Community Care (Local Forums)
The final item of business is a members’ business debate on motion S3M-7667, in the name of Rhoda Grant, on supporting local forums’ involvement in delivering community care. The debate will be concluded without any question being put.
Motion debated,
That the Parliament recognises the value of supporting local forums’ involvement in delivering community care; notes the research undertaken by the Inverness and Highland community care forums that highlights the vital role that lunch and social clubs play in supporting older people in the Inverness area; believes that these forums provide a vital service in creating and maintaining social networks and alleviating the effects of social isolation; considers that, when funding for the Highland Community Care Forum ceases in June, local forums will be left without any independent support and will not survive, and would therefore welcome an extension to Highland Community Care Forum’s present contract to cover the gap between the old contract and the new and a continuation of support for local forums through the new contract so that they continue to have a part to play in the delivery of future localised community care services and are able to undertake consultations on service provision independent of funders.
17:08
Highland Community Care Forum has supported service users and carers throughout the Highlands for more than 19 years. It receives much of its core funding from Highland Council and NHS Highland. Its role is to offer advice to carers and service users and to build capacity in communities. It operates through a headquarters and 11 local area forums that are based throughout the Highlands. The forums are directly supported by seven workers.
Carers in every area of Scotland talk about the isolation that they feel when they first become full-time carers and the difficulty that they have in accessing services. The geography of the Highlands only adds to that isolation, so Highland Community Care Forum is a lifeline for carers in the area.
The forum’s current contract is for a number of services. The mental health aspect of collective advocacy is delivered through Highland users group—HUG—while the learning disability aspect is delivered through people first. The forum also tackles the stigma that is attached to mental health; provides an individual advocacy service for carers; supports service user and carer involvement, engagement and consultation; and supports young carer involvement, engagement and consultation. Part of the contract is being renegotiated, part is being retendered, and the part that deals with service user and carer involvement, engagement and consultation is being ended, with the consultation aspect being brought in-house. The combined impact of the changes threatens the core of the organisation, as it will lose the employed support that helps local forums to exist.
Care forums support the wider voluntary sector and organisations providing services for their client groups, as well as providing vital and close links to carers and service users. The forums also help voluntary groups to source and secure funding from various charities and other organisations. Anyone who works in the voluntary sector knows that that job is complex and can be hugely frustrating. Removing the organisation that supports that work will mean a loss of expertise and community groups no longer being able to access funds. That will eventually lead to greater dependence on the public sector.
A lot of the Highland Community Care Forum’s work relates to adults, although it also provides support for young carers. It has worked with young people in promoting disability awareness, too. The forum also has local awareness and problem-solving roles. It recently identified a problem in an area that had been targeted for loft and cavity wall insulation for older people. The scheme was likely to be undersubscribed, as the older people concerned were not fit to empty their lofts. That perhaps says something about how we develop policy for older people. However, the local forum identified the problem and found a solution, and older people benefited from the much-needed insulation.
The forum supports voluntary bodies that organise lunch clubs and social activities for the elderly. I was recently contacted by constituents who were concerned that Highland Council had increased costs to people using day centres. The council’s argument was that day centres were for people who needed intensive intervention, and that lunch clubs would be more appropriate for those who were more independent. We now face the prospect of losing the very organisation that supports volunteers in running such clubs. I hope that other groups are developed to meet those real needs. Older people are being forced out of day centres, and no other services are provided to help them to deal with their needs. Many of them will lose their social contacts and, with that, their confidence and independence, and they will face even greater isolation.
It could be argued that the consultation aspect of the Highland Community Care Forum’s work is the most important one. How can services be tailored to the needs of users if they are not involved in the decisions? I understand that consultation is to be taken in-house, but I question whether a consultation that is undertaken in-house by the body with a vested interest in the outcome can be fully accountable and transparent.
Highland Council and NHS Highland are currently consulting about taking all elderly care into NHS control. Although I believe that there is merit to that policy if it is implemented correctly, and I am sure that it will benefit older people, there are already concerns that the exercise is a consultation in name only and that those two organisations have made up their minds as to the outcome. Now more than ever, an independent body is needed as an honest broker in that process. It is doubly disappointing that the change in service provision is being used as a reason to take the service in-house.
Although it is funded by the public sector, Highland Community Care Forum is an independent organisation that can act as an advocate for carers and service users. The forum’s close relationship with those groups of people means that it is ideally placed to reach out to them for the purposes of the very consultations that I have just spoken about.
Care is moving from acute institutions to become more community based. We must ensure that that does not place a bigger burden on carers. If they are unable to cope, they need support and information, and that support is often not joined up. My parents recently needed additional help because of illness, so I have first-hand knowledge of how challenging it can be to organise such support. We had a fair idea of what was possible and who we should speak to, but it took us weeks to get the care organised. The process was complex, and complexity leads to communication failures. We spoke to people in hospital, but the relevant information was not passed on to those concerned in the community. We needed to start again with them, and then to liaise between social workers, home carers and care managers until we had a care package in place. It was more like a negotiation about what was needed, what was allowed and what was possible.
Had my parents not had our support, I am sure that they would not have received the care that they needed. When people face such problems they need an independent advocate who will work on their behalf. I do not believe that people will be willing to pursue that advocacy from very same organisation that let them down. It is Highland Community Care Forum and other organisations like it that take on that sort of role and, at times of diminishing budgets, they are needed more than ever.
It is really sad that when cuts to services are faced, it is often the most vulnerable in our communities who lose most. Because of their responsibilities, carers do not have a load of spare time to volunteer and support others. We know that they suffer financially, so any time that they have needs to be spent working to earn an income. Without the support of paid employees, local forums would cease to exist.
Carers and service users need our support, especially now, when they are at the bottom of the pile and tend to lose out more. They need a voice and a strong advocate. Highland Council and NHS Highland may not always like what Highland Community Care Forum says, but it voices the thoughts and concerns of the people it seeks to represent. It is the first point of contact for many carers, who cannot afford to lose it.
17:15
I congratulate Rhoda Grant on giving us the opportunity to debate what is a very important subject for an increasing number of people across Scotland.
I represent a constituency in Aberdeenshire, which is less remote than the Highlands but where a higher proportion of the population live in a rural setting than is the case in the Highlands. Therefore, many of the issues that Rhoda Grant has delineated are familiar to people who live in Aberdeenshire.
It is important that we have in place mechanisms and structures that allow people to make a contribution to those in need. Voluntary arrangements whereby voluntary bodies deliver community care and are involved in its planning are an important part of ensuring that we have a focus on the needs of people in local communities. It is important that people in those communities are involved in the process.
I am not sure that I share some of Rhoda Grant’s concerns about how the council may choose to restructure things. I am not speaking about a council that is a political ally of mine, so I am entirely neutral from that point of view. It is certainly the case that we must ensure that we have arrangements in place that deliver the best value for the money that is available.
We should remind ourselves that the current budget, on which we will make a decision next week, includes some £70 million for a change fund in health and social care, so everyone who chooses to vote against the budget next week will be voting against the provision of money to ensure the appropriate kind of change.
It is important that there is a voice for older people. I am not the only member whose years are marching on more rapidly than they used to and who has seen parents in the system—albeit that, in my case, that was some distance back. It is important that we reduce red tape and improve joint working. Today’s announcement of £2 million for a system of lead commissioning is part of how we can tackle the issue.
There is no question that the care budget is enormous. Because the pressure on it from the rising proportion of our society who are aged will continue to increase, it is important that we leverage voluntary action into caring for our people, but we should not imagine that that is particularly new. I was involved in voluntary action many decades ago and I know that the same is true of other members. Today, however, we expect a great deal of the voluntary sector, which is why it is important that we support it by ensuring that lunch clubs and social events for older people are supported and that there are links between older people and younger people so that we do not simply create an environment in which people who are already close to those in need provide additional care.
I very much agree that we are debating an extremely important subject and I look forward to hearing what the minister has to say on it.
I see that Richard Simpson is likely to speak in the debate and I encourage him to speak to his colleagues about the proposed national care service, which kind of runs against the proposals that we have heard discussed today. Such a service is essentially centralising, which is one reason why it would not have my support. Nonetheless, considerable discussion is to be had between now and the May election; tonight’s debate will be a little part of that.
17:20
I thank Rhoda Grant for securing a debate on a Highland issue that affects many people. I also take this opportunity to commend Maureen Macmillan, one of our former MSPs, on her role as chairman of Highland Community Care Forum, and Caroline Thomson—who is in the gallery tonight—who is the ex-chairman of NHS Highland and is now the vice-chair of the forum.
There is no doubt that local forums and all voluntary sector organisations need experienced leadership and a thoroughly professional approach. Between 1999 and 2003—the first parliamentary session—several local service users contacted me to ask how the Highland Community Care Forum was being used to provide front-line services such as carers and support. I wrote to Highland Community Care Forum to ask for that information and I was sent the annual report. My accounting knowledge was not sufficient to find the information that I sought on behalf of my constituents, so I asked one of my former colleagues at Inverness College, who lectured in accounting to degree level, whether he could get the information that I needed. He took the glossy annual report and spent a considerable amount of time searching for the information that constituents asked for, such as what was spent on salaries and what was spent on carers and support. His conclusion was that the information was impossible to find; it just was not there.
I remember that experience clearly, and because of it, I welcome the new chairman and vice-chairman, and the approach that is being taken by Highland Council and NHS Highland to tender for services in line with national guidelines, and to focus on outcomes, information and transparency.
The Highland Community Care Forum has been built up over 19 years. When I think about my experience, I find it odd that the organisation’s executive director’s briefing states that the forum has been closely monitored for only three years. That is not good enough in this day and age. In difficult financial times, all publicly funded organisations should be accountable for spending taxpayers’ money, particularly given the total value of the current contract of £1.4 million. How many hours of lifeline respite care could be provided for that money?
I confess that I was not aware that the Highland Community Care Forum offered advocacy services. I regularly refer constituents and carers to Advocacy Highland—I referred two in January—and I cannot speak highly enough of the manager, Sheilis Mackay, or of Linda Renton and the other staff who carry out their duties in the most professional, sensitive and supportive manner. There is nothing but good feedback from local people who need and value that service. I hope that NHS Highland and Highland Council will also look at those organisations, which are delivering excellent services in these difficult times, to see how they can be supported. It is not good practice to continue funding without focus on outcomes and with no accountability.
I am not surprised that the Highland users group, under the excellent stewardship of Graham Morgan, successfully achieves all its obligations within the service delivery contract. As an MSP, I regularly receive updates and reports from HUG, and I recently attended a meeting in the Fishertown day centre for mental health patients in Nairn. The meeting was well attended; we heard from users of the service as well as from staff and council officials. That is support for vulnerable people at its best.
When I read about the lunch clubs that HCCF and Age Concern Scotland run in the most remote and rural areas, I wished that I had known about them before, given the unsuccessful struggle that I have had to maintain the lunch club for older people in Kilchoan, at which over-80s are serving other over-80s plates of soup. This week, I received a letter from Fergus Ewing about the threat to the lunch club in Caol, and I totally support him on that. Where is HCCF when those services are being withdrawn? How many lunch clubs does HCCF run, how well are they attended, and what funding is used for the purpose?
Will the member give way?
I am in my last seconds.
Finally, I commend Highland Council and NHS Highland for bringing greater scrutiny and accountability to the funding of local voluntary organisations, and I trust that that will strengthen the Highland Community Care Forum to win contracts, provide services and support vulnerable people in an accountable and transparent manner in the future.
17:25
I thank Rhoda Grant for securing the debate on an issue that needs to be looked into. Local community care forums are well utilised and are an integral part of many older people’s lives. As Rhoda’s motion states, they provide support and help to alleviate isolation—actions that most of us would agree with. The 11 community care forums in the Highlands have effectively built up skills and networks in communities and are reaching out to those who do not necessarily want or need a clinical or statutory solution, but who want independent support in their communities. I welcome the research by the Inverness and Highland community care forums that highlights the vital roles that they play. Highland Community Care Forum is now more than a decade old and has, I gather, achieved some pretty good results.
The independent support that community care forums provide helps to build efficiency in the statutory organisations, including by saving money on hospital admissions. For example, Nairn, with its set-up of a modern community hospital supporting a network of community care and rapid response systems, is a particularly good model. I understand that the Nairn anticipatory care pilot reported that for every £1 spent on home care, £6 was saved in hospital admissions.
We all need to pay attention to the Scottish patients at risk of readmission and admission data that show the numbers increasing, at great cost to individuals and to us as taxpayers. We know that with training, education, support and involvement in service development, the partnership between the community, the carers and the statutory services can have a transformational effect.
I have been lucky enough to have the privilege of visiting HUG, which is one of the delivery organisations, and the Aberdeen mental health project for users and carers. Projects such as those have an important part to play. HUG is certainly a vibrant organisation—questioning that was supposed to last 15 minutes went on for about 45 minutes, and I certainly felt grilled. We need to listen to the voices. I pay tribute to the staff for their energy and dedication, considering the fact that in the voluntary sector they are constantly in a situation in which their jobs are not secure, unlike jobs in the public sector—until recently.
A needs assessment that was carried out in Smithton, Culloden and Ardersier provided some invaluable insights. I was struck particularly by the observation that hearing problems are a barrier to social inclusion.
The general problem is that we have had an astonishing increase in longevity of two and a half months every year since 1997. Now more than ever, we are challenged to meet the needs of older people, not least because the increasing years of longevity are not matched by increasing years of good health.
There is another comment in the report that I referred to that is worth recording. It is that the creation of stronger clubs and increased social networks is all about increasing wellbeing and independence and reducing dependency. Part of the approach is to identify and use the skills of the older people themselves to the full in various organisations. If 80-year-olds are serving other 80-year-olds, that is great if they are willing, able and happy to do it; it is not if they are forced to do it.
The retired and senior volunteer programme of Community Service Volunteers was curtailed by the Government in its clumsy transfer of resources, with no thought for the consequences—half of the development officers were made redundant. We have also seen the number of healthy living centres reduced from 45 to 25, despite the temporary reprieve that was given by the intervention of the Cabinet Secretary for Health and Wellbeing.
On that point, it is worth reminding Richard Simpson—as I am sure he has been reminded before—that most of the centres closed under the previous Labour-Liberal Administration. I caution him about saying too much about that.
I will not take that interruption at face value. When we debated the issue before, five centres had closed under Labour—so we were not totally blameless—but I am told that in the past two years the number of centres has gone down from 45 to 25. Some of the centres may have been integrated into other care, which is fine, but we are currently investigating exactly what is going on. The centres are an important and integral part of community activity. My point is that all the organisations are vulnerable to the current cuts, which we need to look at carefully.
I will finish by responding to Stewart Stevenson’s comment. There is a fundamental difference between what is proposed by the Scottish National Party today and what the Scottish Labour Party proposes. We are not proposing a major organisational change—I cannot repeat that often enough. The community health partnerships, which are statutory bodies that were put in place by the National Health Service Reform (Scotland) Act 2004, exist to provide the sort of community partnership that can lead joint social care locally, not nationally. There is no national structure and, however much he cares to mention it, that is not going to occur. The important thing is that what the SNP is proposing today is the alignment of budgets that was introduced in the Health Act 1999. That has not worked except in a few circumstances and it will not work on a voluntary basis. The time for action in merging these budgets has come, and part of it is about protecting voluntary groups of the sort that we are discussing tonight.
17:30
It has been an interesting and helpful debate. I commend Rhoda Grant for bringing the debate to Parliament and I am pleased to have the opportunity to conclude the debate on behalf of the Scottish Government.
I make it clear at the outset that the work of Highland Community Care Forum and local forums is to be commended. They undertake a lot of important work in engaging with local communities and providing much-needed services to service users and carers, such as the advocacy that was referred to earlier. I am sure that all members support community engagement, advocacy and support for carers. The work chimes very well with what we are seeking to achieve at a national level.
Advocacy services are important, especially for people with learning disabilities and mental health problems. We know that advocacy can make a difference and we have various strands of work under way to ensure the appropriate provision of advocacy services throughout Scotland for people who need them. Our carers strategy, which was published last summer, also reinforces the importance of advocacy to the most vulnerable carers.
Community-led action to establish networks of local support groups is immensely important in remote rural areas. The most vulnerable people rely on those groups to help them to come together to support each other, to exchange views, to receive information and advice, and so on. Even when the volunteers are over 80 and serving soup, it is about building community capacity and supporting people who are already doing that work. Community engagement, too, when done properly, is immensely empowering and rightly gives people a say in how their communities are run, what services they value and how those are provided. People then have a stake in the community and are equal partners in all the decision-making processes.
Highland Council must make its own decisions about retendering, negotiating new contracts, extending existing contracts, how it takes forward community engagement and how it supports community groups and builds capacity at a local level. I make it clear, however, that procurement decisions should rarely be based on price alone. The Scottish Government’s guidance on the procurement of care and support services underlines the need for greater emphasis on quality than on cost. The procurement of care and support services should involve service users and carers as active partners in defining their needs and the outcomes that they require. That is one of the guiding principles in the guidance. The guidance also recommends that councils be proactive in involving service providers in service design and the development of service specifications. They should aim to maximise service providers’ specialist knowledge and experience while ensuring that they do not gain a competitive advantage in the subsequent procurement process.
In all of that, what are important are the outcomes that are achieved for people who live and work in the area, including—or especially—the most vulnerable, such as the older population, those who are ill or frail, children, people who are isolated and carers. I am sure that there will be a role for both the statutory sector—the council and health board—and the voluntary sector in helping to achieve positive outcomes. Effective partnership working is key to better outcomes.
I wonder whether the minister would like to comment on the point about the service provider taking things in-house and becoming the organisation that operates the advocacy side. In such circumstances, the advocacy is not really independent. Does the minister think that that is a problem on which some guidance is needed?
I suppose that service users will be looking for the best advice. I understand the concerns that exist, but we must look at this from the same end of the telescope as the service user is looking at it and support the best-quality advice. We should bear those matters in mind, as they are important.
I understand that Highland Council has indicated that the existing level of resources for support to carers will be maintained. If that is indeed the case, that is welcome. The organisation or organisations that deliver support to carers in the future must deliver good outcomes for carers and those they care for.
I am pleased that there is a commitment by the council, health board and the voluntary sector to provide much-needed support to carers and young carers, including those who live in the remotest areas. We want there to be local implementation of our national carers and young carers strategy.
Subject to approval of the draft budget bill, we will have a further £5 million across Scotland in 2011-12, on top of the £9 million over three years to 2011, for carer information strategies. NHS Highland will get its share of that money to further support carers and young carers. We have also awarded £5 million to the voluntary sector for the provision of short breaks across Scotland. Funding for the first round will be given to good voluntary sector projects after bids have been assessed.
My understanding is that the council is seeking to achieve even more support for community groups to support activities ranging from social groups and networks, such as lunch clubs, classes and health-promoting activities, to formal service delivery.
There is a role in Highland, and throughout Scotland, for community capacity building, including expanding volunteering and establishing social enterprises. That ties in with our reshaping care programme. Our community capacity building strand of work will help to support the implementation of the change fund—the £70 million to help to optimise the independence and wellbeing of older people at home or in a homely setting. We envisage that the community capacity building work will mean close working with established third-sector organisations of all types and sizes and with specific geographical and interest-group communities.
I will end on a positive note by observing—in relation to Richard Simpson’s point about the integration of health and social care—that there is an emerging political consensus that the end point that we all want to get to is a single system that integrates health and social care. There is a healthy debate to be had about the best model for getting to that point. There are merits in the lead commissioning model, not least because the legislation, going back to the Social Work (Scotland) Act 1968, is complex and a lot of complex legislation would be needed to change that. However, we can agree on the destination point, because we think that that is best for service users and patients. If we can agree on that, we will have made some progress.
This has been a useful debate. I hope and expect that the local forums that Rhoda Grant has brought to our attention will continue to be supported and that there will continue to be good engagement with local forums and groups.
Meeting closed at 17:38.