Elderly and Disabled People
The next item of business is a Scottish Conservative and Unionist party debate on motion S1M-790, in the name of David Mundell, on services for elderly and disabled people, and amendments to that motion. I call Mary Scanlon to speak to and move the motion.
I am delighted to speak to the motion. The Executive and the Parliament will be judged by how they care for the most vulnerable in our society. I am pleased to take part in this debate, to ensure that the views are heard of those who are unwilling or unable to speak up for a better service.
I commend the Health and Community Care Committee for allocating time to this issue and recognising the need for care in the community to be a priority for the health service. I have not been reassured by any of the evidence that we have heard in that committee. If anything, the submissions have served only to heighten my concerns.
Although we have to address pressing problems today, we also have to lay foundations for preventive care and support to ensure that the problems of today are not the problems of the future.
While I welcome the earmarking for preventive care of £26 million of hypothecated tax from cigarettes, the clear message is, "Smoke more fags and the national health service gets more money." However, if Scotland smokes more fags, the NHS will need more money. With around 2,500 blocked beds in Scotland, not only is the Executive failing to provide those patients with the appropriate care, but the patients are being imprisoned and institutionalised in hospitals, although research shows that that approach disables patients and results in a loss of independence.
The enforced bed stays also prevent other patients from accessing health care and cost around £90 million a year. In order to help the elderly, the mentally ill and the disabled, it is clear that we need one budget. The Conservatives believe that that should be a health service budget that can provide seamless care from hospitals to homes and the community.
A recent report by the Scottish health advisory service on services for older people in the Highlands says that there is no multi-agency strategy for older people's services in the Highlands that could create a vision or a model for the delivery of care. I say to the minister that there is no multi-agency strategy for Scotland. The only thing that is clear about the Executive's strategy is that there is no strategy.
The report goes on to state that a Highlands-wide needs assessment should be undertaken. I suggest that we need not only a Highlands-wide needs assessment; we need a Scotland-wide needs assessment for the elderly and the disabled. The same report says that there is no vision for older people's services in the Highlands, nor is there a lead person to take services forward. Today we look to the minister to set out a clear vision and to become that lead person to oversee care of the elderly and the disabled.
It cannot be right that an elderly person who has exercised his or her choice of taking a place in a home in the private sector is told by social workers that they will receive no funding for six, nine or 12 months. However, if he or she wanted to occupy a room in a local authority-owned home, he or she could have instant access to funding. That makes a mockery of freedom of choice. It cannot be right that there is a two-tier health service for the elderly, in which those who can pay receive the care of their choice at the time of their choice, and in which those who cannot pay are left languishing in hospitals while the NHS and social work departments engage in their system of cultural incompatibility and attitude preciousness—as it was described to the Health and Community Care Committee.
We must be able to measure best value, quality and the most effective care for the elderly, whether it is provided by councils, privately or by the voluntary sector. Age Concern says that many older people are being forced to go private, to use savings and to pay for treatment that they previously expected to receive through the NHS. The recent Accounts Commission report mentioned that the highest costs did not always correlate with the highest quality, and that councils should base decisions on the local provision of residential and nursing home care on sound information about the quality and cost of providers. There is also concern that those decisions should be, and are not, open to public scrutiny.
Today, I ask the minister to hold not only the health service managers but councils to account for care in the community. In a press release this week, the Minister for Health and Community Care announced:
"One year on from devolution, we have achieved a great deal in the NHS."
I agree with that statement, and give credit where it is due. The Executive has achieved a flu crisis the like of which has not been experienced for years. Despite a promise on 10 January to set up a working group, on 4 May there is still no working group. The Executive has achieved more blocked beds in Scotland's hospitals than there have ever been. There have been more petitions, meetings and marches by the people of Scotland, who are worried because they do not trust the health service that they have known and always depended on.
The Executive has had an acute services review in Scotland carried out by health trusts in a secretive, arrogant and bullying manner, as it threatens, centralises and rationalises our hospital services. That has not been debated in public, so it is hardly surprising that the public are worried. There are also more than 1,200 unfilled nursing vacancies in Scotland.
In backing what Mary Scanlon has just said, I draw members' attention to a paper that was written by Dr Anthony Toft, the past president of the Royal College of Physicians of Edinburgh, and submitted to the Lothian division of the British Medical Association in February. He discusses the climate of fear in the national health service, and says that it has spread from the management to the doctors. The sort of response that the Executive has frequently given in this Parliament is similar to that which was displayed by Lord Callaghan, who returned from a trip abroad and said, "Crisis? What crisis?" In fact, everything that Mary Scanlon said is borne out by that paper.
I thank Margo MacDonald for her intervention—I, too, have been quite shocked by the bullying, arrogance and secrecy.
Ministers treat members' business debates initiated by members of their own party with arrogance, responding with a party political broadcast that does not address the unique points raised. The members' business debate last Thursday, which was initiated by a Labour member, was an example of that practice. If ministers treat their own people like that, there is little hope for the rest of us. If the culture of bullying and arrogance is to change, that change must start with the ministers.
We have also heard today that Scotland's only heart transplant unit is turning away hearts for transplant. As we enter the debate of presumed consent for organ donation, the health service lacks the resources to carry out donor transplants.
The Executive has also achieved a budget process that is secretive and complex. We cannot trace where the money goes, whether it addresses clinical priorities and whether it provides best value. The Executive has managed to achieve a joint investment fund for general practitioners, to enable them to offer additional services to patients. However, the process has been made so difficult that no GP practice in Scotland has been able to get a penny out of that fund.
We can add to that long list of achievements, as the Executive has managed to achieve more glossy brochures, more focus groups and more announcements on the same pot of cash than has ever been achieved before in the world of politics. In one year, the Executive has achieved a level of arrogance that the Tories could not reach in 18 years.
I refer to targets. We were promised NHS Direct by early 2000. Members could be forgiven for thinking that a nurse-led service would involve the Royal College of Nursing. However, the RCN has not even had a telephone call about that service.
Another target is that the Executive
"will launch a new generation of walk-in/walk-out hospitals."
Yet the Scottish Association of Health Councils knows nothing about that target, saying that no patient has ever benefited from that type of care or been assessed under it. The chairman of the board general managers group said yesterday that health board managers had been given no targets or guidance on walk-in, walk-out hospitals.
On top of that, we have the target of establishing 80 one-stop clinics by 2002, yet no planning or budget allocations are in place. More statistical information is given about the Meat Hygiene Service than about the national health service. When we ask civil servants about income, we are told that income is "netted up"—a few more weeks of such jargon and civil servants will be more than "netted up".
All that adds up the fact that spending by the national health service in Scotland and by councils on health care is difficult to trace. We cannot even identify the money allocated to health targets in Scotland. What has happened to the patient-centred health service? The minister is in a position to address the problems of today's health service, and to set in place plans for care of the elderly and disabled—
I will give way to Kay Ullrich, although I am on my final sentence.
Have I come to the wrong debate? I thought that this debate was about community care.
This debate is about community care, but as members of the Health and Community Care Committee are aware, we cannot see where money is being spent on community care. We are asking for accountability and for the needs of the elderly and disabled to be met, and for that to be done, the appropriate management structure must be put in place.
Please come to a close.
I ask the minister to address the problems of today's health service and to put in place plans for the care of the elderly and disabled. I ask him to get a grip of the health service and to start to listen to the people whose lives depend on the services that he manages, in order to ensure that they are given dignity, respect and the care that they need.
I move,
That the Parliament notes that many elderly and disabled citizens across Scotland feel let down by the Scottish Executive and its failure to deal with issues which most directly affect them; further notes that such citizens are being faced with escalating charges for variable social and other services provided by local authorities; believes that many local authorities are taking measures which restrict choice for the elderly in their selection of nursing or residential care; considers that a lack of local authority resources for nursing home places and a lack of co-ordination between health and social work has led to a 40% increase in bed blocking in the NHS since 1997; recognises that local authorities are systematically withdrawing financial support from facilities used by elderly and disabled citizens, and calls upon the Scottish Executive to abandon its agenda of political correctness and replace it with a programme that delivers to Scotland's elderly and disabled citizens affordable services, freedom of choice in care and the dignity and respect they deserve within our society.
It will come as no surprise that I reject the terms of the Conservative motion. Apart from anything else, it is a bit of an all-embracing motion for a 90-minute debate. However, I welcome the choice of this morning's topic, which is of great importance. I have to agree with colleagues on the Scottish National party benches that it is a pity that the Tories chose not to address the motion that they lodged. Mary Scanlon spent more time talking about the Minister for Health and Community Care than about the elderly and disabled people who feature in her motion. They received no mention at all.
I welcome the debate because improving support for our more vulnerable fellow citizens is precisely the kind of opportunity offered to us by the people of Scotland almost a year ago. I join Mary Scanlon in welcoming the decision by the Health and Community Care Committee to conduct a major investigation into community care and care for the elderly.
Since last year, we have increased investment in services for older people to around £2 billion. Making something of the opportunity that we have means not only spending more but spending better. It means putting people at the centre of services, listening closely to what the people who use those services have to say and acting on that.
Every time I meet representatives from older people's organisations or disability groups, they all ask for widened access to direct payment schemes, to allow them to have care packages tailored to individual needs. I confess that that is not a message that I expected to hear, but it is a pervasive one. I have listened, and the Executive will, this year, extend direct payments to people over 65. That is an improvement to service demanded by those who want to use the service.
The overriding message that I hear is that, like everyone else in Scotland, older people and people with disabilities want to live full, independent and secure lives. We do not presume that older people are passive recipients of services, but where people need support, they expect it to be flexible, appropriate, efficient, sustainable and of high quality. That is why we have focused on better and quicker decision making, helping more people to get care at home, and that is why we insist on agencies working better together.
We are taking steps to ensure that we move from rhetoric about the benefits of joint working to real changes that benefit the users of services. This year, £7.5 million has been invested specifically to do that. It is unfortunate that Mrs Scanlon does not recognise that agencies can work together. Indeed, Highland Council has been able to appoint someone to lead on children's services, and there is no reason why bodies providing services for older people cannot also work together.
I am sure that the minister will agree that providing aids and adaptations for people with disabilities is a complex area and raises a whole range of issues. He has talked about working together, but I suspect that much work will be needed in adapting buildings, installing ramps and providing various aids, given the variety of arrangements that exist in different authorities. Some authorities, as I am sure he is aware, provide adaptations free of charge, some will reimburse costs and others have different arrangements again. What advice will the Executive give to local authorities to bring about uniformity of practice, so that agencies throughout Scotland can work together to sort out the problem?
That is a good point. The joint futures group, which I chair, is currently developing practical non-negotiable steps to ensure better joint service delivery. Aids and adaptations are one of the areas that it is examining, and I think that we should perhaps go beyond merely giving advice and be more directive about things. I hope to make progress on that issue soon.
Will the minister give way?
I have just taken a lengthy intervention and I would like to move on. I am watching the clock.
Any serious approach to improving services must have quality of service provision at its heart. That is why we will establish the Scottish commission for the regulation of care, which will for the first time enforce uniform national standards in all areas of care—residential, day and home care—whoever provides it. Older people themselves are being fully involved in the process of drawing up the care standards that will be used. The standards of residential care for older people will be issued for wide consultation very soon.
We have also recognised as never before that much, and perhaps most, of the care that is delivered in Scotland is provided by informal carers. As we speak, carers throughout Scotland are discussing with local authorities how the £10 million that has been earmarked for carers services will be used. That is local authorities being held to account: not by the Executive, but by the people who depend on the services that the authorities provide. Carers who have never received support are responding to a media campaign to identify hidden carers. Those are not small measures—they will make big differences. They are not quick fixes—they are changes to how services are designed and delivered.
Alongside those measures, we are aware of the need to address issues of charging for care. Funding for care is being actively considered as part of the spending review. The work of the joint futures group on charging for home care will feed into that. I agree that people need a system that is sustainable, fair and consistent, and it must consider funding of home care as well as residential care. I am determined to deliver that, and I will take the time to get it right.
I draw the minister's attention once again to the meeting in February of the local arm of the British Medical Association, which said in its report:
"We are particularly concerned regarding the role of social work, nursing homes and home nursing and whether there will be enough funding for the care of the chronic sick and aged persons, and particularly those outwith hospital beds, but so unwell as to be unable to be cared for in their own homes."
I appreciate much of what the minister said about the mechanism that he means to put into effect, but here we have doctors concerned that the funding might be inadequate. They also draw attention not to bed blocking, but to early discharge into communities where carers are not ready to take on board the caring that they will have to do.
It would not be possible to respond to those issues in the time that I am allowed, but I wish to make this point. We are not ignoring those issues and concerns—we are addressing them, but we are addressing them thoroughly. We are working with local authorities and health boards to ensure that improvements are sustainable, and with users and carers to make sure that the improvements are what is needed.
However, clearly there are priority areas on which we can focus investment now. That is why earlier this week we announced that £60 million of the additional national health service funding in the budget will be distributed to the NHS in Scotland. But before that can be spent, the service must demonstrate how it will improve performance in four key target areas, one of which is a major drive in conjunction with local authorities to minimise delays in discharge from hospital. From 1 April we introduced a mandatory quarterly census of delayed discharge, not only of the number of discharges, but of the causes, of which there are at least 40. That means more information as well as more resources to allow a permanent reduction in delayed discharge.
In summary, investing resources, setting higher standards, driving joint working and putting people at the centre of service design and delivery is the path on which we have set out in the past year. We will not be deflected from it, because it is the right path.
I move amendment S1M-790.2, to leave out from the first "notes" to end and insert:
"welcomes the Executive's commitment to improving service provision for frail elderly and disabled people in Scotland by creating modern user-focused services; notes the progress of the Carers' Strategy in Scotland, the drive towards joint working between the NHS and local authorities, and the development of national standards for care; further notes the additional funding for health boards announced this week to be used in part to reduce significantly delayed discharge, and endorses the Executive's vision of a Scotland where every older person matters."
Members will be relieved to know that I will speak about care in the community, but I have to commend Mary Scanlon for her bravery in standing inside the glasshouse while she threw stones at new Labour on this issue. Everyone welcomes a sinner who repents, but in her case repentance seems to have taken the form of total amnesia. Has she forgotten that it was the Tory party that introduced the National Health Service and Community Care Act 1990, the concept of which everyone agreed with, but that it was also the Tory party that refused to back the initiative with adequate resources? Of course, that long-standing Tory underfunding of community care has continued under the new Tories.
Rightly, much has been said about the 2,500 elderly and disabled people who are languishing in inappropriate hospital beds and who are unable to access the type of care that they have been assessed as needing. Let me put that into context. It means that an average-sized local authority will currently have around 150 people on its waiting list for long-term placement, one third of whom will be waiting in hospital beds. The local authority will have funding to place only two people per month.
It does not take a genius to work out that we are faced with a never-ending waiting list. For practical reasons, social work departments will always place people who are in their own homes—where they are deemed to be at risk—before they place people who are in hospital beds. Those in hospital beds might be inappropriately placed, but they are still seen to be safe.
A stand-off seems to have developed on funding. Local authorities claim that they are being starved of the funding that they need to provide adequate care in the community, while the Executive claims that local authorities receive sufficient funding—they cannot both be right. The facts, however, seem to support the claims of the local authorities. We all know that there have been years of underfunding and that, as a result, local authorities have run up huge deficits. This year's local government finance settlement will mean yet another real-terms cut.
Is it any wonder that when Sir Stewart Sutherland compiled his commission's report, he found that about £70 million had been diverted from social work departments' indicative funding for community care to other social work areas? The Association of Directors of Social Work has said that, because of the severe cuts in social work departments' funding, money that was earmarked for community care will have to be diverted to ensure that priority areas—such as child protection and families—are adequately funded. Is that what the Executive wants? Local authorities are robbing Peter to pay Paul and, unfortunately, evidence suggests that the Peter who will continue to be robbed is elderly and disabled.
The new council budgets show that the first cuts have already been made in services to the elderly and the disabled. Since new Labour came to power, 10,000 fewer people have been receiving home care. Sheltered housing wardens have been removed and home helps' hours have been slashed while charges have been raised. Day centres have closed and, regrettably, the list goes on and on. It makes one wonder why, when local authorities are faced with cuts, they immediately make scapegoats of the elderly and the disabled.
There can be no doubt that the way forward for community care is full implementation of the recommendations of the Sutherland report, but we have been deafened by the sound of new Labour's dragging feet in the past 14 months. While Labour delays, the misery gets worse. Surely there cannot be a member who has not had a constituent's inquiry on community care. So far, all that Parliament has had from the Executive are holding answers, the occasional touchy-feely soundbite and—of course—self-congratulatory amendments such as that which we are debating today.
Can I take it from that, that Kay Ullrich believes that the formation of the independent Scottish commission for the regulation of care is a touchy-feely soundbite? The formation of that commission meets one of the key recommendations of the Sutherland report.
I know that the formation of that commission was one of the key recommendations of the Sutherland report, but we are all waiting to hear what will happen regarding the recommendations on personal care, the three-month disregard and many other facets of that important report, which has been lying gathering dust on the shelf for 14 months.
If Iain Gray has any doubts about the reality of community care today, he should listen to the elderly and the disabled. He should listen to their carers and to the social workers and health workers who are totally dismayed when they look for resources, but find that they simply do not exist.
No matter how the Executive tries to spin the matter, patients and social work and health care professionals will tell Iain Gray loud and clear, "Community care ain't working."
I move amendment S1M-790.1, to leave out from the first "that many" to end and insert:
"the failure of successive Conservative and New Labour Governments in Westminster and of the Scottish Executive in Holyrood to provide adequately for elderly and disabled citizens in Scotland; condemns the cuts in grants to Scottish local authorities which have undermined much of the good work being carried out throughout Scotland at a local level; supports greater guidance being given to local authorities to ensure that money intended for the provision of community care and other services for the elderly and disabled is channelled into those areas and not diverted into other sectors of local authority spending; urges real joint working and partnership between central and local agencies, and calls upon the Scottish Executive to implement in full those aspects of the Royal Commission into Long Term Care of the Elderly which fall within the scope of the Parliament."
I am bound to say that the Tory motion is convoluted and the way Mary Scanlon spoke to it—addressing matters that are not in it—did not assist in clarifying what the Tories are trying to put across. The motion is about issues such as bedblocking, local authority restrictions and liaison between social work and health care. Those are central issues. There is a bit about the disabled, but I think that the disabled deserve a separate debate. This is not the place to deal with that issue and I do not propose to do so.
There are undoubtedly a number of issues that need to be addressed, but who are the past masters here, for goodness' sake? The previous Conservative Government, which created the internal market. The two-tier system about which Mary Scanlon waxes indignant was also a creation of the Conservative Government, which set one health trust against another, cut local government services to the quick and widened the Pontius Pilate-type fault line between councils and health boards into a yawning chasm. The Executive has had to try to repair the damage and put in place again a health service that meets need in these areas. If we are talking about repentance, I would advise our Conservative colleagues to let a little more time pass before they become too indignant on these matters.
Does the member agree that the waste that went on in councils was responsible for their failing to play their part when the community care project was set up? In particular, councils supported huge contracts that were run badly by direct labour organisations and lost hundreds of thousands of pounds. Does the member agree that councils chose not to put community care high enough up their agenda?
There is an element of truth in what David Davidson says, but it is not the central issue. The central issue is the bureaucratic and structural reorganisation that caused the various problems and the lack of mechanisms to deal with them. That is now being addressed.
There is a great deal of common ground in this debate: all parties represented in the chamber have committed themselves to increases above the rate of inflation in spending on health and the associated area of community care. We all want value for money in the way those resources are spent and it is fair to say that none of us has a monopoly of good ideas regarding the way in which the problems might be tackled. The work of the Health and Community Care Committee in that regard is important. I hope that in due course the Executive will take note of its recommendations.
What is the scale of the problem and what are the objectives of public policy in this area? Research by my party estimated that bedblocking costs more than £30 million a year in Scotland. The fact that our figure differs so widely from that given by Mary Scanlon bears out her call for a Scotland-wide needs assessment. Parliamentary questions have revealed that each bed costs between £700 and £1,000 per patient per week, depending on the specialty. In December 1999, there were, on average, 35,000 available staffed beds in Scotland, more than 2,000 of which were accounted for by patients, mostly elderly, whose discharge had been delayed. As Iain Gray rightly says, this is a complex problem, but it is clear that we can do better. We must put considerable effort into that.
The people whom we are discussing are not just numbers or statistics, they are individuals with varying circumstances. They cannot be heaved about the place as if they were freight—they are all individuals and they all matter. For most of them, undoubtedly, the preferred option would be high-quality care at home, which the motion does not address. For others, it might be residential or nursing care. The difference between those two types of care is important, as the Sutherland commission noted. Residential places cost between £220 and £360 a week, whereas a place in a nursing home has been estimated as costing between £700 and £1,000 a week, which is not very different from the cost of an NHS bed. There are cost savings to be made, but they are not quite as great as people sometimes suggest. The 40 causes of delay that the minister mentioned are the key issues.
There are practical issues, including issues of availability. In England there is an entirely different pattern of health care, with more than 90 per cent of all homes and 83 per cent of places in residential care homes being provided by the independent sector. That is not the position in Scotland, where only 5 per cent of health care takes place in the private sector. That includes hospital care as well as nursing care. There are not enough designated nursing home beds to deal with the bedblocking problem. Comparisons that have been made recently in the press with what happens in England do not stand up to examination.
The Scottish Executive's multi-level approach to this issue, in which the emphasis is on narrowing the Pontius Pilate divide between social work departments and health services, is important. Speedier assessments, the use of the same definitions on, for example, delayed discharges, and incentives to work together will cut the bureaucracy that is part of the problem. There is also a cultural issue. The Scottish Association of Care Homes talks about a "dead man's shoes culture", meaning that for budgetary reasons councils delay assessments until a patient dies, despite the fact that there are vacancies in care homes. That is a growing problem because of the fact that people are living longer.
I sympathise with the Government's problems, but we do not want spurious markets, forced privatisation of care, or ill treatment in ill-regulated and unsuitable establishments. If possible, we want care at home, rehabilitation to a lesser dependency wherever practicable, and good quality care at all levels. Those are the Executive's objectives and I hope that ministers will take on board the ideas that have come from this debate and from the Health and Community Care Committee.
Members should note that time is limited. I will indicate to members when I want them to wind up. To accommodate as many as possible, I will ask members to adhere strictly to the four-minute time limit.
I would like to widen the debate to include the general services that are provided to the elderly and disabled. The Executive's social inclusion strategy must ensure that every older person matters. Its objectives must be, first, to ensure that older people are financially secure and, secondly, to increase the number of older people who enjoy active, independent and healthy lives. To date, there has been more rhetoric than reality.
The 73p increase in pensions, which was more than wiped out by council tax, rent and water rates increases, hardly lives up to the first objective. The £5 billion windfall tax on pensions did not live up to it either. The recent local government settlement certainly does not support the second objective. Although the overall settlement grew, so much was ring-fenced or top-sliced to meet the Executive's priorities and spending guidelines that councils had to make substantial cuts in other service areas.
In recent weeks, we have seen the closure of libraries, a reduction in new book investments and an increase in audio-visual and internet charges; an increase in charges for home helps and meals on wheels; the proposed closure of the Carrick Street day centre in Ayr—which was a major issue in the recent by-election; an increase in charges for leisure and sports facilities; a reduction in travel subsidies; an increase in charges for burials; and a reduction in grass-cutting services for the elderly. The list goes on. The only thing that new Labour is not cutting is the grass. Ask the residents in Fife.
There have been reductions in grants to the voluntary sector, which has an obvious impact on the elderly. Nursing homes have been closed because Labour-controlled councils will not increase payments even in line with inflation. The disparity between fee increases and cost increases in recent years has had a devastating impact on many providers and therefore on the services provided for older people.
Labour policies have impacted adversely on nursing homes. Labour's disastrous working time directive will add 1.5 per cent to the payroll costs of most homes. The salaries of trained nurses have increased by an average of 7 per cent. That is welcome, but nurses make up 33 per cent of the work force of most homes. Labour policies have also led to increasing suppliers' costs.
Much has been said in the chamber about free television licences for the over-75s and about winter fuel allowances. I should declare an interest, because I have just learned that I will receive that allowance. Although those measures are welcome for existing pensioners, new pensioners will still be £500 worse off as a result of the abolition of the age-related married couple's allowance. Once again, Gordon Brown gives with one hand and takes away more with the other.
As is becoming common with this Executive, new burdens are not being financed. I do not criticise local authorities for that—they cannot pay what they do not have—but I do condemn the Scottish Executive. It has let down the elderly, who are in the twilight of their lives. They do not want jam tomorrow; they want a little butter now—to improve the quality of their lives, to avoid constant scrimping to make ends meet and to live out their remaining years with a degree of independence and happiness. That is all they ask for and it is what they deserve.
I would like to start by thanking the Conservatives for today's motion. Care for the elderly and disabled is key to any civilised society. I also welcome the opportunity to highlight some of the good work that is being carried out by the Scottish Executive, while also highlighting the mess that we have been left to deal with after 18 years of Tory neglect.
I am not sure whether the Tories are guilty of poor timing or poor judgment. I suspect that it is a little bit of both. The Tories lodged a motion highlighting the problem of bedblocking in the same week as the Minister for Health and Community Care announced that £60 million would be allocated to health boards, with the key condition of a reduction in the number of delayed discharges. Once again the Tories are lagging behind the debate rather than leading it. It is with breathtaking hypocrisy that they accuse us, as we begin to deal with the mess left by the internal market, of restricting choice and, as we enter a period of the highest sustained spending in the history of the NHS, of systematically withdrawing financial support.
We are systematically increasing spending on social services: an extra £51.3 million this year, £43 million next year and a guaranteed £35.7 the following year. However, meeting the needs of older people and those with disabilities is not just about increased spending; we must also ensure that services are responsive to users' needs.
Can Karen Whitefield tell me whether, unlike in every other area in Scotland, the home help service in her area is increasing?
I will get on to the services in Lanarkshire, which I am proud of, in a minute.
It is important that services are centred on people, as individuals, not on bureaucracy. The Sutherland report recommends that more people should receive high-quality care that allows them to stay in their own homes. That is the view of most of my constituents and the majority of elderly people in Scotland. I am pleased—
I have already taken an intervention and time is short—I am sorry, I am moving on—
Will the member—
The member has indicated that she is not taking an intervention. Please sit down.
I am therefore pleased that the Scottish Executive is responding to the need for improved and better co-ordinated home and support services. The joint futures group—
I am sorry—we have heard enough of Tory views of health care. We need to talk about realities instead of fantasy.
The joint futures group on community care will respond to the Royal Commission on Long Term Care for the Elderly by creating the right conditions for productive partnership working between health boards and social care services. Improving home care services helps to alleviate the problem of bedblocking and frees resources for acute services.
I am pleased to say that Lanarkshire Health Board has below average bedblocking and that there has been a drop between last year and this. The health board also reports an improved occupancy rate in private nursing homes between March 1996 and March 1999 of around 82 per cent of available beds. In the past year, the occupancy rate rose to 93 per cent. That improvement reflects a significant increase in the number of people supported by social work departments making use of resource transfer from health to social care as a consequence of the local joint strategy for care of the frail elderly.
To borrow a phrase, "the truth is out there"—but it is not in the Tory motion. The Scottish Executive is accused of following a politically correct agenda. If providing co-ordinated home-based health services for elderly and disabled people is political correctness, we are guilty. I call on the Conservative party to abandon its agenda of political hypocrisy and support the modernising programme of the Scottish Executive instead.
I begin by paying tribute to the army of home helps who, in the face of adversity, keep a totally under-funded and stretched service going by their dedication to their clients, going beyond the call of duty. Karen Whitefield should speak to the home helps in her area. They will tell her that the service has been reduced year on year, cut after cut, as it has been elsewhere in Scotland.
I will draw on my experience as a home care organiser in one of the most poverty-stricken areas of Glasgow where we experienced a consistent reduction in the home help service and the closure of the home from hospital scheme. The service was inadequate to meet people's needs and restricted to those in immediate or imminent danger of being received into care. It therefore excluded many people whose lives would have been improved by receiving the home help service.
Those lucky enough to receive the home help service received an inadequate service, despite the best efforts of the dedicated home helps and the hard-working managers who had the weekly task of putting together the jigsaw puzzle to ensure that hundreds of clients received some level of service in the face of unfilled home help posts, frozen posts, sickness and holidays. That often involved last-minute phone calls to clients to ask whether they could manage as someone else was in more dire need. I am talking about people who needed assistance to get in and out of bed, assistance to wash and who needed to have their meals prepared—all basic human needs. It is a cinderella service for some of the most vulnerable elderly and disabled members of the community.
On top of all of that, year upon year, I had to send out letters to tell people about the escalating charges; they were going to have to pay more for receiving less. I would often have to visit a client who had been identified as no longer being able to remain at home. We were then faced with another dilemma: it was almost impossible to have someone admitted to care in the area because of the strict limit on the number allowed to be admitted to residential or nursing homes due, yet again, to budget constraints. Once the quota was reached, no more people could be admitted, so it came down to the luck of the draw.
It is no wonder that we often had to resort to persuading reluctant GPs to agree to admit an elderly person into hospital, which would at least get them out of their home and into a safe environment. That was not easy when GPs also had instructions not to admit people to hospital due to bedblocking. I and my colleagues fought tooth and nail to get confused and frail elderly people into hospital because they were at risk. I make no apologies for that. That was and is the reality of community care the length and breadth of Scotland.
Something radical must be done. Iain Gray talked about the £60 million put in to assist discharge from hospital, but home from hospital schemes have already closed, so in essence that money will only set up what has already been removed; it is completely inadequate to solve the problem. We must have a radical overhaul of the system and a major injection of resources to ensure that they are adequate to provide intensive home care when that is required to allow someone to remain at home and residential and nursing home places when remaining at home is no longer an option.
Anything less than that is not good enough, because our elderly people deserve much better. They deserve, and have a right to, a quality of life.
My last job in social work was to assess elderly patients in Drumchapel hospital for community care. I also trained workers in residential care and, as a councillor, was chair of an advisory group assessing standards in residential care. At that time I was also chair of the social work resources committee, which looked after the money for social work in Glasgow. My experience in this matter is obviously not narrow.
I do not believe that any member wants a return to when older people remained in hospital when it was not necessary, but I believe that this motion, by implication, seeks to broaden the role of the private sector in the provision of social and health care. As Robert Brown said, Scotland has not gone down that road and I do not believe that it should.
The motion also states that citizens are being faced with escalating charges for variable services. Social work is not a universal service; it has always been means tested. In Renfrewshire, and indeed in Glasgow when I was there, each social work client gets a benefits check. In the past four years, that has generated some £3.65 million for home care clients in Renfrewshire.
The motion also says that the provision of local authority residential homes has steadily declined. That is true, as such homes are closing and the balance of provision in most authorities is heavily weighted in favour of non-local authority homes. However, users and carers are still offered a choice. One reason for so-called bedblocking is that users are holding out for a vacancy in their preferred home. It is correct that they should do that. The whole ethos of the National Health Service and Community Care Act 1990 is that people should be able to choose where to go.
I am concerned by what Kay Ullrich, for example, said about the possibility of moving patients who are blocking acute beds into nursing homes after three months. I cannot think of any patient whom I have assessed being willing to go into a nursing home as a stopgap before going home. Patients who go into nursing homes are highly dependent and they know that, unfortunately, they will probably live there until they die.
Will the member give way?
No, I have no time to take an intervention.
I am very concerned about that method of dealing with blocked beds. There are many other methods.
Mary Scanlon spoke about local authority withdrawal of community care funding. I can only speak for Renfrewshire and Glasgow. Renfrewshire has allocated all new moneys that it has received for community care from central Government since 1996 to the expansion of provision. In addition, new moneys that have been allocated for the support of carers have been fully committed and the resource transfer of £3.7 million from the health board has been fully committed to developing community care services. Research for the Health and Community Care Committee's report on the subject may show that provision is patchy, but some councils are providing good community care services.
The Scottish Executive agenda is also about moving from traditional forms of residential care toward care and support at home or in different forms of supported accommodation in the community. Those approaches recognise and strengthen the rights, dignity and respect of vulnerable older people and adults with disabilities. They also reflect the wishes of users and carers. Representative groups, carers, users and statutory agencies are keen to develop a partnership to work together, with joint investment of resources by the key agencies. As Iain Gray said, that will take time. I believe that that is the hallmark of a mature democracy, not of political correctness. Our aim is to create a genuinely tolerable society for everyone, including our elderly constituents. I urge members to support the Executive amendment.
It is particularly important to mention the work of the voluntary sector. I strongly believe that, as Mary Scanlon and others have said, this society must recognise that it is failing pensioners. There is a danger that agism is replacing racism.
Recent attacks on the elderly by Labour politicians—outside the chamber—cannot continue or be condoned. In my constituency, pensioners have been made to feel worthless and neglected by South Ayrshire Council's closure of the Carrick Street halls. The symbolic act of closing lunch clubs and the Carrick Street halls makes pensioners feel belittled and devalued. That is not good enough in a civilised society. Selling property for profit must not come before providing for pensioners.
Responsibility for the care of those badly treated pensioners is falling more and more on to the voluntary sector. In Ayr and Troon, Churches are taking on the job of providing lunch clubs in church halls with a willingness and enthusiasm that is truly humbling. I pay tribute to the leadership and enthusiasm that has been shown by the Church leaders with whom I have been in touch on this matter.
As some members have said, a fundamental reassessment of the position of elderly people in society is needed. If it is Government policy gradually to reduce support for the elderly, we have a problem on our hands. The facts speak for themselves. Whether it is robbing pension funds, cutting tax relief for health care schemes, closing lunch clubs, or withdrawing facilities, the impression that is received is consistent: people should not get old because the Government will ignore their needs and neglect them. That must stop.
At present, the burden of care is being picked up by families and communities. If that is to continue, we need legislation to encourage the family unit, rather than to destroy it. We need the reinstitution of a significant tax relief for married couples, because the nuclear family unit provides the first line of care for the elderly. We need to smooth the path of and give more recognition to the voluntary sector for the increasing work that it is about to undertake on society's behalf. Above all, we need to change mindsets and to stop the Administration treating pensioners as second-class citizens.
Society must start squaring up to its obligations to a generation to whom we all owe a debt. Members have quoted many people. I shall quote from the Bible: "As ye sow, so shall ye reap". We must remember that we will all get old someday.
I think that that was the new member's maiden speech and I congratulate him on it.
I have been sitting here thinking that the catering department is not to blame for the great clashing of pots calling kettles black that we have heard this morning. The Conservatives—if I have got it right—are getting stuck into new Labour for the offence of following Tory policies. There is logic there somewhere, although I have not yet worked it out.
In the short time available to me, I want to talk about the elderly and those with disabilities. The talk everywhere is of social inclusion, but all I see on reality street is social exclusion, as facility after facility closes. Mary Scanlon referred to bullying. That is true of social work departments where good social workers attempting to stand up for their clients are being bullied.
Fortunately, here in the Scottish Parliament we meet real people who come from the outside to protest. I am sure that members will never forget the occasion when members of the deaf-blind community visited us. One young man, who has been deaf-blind from birth, told us that his one treat is a weekly visit to the bowling alley. He also told us that the treat must stop because his care attendant from Crossroads is being withdrawn.
People with multiple sclerosis cannot get decent wheelchairs, or beta interferon, which would help prevent many of them having to use a wheelchair in the first place. A typical letter in The Herald from someone with a disability says that, just a year ago, their home help charge was suddenly raised from £1,500 to £2,700 per annum and that this year they are being asked to pay a new charge of £104 per annum for use of a community service alarm that has hitherto been free. The writer says that at least that can be cancelled and they can accept the risks of lack of mobility. They would not pay up for the alarm because they could not. The letter came from West Kilbride, but it could have come from anywhere.
The author, Anthony Powell, stated:
"Growing old is like being increasingly penalized for a crime you haven't committed."
That sums up our agist society. Age discrimination can kill. When the terrible news broke yesterday that the heart transplant unit at Glasgow royal infirmary might have to close—something that we will resist powerfully—the first fear was that people over 50 will not receive heart transplants and are going to be written off.
We are returning the elderly to an age of fear, which is where they came from. They were born into an age of fear, where people talked of the shilling cough and the three shilling cough—they were frightened to get ill because they could not afford treatment. They created the welfare state to end that fear. They are being sent to an age of new fear. They are frightened of losing their homes to pay for care in their last years, of coping with the withdrawal of home help services and of being written off by the national health service that they created with the deadly initials DNR—do not resuscitate. Even the language of today's bean-counting NHS is chilling and Orwellian newspeak.
Who are the bedblockers? They were once the young, strong men and women who brought this nation through a world war and who went on to create the welfare state from which we all benefit. The bedblockers are the men and women who worked and contributed to society for 50 years, from 14 into their 60s. They are the people who are being betrayed. They are the people who deserve the best of times for a change and who deserve at least to live with decency or dignity. If we let them down, they will rebel against us. No seat is safe, nor does it deserve to be.
Listening to Opposition members this morning makes me wonder whether they have been like Rip Van Winkle. Have they been to sleep and blotted out their consciousness in the years of Tory misrule? Do they have collective amnesia, or were they just plain insensitive to the suffering of our people in those years?
David Mundell's motion made me reflect on the long budget meetings when I was a councillor and depute leader of the then Fife Regional Council during those years. My recollections are of grim times, when the local authority budget-making process meant that, year after year, we were forced to identify cutbacks of £20 million and more. We do not need lessons from the Opposition.
We have considered the past, but if we look into the crystal ball, what we see ahead of us with the Tories is the new Tory health tax. The Tories have said that people will have to go private for major operations. This is nothing short of a Tory tax rise on hard-working people. For example, the Tories have said that people should pay for hip operations. Hip replacements cost at least £5,000, but the Tories say that that is not expensive. Now they admit that they want to privatise the health service and to charge people for major operations.
Will the member give way?
No, I am sorry.
The Tories want people to pay to see their general practitioner. [Interruption.]
Order.
The Tories want people to use the NHS only for life-threatening conditions. They would reduce the NHS to a second-rate safety net service.
The Tories' own Norman Fowler started the care in the community policy ball rolling. Patricia Godman, Kay Ullrich and others have said this morning that they agree on the policy but that it never received the funding to make it work. My colleagues in the Scottish Executive, in having to work on that legacy, have an especially difficult task to cope with. The fundamental role of the local authority changed from being a provider of services to being an enabler of services, the bottom line being that local authorities were handed one of their most important, difficult tasks in history.
I represent Dunfermline East constituency—a bit of a misnomer because the constituency does not have any part of Dunfermline in it. There is no shadow of doubt that there is a strong tradition of concern for and care of the elderly in that area. Reflecting that, the constituency has many active pensioners and carers groupings with a history of working in close partnership with the council and with Fife Health Board for better services.
Fifers believe in pragmatic politics. The Labour council considers the care of its elderly in a wider and more holistic way. It is the only council in Scotland to have free public transport for pensioners. Only two other places in the UK have such a scheme: Liverpool and London. Some £13 million of public money is spent on subsidising buses and trains for the benefit of all elderly and disabled people in Fife. I sincerely hope that, in the fullness of time, Scotland can show a guiding light and can provide free public transport services for all our pensioners.
The Scottish Executive recognises and acknowledges that there are real problems to be tackled in our communities. However, against a background of years of Tory neglect, it is having to seek the co-operation of local authorities and health boards in what is an extremely difficult mission. If we consider some of—
Will the member give way?
I am sorry. I do not have time.
Turning to the bedblocking that has been talked about this morning, the Scottish Executive is committed to ensuring that the problem of delayed discharge is dealt with. Like Karen Whitefield, I welcomed the news on 1 May, when Susan Deacon announced the £60 million of the new budget money. In a move designed to deliver better results, the money is going to health boards with strings attached. The money is to be used to improve performance, and health boards will be given their share of the cash only when they have shown how they will use it to improve patient services. One of the key target areas for improvement is a major drive to reduce the number of delayed discharges from hospitals, which lead to blocked beds in Scotland.
I hope that we will support the minister this morning.
Winding up the debate will be quite difficult, because it has had many different strands. I will try to go through what members have said and pick out the underlying themes.
Information has been a running theme throughout the debate. Mary Scanlon mentioned Scotland-wide needs assessment. Bruce Crawford talked about aids and adaptations and the wide difference in provision around the country. Robert Brown picked up on the need for information and, as Trish Godman said, information can be used to help people to access benefits and bring much more money into the system. Trish Godman and Helen Eadie outlined areas of good practice; such information can be shared. We need to tighten up systems and collect information in ways that will enable identification of needs, co-operative working and monitoring of effectiveness. Iain Gray mentioned the quarterly review of delayed discharge, which will be useful. That information can be fed into the system to make it better.
Mary Scanlon also mentioned the acute services review. That review is not necessarily a bad thing; indeed, it is very necessary. The review must be done properly and must involve people, but when resources are under pressure, they must be used effectively. To me, reviewing and rationalising services is a good way forward if we do it properly, take people with us, and explain what we are doing and why.
Iain Gray gave recognition to informal carers. I want to highlight the work of young carers, to which an awful lot more attention needs to be paid. Those young people are picking up adult responsibilities without having access, in an adult way, to support and resources. That is a key area.
Kay Ullrich talked about years of underfunding, especially for local authorities, and I quite agree with her on that. I was astounded by Keith Harding, who went on about pensions and local authorities, funding for both of which was eroded systematically by the Tories. I was also astounded by his remarks about the working time directive. We all want more services, but not at the expense of people having to work long hours for poor pay, with bad training. That was appalling.
If the member had listened, she would know that all I was saying was that the working time directive had had an impact on nursing home costs that local councils will not meet. The directive is putting nursing homes in difficulties, and many are closing.
I think that I heard exactly what was said, and my remarks stand. We cannot provide more and better services at the expense of the staff who work in the homes. We have to meet the costs; it is right that we should do so.
Does the member agree that it is quite awful that Aberdeenshire Council has passed on huge charges for warden services to the elderly as a means of trying to balance its badly run books? Does she agree that it is bad for a council to single out a defenceless part of the community and deprive the elderly of the little money that they have?
I challenge that. Aberdeenshire Council is not badly run. Given the council's funding, it provides services at a much lower cost per head of population than almost any other council in the country. The council is grievously underfunded and is having to take measures that are deeply regrettable, but that is not down to bad management.
Services need resources, but resources can mean less dependency on services. The basic old age pension has been devalued over two decades. If people of pension age had a reasonable income, they would be far less dependent on social services and health services. The most effective thing that we, or Westminster, could do for the elderly and the disabled would be to whack up the basic pension. It was interesting to hear the minister say that people mostly wanted direct payment schemes that enabled them to purchase their own services. That brings us back to the point that if we give people a decent income, they can sort out their affairs for themselves.
Although this has been a reasonable debate, Helen Eadie's speech gave the lie to any suggestion that last week's rebellion over warrant sales would herald a new, refreshing era of independent and radical criticism from the Labour back benches. Regrettably, her speech was nothing more than a Scottish Executive press release.
I will concentrate on three areas, one of which—institutional agism in the NHS and the question whether rationing exists—has not received sufficient attention in this debate. I will also touch briefly on local authority funding and the position regarding the Royal Commission on Long Term Care for the Elderly.
The Executive has said that the rationing of health care—the idea that the elderly would be pushed down the list, would not receive treatment or would be excluded altogether—does not exist; in fact, we heard the same claim only a few days ago. Everyone is interested to hear the minister's response to the criticisms of the British Geriatrics Society, which has cited examples of over-75s being excluded from important Government targets and of over-65s being rarely offered breast cancer screening, even though two thirds of mortalities from that disease come from that age bracket. Such criticisms suggest that there is a systemic problem with older people's access to the same level of service that others receive in the NHS. We must identify whether that problem exists, and if it does exist, I hope that the minister will act quickly to ensure that such unacceptable discrimination in the NHS does not continue.
On the issue of local authority funding, we should start where Nora Radcliffe left off. If a coalition partner claims that there is grievous underfunding of local authorities, perhaps the problem exists. Furthermore, we have not yet had an answer to Kay Ullrich's question whether local authorities' claim that they are not receiving adequate resources was right or wrong. Labour councils are blaming the Labour Executive for the situation, but the Executive has not provided any answers.
Let us examine the figures. Since 1993, there has been a real-terms drop of 9 per cent in local authority funding. The Tories should not look too smug, as that includes the period when their party was in power. For 2000-01, there is a shortfall of £298 million in local authority funding across Scotland. Those figures are from the Labour-controlled Convention of Scottish Local Authorities, not from the SNP research department. Is it any surprise that there is bedblocking and that 2,500 to 3,000 are receiving inappropriate care? That is the problem that we must address. Until we get into the figures for local authority spending and make such funding adequate, we will not make any necessary progress.
Shona Robison made a very telling speech about the reality of the shortfall in local authority funding and how that will affect services such as home helps and the ability to help people to care for themselves at home. Those services are critical to the philosophy of community care, and will not happen without adequate resources.
The Royal Commission on Long Term Care for the Elderly has become something of a totem for this Government's commitment to the elderly. Although no one wants to undermine attempts to implement some of the commission's recommendations—for example, the national care commission, which the minister mentioned and which should be welcomed—we must ask about the Executive's attitude to the rest of the report. As so many measures, such as the three-month disregard mentioned by Kay Ullrich, could be implemented overnight by the Government, we must ask why it chooses not to do so. It has been suggested that some of those powers are reserved to Westminster; however, that is not really true. Age Concern and other organisations have said that all but two of the key recommendations can be implemented by this Executive, if the will is there.
Most people in Scotland understand that we need a rational and mature debate about provision of care for the elderly in the NHS and local authorities and as part of the community care philosophy. However, such provision must be backed by adequate resources. Without that, and without the implementation of the Sutherland commission's recommendations, most people will rightly say that the Government's commitment has been radically undermined.
I have listened to the debate carefully. I appreciate and have certainly never denied that people face real problems and that services must improve. My point, however, is that considerable progress has been made. In the first year of the Parliament, a firm foundation has been laid for genuine and sustainable improvement in services for some of our most vulnerable citizens. That does not indicate indifference or complacency—it is a fact.
We are helping agencies to work together to focus on people's needs, setting higher standards, supporting Scotland's carers and increasing investment in health and social care. As I have said, we believe that listening is central to getting that right—taking the time to listen and to consult on issues such as, for example, national care standards.
I am happy to listen in the chamber too. I did listen carefully and thought that I heard Mary Scanlon announce a Tory policy to remove community care from local authorities and shift it to the NHS. I confess that the idea flashed by before she could develop it, so I cannot be certain that that is what I heard. Trish Godman heard an echo of privatisation, which was perhaps there too, but Mary did not go on to develop that either. She did not develop either of the two apparently new policies that she announced.
I listened in vain for constructive engagement from the SNP in how we can improve services for the elderly and disabled. I confess that I saw a glimmer of a constructive proposal in the SNP amendment, but maybe I was clutching at straws. Opposition members, as always, have focused on spinning the numbers, so that a £53 million increase in local authority social work is called a cut and introducing a proper census to identify regularly the scale of delayed discharge is called ignoring the problem.
Will the minister give way?
No, I am sorry.
Increasing NHS resources by £300 million and then by a further £173 million is called failing to invest. Progressing Sir Stewart Sutherland's recommendations on the care commission, on carers, on direct payments and on joint working between agencies is described as gathering dust and touchy-feely soundbites. Duncan Hamilton may not have described it as that, but Kay Ullrich certainly did. She referred to the sound of dragging feet. She has told me before that she hears dragging feet. I am quite concerned about it. I am reminded of Caligula, who constantly heard the sound of galloping horses in his head. Things ended rather badly for him.
Will the minister give way?
No.
Where was the debate about the new models of sheltered and very sheltered housing that I have seen in Brechin and Moray, where older people are being given the chance to move back to their own tenancies, which offer independence within the security of an intensive home care package? Where was the debate on community rehabilitation teams, such as the one in Edinburgh, which are so successful that they can lead to a reduction in dependency following a hospital stay? Where was the debate on day care and respite for those with dementia, provided in homes not institutions, as I have seen in Stirling, Falkirk and Clackmannan? What about the brokerage of independent living fund direct payments in Grampian, which is giving disabled young people homes, jobs and the lives that they want?
I agree that too many people do not have access to those kind of improved services, but they are around and I would like a rational debate about them. I am open to suggestions from anywhere as to how we can do more to spread good practice and bring in new and better approaches.
Will the minister give way?
Certainly.
I see that the minister will take interventions from his own party.
If the minister would like to learn more about spreading good practice, I invite him to come to my constituency, where not only was the first charter mark award in Scotland for a local authority elderly care home won last year, but the NHS has won a charter mark award for its care of the elderly. Will the minister come to see such partnership working in practice?
I thank Cathie Craigie for that invitation. I say to Duncan Hamilton that that was a tougher intervention than most of his.
We have yet to hear from the Tories, for whom David Mundell is winding up. When I came in at the end of the previous debate, Peter Peacock pointed out that David Mundell is a reasonable and positive member of the Parliament. I go along with that, so I look forward to hearing him develop the policies that were hinted at by Mary Scanlon. I look forward to hearing about the Tories' new ideas, their alternative approaches and their proposed strategic shifts in service delivery. Presiding Officer, I am nothing if not an optimist.
I feel rather like Johann Lamont did last week during the warrant sales debate, when she received praise from Tommy Sheridan.
It is important to have had this debate and, as I said at the conclusion of the previous debate, it is important for the Parliament to have discussed this morning's issues. Iain Gray, in his winding-up speech, mentioned some other things that are worthy of debate in this chamber in the more expansive way that is possible with the time available. Robert Brown made a similar point. We could have had the whole morning devoted to either of the two topics. We wanted to raise a further important issue within the time that was available to us. The two topics are fruitful ones, and are worthy of discussion in the Parliament.
I appreciate the fact that the motion has covered a lot of issues, on which we could spend a great deal of time. Within David Mundell's motion is a criticism of what is described as the Executive's "agenda of political correctness". I point out that the Conservatives have on occasion used their debating time to discuss matters such as section 2A, when the same time could have been spent discussing services for the elderly and the disabled. I hope that such discussions will be the pattern for the future.
As I indicated at the end of the previous debate, it was the Executive that put section 2A into the political environment. The Executive has allocated time to the census debate, time which could have been used much more usefully to discuss topics such as those chosen for today. I hope that this morning's debates set a pattern for the discussion of issues that people are concerned about.
I want to comment on two contributions. I could agree with most of Trish Godman's contribution, but when I drafted the motion, I had no hint of privatisation in my mind. As far as I am aware, there is no such hint in our policies here in Scotland. As for Helen Eadie, I do not know where she got the statements that she referred to. The Conservative party in Scotland will make policies for Scotland, and that is underpinned by our view that all NHS treatment in Scotland is free at the point of delivery. That is clearly our position. I do not know what the source of Helen's material was, but it was not accurate in relation to our position in Scotland.
We often talk in terms of social inclusion, and not a day goes by in this Parliament when it is not mentioned. That is not a topic that people talk about in the post office queue or in the supermarket, and it is therefore important that we discuss the issues that people really understand and are concerned about. Those include the question of why, for example, people in Stranraer are faced with the cost of their meals on wheels service rising overnight from £1.05 to £2.99, the highest price in Scotland. The same meals on wheels service may cost £1.40 here in Edinburgh.
A number of views have been expressed in relation to the past, and many MSPs seem to be wedded to a blame culture. From my positive stance, I really want to improve things by dealing with the immediate practical problems facing elderly and disabled people throughout Scotland. Everyone must acknowledge the fact that the elderly population is growing. In parts of the South of Scotland, which I represent, one in four people is over the age of 60, and a growing part of the population is over 80.
It is vital that an effective strategy to ensure that people receive the help and support that they require lies at the heart of the Executive's priorities. It is clear from a range of evidence that Scottish pensioners feel let down, and not just by the UK Labour Government's promises of massive pension rises—promises which have come to nothing, of course. They also feel let down by the way in which the Executive has presided over an allocation to local authorities whereby council tax increases have outstripped pension increases.
Pensioners and disabled people find themselves paying for services for which they did not previously pay or facing massive price hikes. I have given Dumfries and Galloway as an example, although I do not regard that council as typical as it is led by an odd coalition between Labour and the SNP, which appears to disagree on everything bar allowance payments.
In the south-west, an area that is typical of Scotland, elderly people are being deprived of a choice about the home in which they will receive nursing care. I do not want to comment on the legal action or the auditor's report in relation to externalisation of residential homes in Dumfries and Galloway, but this Parliament must be able to reaffirm its view that people are entitled to freedom of choice when they are required to move into residential or nursing care.
The basic entitlement of any elderly person in Scotland should be the freedom to choose an establishment that is close to their community and their family or where people that they have known all their lives are living. They do not deserve to be shipped off to a place in which the council has been able to purchase spaces on a bulk basis and which is miles away from their domestic connection. They certainly do not want to be part of the bedblocking problem that Mary Scanlon mentioned earlier.
Bedblocking is one of the clearest ways in which the Executive will be judged on its aim to deliver joined-up government and an holistic approach. It is clear to the public that, while having elderly people in NHS beds might save £300 to £400 a week, it costs another section of the public purse nearly £1,000 a week and deprives someone else of a medical place. We need to see evidence of co-ordination between agencies rather than a scramble for funds.
A number of the most significant issues for the elderly and disabled groups are, as Kay Ullrich and Duncan Hamilton pointed out, reserved matters. Pensions, which we debated some weeks ago, is an obvious issue, as is the UK Government's response to the Sutherland report. We must have that response as soon as possible. The Government must work more closely with the UK Government, not just on politically correct issues, but on issues that matter to the Scottish people. The Executive must adopt a programme that delivers to our elderly and disabled citizens affordable services, freedom of choice and the dignity and respect that they deserve.