personal care, as the policy stands and without bringing in any other groups, is likely to treble. What are your comments on the sustainability of the policy?
As members will be aware, David Bell's work looked many years ahead. The conclusions were that the policy is affordable, although costs will increase. We concur with that, although our evaluation is partly to allow us to make our assessment of that. We will certainly take David Bell's evidence into account. Likewise, as a consequence of the review and evaluation of the policy, we will consider whether to extend it to other groups and, if so, how to do so. We have commissioned work on younger disabled people that may be relevant.
I am particularly interested in the extension of the policy to include younger disabled people, on which we heard evidence. I suspect that younger disabled people would want to stay at home with care packages that are suited to their needs, which are different from those of the elderly. When do you expect to report on that?
We will not attempt to report in pieces in advance of the full report, which we hope to produce by the end of this year. We have research in hand on younger disabled people but, to put the matter simply, I do not want to commit the minister to take a particular course of action at this stage.
That is my job.
Yes. All I can say is that the issue will be included in the review and the report.
Minister, are you confident that, in the medium to long term, the policy is sustainable, given the costs?
Absolutely.
We now move to questions on the care commission. I have a two-part question on inspections. The first part is on duplication of inspections. It must be said that even local authorities report obvious duplication between their inspections and the care commission's. As we understand it, only eight of the 32 local authorities have agreed memorandums of understanding with the care commission. Do you agree that duplication of effort ought to be reduced, for example by sharing inspection information and results with local authorities and pursuing memorandums where possible?
I agree that every effort should be made to reduce duplication and to avoid it where possible. However, a local authority's role in relation to a care home is clearly different from that of the care commission. The care commission is a regulator and it sometimes shares an interest in a service provider with a range of other regulators—such as the Social Work Inspection Agency, Communities Scotland, NHS Quality Improvement Scotland for some health services and Her Majesty's Inspectorate of Education for education—with whom sharing inspections and asking a common body of questions makes sense. A local authority's interest in a care home is often as a customer.
Well, he who pays the piper calls the tune. However, there is still an enormous crossover of required information, which is presumably why we have eight memorandums. I am surprised that there are not 32. Is there anything that we can do to push that along?
We would certainly like there to be 32 memorandums and the care commission is working actively towards that end. The commission's relationship with local authorities is slightly different from its relationship with other regulators, but I agree that it makes good sense for the local authority and the care commission to have a memorandum as far as possible.
Can you do anything to make the commission achieve 32 memorandums a little faster?
I can simply encourage it and the local authorities to move in that direction. We are doing that.
What about streamlining, on which I gave the example of the hospice?
To address that would require some legislative changes, as you are perhaps aware. We would be interested to hear the committee's views on that on completion of its inquiry.
Streamlining would require legislation, whereas addressing duplication of effort would not.
It would. However, on the duplication of effort, under the Regulation of Care (Scotland) Act 2001, I meet the chair and chief executive of the care commission twice annually. One of those meetings with the chair will take place next month and I will make to her the points that you have raised with me about duplication and the fact that eight memorandums are good, but 32 would be better.
On a number of occasions, care providers raised with us the issue of fees. In your opening remarks, you said that there is a difference between early years services and services for the elderly, in that fees do not have to be paid for the former. You said that there was a sound policy reason for that, which was to stimulate the market in child care. Why do you not want to stimulate the market in care for the elderly? That would ensure wider choice for those who use the services.
That question raises several different angles. First, on what the relationship between the regulator, Government policy and the market should be, care homes operate in quite an active market. By the coming financial year, we will have reached full cost recovery for care homes. There is no evidence that that is inhibiting the market or the provision of services. New entrants are coming into the sector with new services and there are signs—through Scottish Care, for example—that care home providers are working on raising quality and achieving consistency of service. Scottish Care welcomed the announcement on fees this year, because it recognised that it could readily live with those fees.
Why does the elderly care sector have to pay for its regulator, whereas other sectors, such as that which the Food Standards Agency regulates, do not?
That could be a general question, but I will answer it as far as I can without going into detail about other agencies. The situation reflects market sensitivity. The regulatory burden of some aspects of food standards might be significant for business outcomes, whereas we do not believe that that is the case in the sectors in which we seek full cost recovery for the care commission.
That was not a very satisfactory answer, but perhaps it is a general question for the Executive rather than a question for the minister. We may pursue the general policy.
That is correct.
You largely dealt with what I will ask about in your introduction, but anything that you can add would be welcome. The Executive meets the costs of registration and inspection in the early-years sector but not in the elderly care sector. What is the rationale for the disparity?
The principle is that the Government may make a policy choice to subsidise. However, even when it does that—as we have with child care services—a degree of transparency would not exist if we did not have a general policy of full cost recovery, because the care commission publishes the costs of inspecting services. I hope that that makes sense. In other words, we have a policy of full cost recovery that means that all the charges for all the sectors are made public, but in some cases we make a policy choice to subsidise those costs.
Care commission staff and others raised concerns that that skews their priorities in some way because care homes expect a certain level of inspection for their money. That relationship exists because of the fee structure. If the fees did not exist, the care commission would be able to focus on those homes or services that need extra levels of inspection, but that cannot be done because of the fee structure. Do you not accept that that is a major downside of the self-funding policy?
No, I do not. I recognise the situation that you describe, but the care commission is not obliged to carry out two inspections of every care home each year—one of which has to be unannounced—because of the fee structure; it does so because the law says that it should. We took the power to vary that in the Smoking, Health and Social Care (Scotland) Act 2005, and I fully expect that we will use it. We will therefore be able to offer the care commission greater discretion in relation to care homes, for example, and allow it, as Shona Robison suggests, to focus on those providers or sectors that cause it the greatest concern, irrespective of the fees regime.
Following on from a statutory instrument that we agreed previously, are you doing anything to reduce the regularity of care commission inspections?
We have taken the power to do so, and we are considering what to do about it. I am consulting colleagues across the Executive, because this is not just a Health Department issue; the Education Department has an interest, for instance, in child services and the Development Department has an interest in housing support. We are considering the possibilities.
But the issue is under active consideration.
It is.
We still have to deal with the issue of complaints to the care commission, and we are running a little over time. Janis Hughes wants to raise that issue. This will be the end of our session with you, minister.
We received a large amount of written and oral evidence about the complaints system. Anonymity and the protection of those who want to complain but who fear recriminations was raised fairly frequently. Is the current system for registering complaints satisfactory?
It is important to recognise that once a complaint is made about a service it will be acted upon, and should the care commission uphold the complaint it will continue to monitor the provision of that service. If a complainant finds that their situation does not improve or becomes worse following the complaint, the monitoring should pick it up.
Anecdotal evidence suggests that people are reticent about complaining because they fear recriminations, so what about the anonymity factor?
Complaints can currently be made anonymously. It does not often happen, but when it does the care commission prioritises them, because it assumes that there is a reason for such complaints and it acts accordingly. Investigating a complaint can sometimes be easier when the person identifies themselves, because they can give direct evidence. However, when a person wants to complain anonymously they can do so, and their complaint will be given priority and treated as important.
On the reporting mechanism for complaints, one issue that was raised was that when complaints are made or a problem is identified during an inspection, the care home or provider can take action to remedy the situation but it is not always documented, for example online. That could lead to the wrong impression being given to people who are looking for information about an establishment. COSLA raised the issue of the mechanism for communicating complaints to service providers, such as local authorities. Is the mechanism effective or does it need to be changed?
When the care commission believes that a complaint or an allegation of abuse or other action is serious and significant, it has discretion to inform other agencies about it. We expect it to do so where necessary to protect the interests of the general public. However, that decision is left to the discretion of the care commission. There would be no great merit in our instructing the commission to pass on the details of every complaint, because some are not of major significance to users. That is why the care commission has been given discretion to share significant information that people ought to know about. We do not want to create unnecessary bureaucracy by having the commission report relatively minor complaints, which might get in the way of its communicating the important ones.
I take your point, but I am sure that you understand where local authorities are coming from when they say that they are concerned about not being notified of incidents that are reported to the care commission that reflect on service providers, because that means they cannot take appropriate action.
That certainly should not happen. If the care commission finds out about something that impacts directly on the interests of a local authority, we expect it to use its discretion to pass on that information. As I said, I will soon start meeting the convener of the care commission regularly. If the committee wishes to provide any examples that I ought to draw to her attention, I would be happy to do so.
You said that the care commission has discretion to share information with other agencies. Do you agree that it should also share information with residents? Surely if a complaint about a care home has been upheld, the other residents have a right to know what has been going on in their home. Would you be prepared to raise that issue with the convener of the care commission at your next meeting?
I am happy to seek her views on whether there have been problems in that regard. There are some upheld complaints about which it would be disproportionate to tell every resident, because it might cause undue concern. However, where complaints about a serious situation have been upheld and residents ought to know about them, I expect a procedure to be followed. We have to bear in mind the fact that there might be data protection issues, which can limit the degree to which information can be shared.
I am sure that information could be provided in a way that does not breach confidentiality. The care commission's view was that it was the care provider's duty to provide information. However, the evidence that we heard from concerned relatives was that it might not be in the provider's interests to share such information, therefore the care commission should ensure that relatives are aware that a complaint has been made, although they need not necessarily be told about the circumstances in great detail. I would appreciate it if you could raise that matter.
I am happy to do that. It would be helpful if either Shona Robison or the rest of the committee shared details of cases that I could raise.
I thank the minister and his officials for coming along. I will suspend the meeting for a minute while we swap over witness name plates. I do not want everybody to run away, because the suspension will not be long.
Meeting suspended.
On resuming—