Plenary, 05 Oct 2000

Meeting date: Thursday, October 5, 2000

Official Report 715KB pdf

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Older People (Care)

The next item of business is a statement by Susan Deacon on care for older people. There will be questions at the end and no interventions.

My statement sets out the Executive's plans for the care of older people and its response to the report of the Royal Commission on Long Term Care for the Elderly. I will set out a radical, wide-ranging package of measures that will deliver real improvements to the care of older people in Scotland. First, I shall put those proposals in context.

We live in an aging society. In the past 70 years, the number of over-65s has more than doubled. Between 1995 and 2025, the number of over-80s will increase by 50 per cent and the number of the very old—the over-90s—will double. Already, one in five of us is over 60.

The Labour-Liberal Democrat coalition has put older people at the heart of its agenda for social justice and has reflected that commitment in its policies, legislation and spending plans. We aim to give Scotland's pensioners warm homes, affordable transport and better care. We want to add life to years, not just years to life. We value the contribution of older people and hope to enable all Scots to fulfil their potential right through life.

The First Minister has made clear our commitment to raise the standards of care and to use our resources to deliver the maximum possible benefits to the maximum number of people, especially those in greatest need. Today, we translate that principle into practical effect. In reaching our decisions, we have had specific regard to the royal commission's report on long-term care—by any measure, a milestone in the discussion on the care of older people.

On behalf of the Scottish Executive, I pay tribute to Sir Stewart Sutherland and to the members of the commission for their thorough and sensitive report. I thank also all those who gave their time and energy to submit views and evidence to the commission. From an early stage, we have actively addressed the issue of care for older people and have taken forward many of the royal commission's recommendations.

We agree with the principles of fairness and equity upon which the report is based and are determined to give practical effect to those principles, both now and in the future. We are determined to address the many, varied and changing needs of older people across Scotland.

The royal commission report made 24 recommendations. I have today published a detailed written response to those, which has been made available to members. We have already taken forward several of the key recommendations.

We will establish a Scottish commission on the regulation of care in a bill that will be introduced by Christmas; we have extended the system for making direct payments to the over-65s; and we have launched a strategy for carers in Scotland. But we want to go further.

First, on joint working, the royal commission report stressed, again and again, the need for far better, clearer, more co-ordinated and more co-operative arrangements between the providers of care—notably the NHS and local authorities—and the independent and voluntary sectors. In recognition of that, last November I established the joint future group, which is chaired by Iain Gray. Many of our proposals build upon that group's work.

Joint working may be desirable in many areas; in the care of the elderly it is essential. Too many people fall through the gaps between different care providers. Too many people suffer as a result of inefficiencies and demarcations. I want today to mark the beginning of the end of those system failures.

Many agencies are already doing good work to deliver care centred on the needs of older people by pooling budgets, co-locating and integrating structures and services. That good practice must stop being the exception and become the rule. We do not believe that imposed structural change or forced integration of NHS and social work services would be in the best interests of those who depend on care or those who deliver it, but we believe that much can, and must, be done to improve dramatically the current state of affairs.

I announce today that by 2002 we expect all community care services for older people to be jointly managed and jointly resourced. We will expect every health board and every local authority in Scotland to put those arrangements in place in the course of the next financial year. We will legislate to remove any remaining obstacles to effective joint service delivery.

We will also work to ensure greater fairness and equity in the provision of care across Scotland. For example, the variation in home care charging across Scotland is vast. In some local authority areas all services are free; others apply a maximum charge, which ranges from £11.50 to £85 per week, while a few charge the full cost of the service. That is patently unfair.

I am pleased that the Convention of Scottish Local Authorities shares that view and is working with local authorities to address that variation. We hope that change can be achieved by agreement, but we will not leave that to chance. I therefore announce our intention to legislate to have, in reserve, the power to issue guidance on charging across Scotland which authorities would have to follow.

I turn now to residential and nursing home care. Of the three quarters of a million Scots aged over 65, the number in long-term care at any one time is around 34,000. As the royal commission notes, one of the greatest worries facing many older people is that of selling a home to pay for care. We will act to reduce that uncertainty and distress.

I therefore announce that we will implement the royal commission's recommendation that, for the first three months following admission to residential care, the value of a person's home will be disregarded from the means test. That will give people time to think about their future after entering residential care and will enhance the possibility of rehabilitation and a return home.

We will also make more local authority loans available so that more people who are in care do not have to sell their house to fund that care. Furthermore, we will increase the capital limits used to assess charges and restore them to their 1996 values, which will bring the upper capital limit to more than £18,000, so that more people can keep more of their capital while in care—and we will do more to enhance security, reduce uncertainty and remove inequities.

We agree with the royal commission's view that the current arrangements whereby nursing care is provided free of charge in a hospital or community setting, but is charged for in nursing homes, is anomalous and neither justified nor defensible. I am pleased to announce that, in future, all nursing care will be provided free, regardless of where the person receives that care. We have set aside resources—£25 million initially—to fund that change and we will legislate for it as soon as possible.

The royal commission also recommended that personal care should be provided free of charge. The main practical effect of that proposal would be to reduce the cost of care for the 7,000 or so Scots in residential care who are self-funding. We agree with the principle of equity that underpins the recommendation, but we also believe that, to make that change at this time, when so many wider needs exist for tens of thousands of older people, would not be right.

We are determined to continue to address inequities and anomalies. For example, we believe that the old distinctions between a medical bath and a social bath have no place in a modern care system. We recognise that people who have some conditions, such as Alzheimer's disease, require a high level of care, if not specific medical intervention. It is our view that neither the rigid definition of tasks nor the professional demarcation of nursing offers a way forward. Care must be provided on the basis of a person's need, rather than on definitions of what is done or who does it.

In making the move to the provision of universally free nursing care, we will work closely with the nursing profession and others to ensure that the arrangements for assessment and delivery of care are effective and are based on need. I have today asked Anne Jarvie, Scotland's chief nursing officer, to lead that work and to report to me by the end of the year.

Much of our discussion and this statement have focused on residential care. However, as I said at the outset, we are determined to address the needs of all Scotland's older people. Most older people, including many of the very frail, live at home. All the research, and feedback from older people themselves, confirms that, as far as possible, most older people want to stay there. They want to receive care at home—not in homes.

I am therefore announcing today a major investment package in community and home-based care for older people. It will be the biggest such investment and change since the inception of community care. It will maximise the independence, dignity and quality of life of thousands of Scottish pensioners.

It is wrong that an older person should end up in hospital or in a home simply because their carer falls ill. It is also wrong that an older person should end up in a home for lack of a zimmer frame, a raised toilet or a bath aid, and it is wrong that an older person should end up institutionalised, simply because they are no longer able to get out to the local shops.

We want to right those wrongs. Following on from the spending review commitment that Jack McConnell made on 20 September, I announce today new money for local authorities to do just that, by delivering more and better services. There will be additional resources of £30 million next year and £36 million in the following year, and by 2003 an additional £60 million will be allocated to local authorities to deliver a step change in care to older people in Scotland. Those resources will give older people the independence and choice that are currently denied.

That package will be used to deliver rapid response teams in every part of the country, which will provide fast, flexible support to up to 18,000 older people at home, such as pensioners who fall ill and for whom a short period of help might mean they do not need to go into hospital.

The money will also be used to provide free home care support for those who need it for up to four weeks following discharge from hospital, such as a person recovering from a broken hip. That support will provide extra care at a critical time for at least 15,000 Scots—it will help them to get home from hospital more quickly, and it will actively support their recovery.

There will be 1,000 additional long-term home care packages for those in greatest need, such as people who have had a stroke and who might otherwise have to go into a nursing home. We will provide 22,000 more weeks of respite care to help thousands of older people, their carers and families, many of whom currently receive no help. Every part of the country will have a local service for shopping, laundry and minor household repairs, which will help to preserve precious independence at home for another 10,000 to 15,000 older people.

We will go further. I can also announce that we will release an additional £5 million with immediate effect to provide older people across the country with much-needed equipment and adaptations. That will make a massive impact on the backlog of 10,000 people waiting for equipment.

We will continue to invest to address the tragic situation of the hundreds of older people who languish inappropriately in acute hospital beds for want of the correct care at home or in residential care. This week, we released £10 million extra to local authorities to address delayed discharge. Today, I can confirm that that additional investment will be repeated next year, the year after and the year after that.

We will not leave change to chance. Investment must deliver improvement. That is why we will work hand in hand with Scottish local authorities to deliver change, in a partnership for Scotland's pensioners. We will now enter formal discussions with COSLA to put in place with local authorities across Scotland new partnership agreements for care of the elderly from April 2001. Our joint aim will be to ensure that the additional investment that I have announced today is spent where it is intended to be and delivers the improvements that are needed. In short, we are supplying not cash with strings but cash for results.

Our work does not end there. That is by no means the last word. We are determined to drive forward further improvements for Scotland's older people. The joint futures group's recommendations will go out to consultation shortly, to take forward measures to deliver better joint services and address the gaps and duplication that currently exist in such items as needs assessments, occupational therapy services and equipment supply. To kick-start that work, £3 million will be made available in this financial year.

The new Scottish commission for the regulation of care, once established, will also contribute to developing policy and thinking on the future of care in Scotland. Later this year, the Health and Community Care Committee will publish its report on community care. That, too, will inform our work. In November we will publish the Scottish health plan. I give a promise now to Scotland's older people that their needs will be at the heart of our proposals.

Today's announcement is a milestone in the drive of this Labour-Liberal Democrat Executive to improve living conditions, quality of life, support and care for older people in Scotland. Wendy Alexander has set out our commitment to the warm deal—to installing central heating free for 70,000 older Scots, making their homes warmer, healthier and safer. Sarah Boyack has set out our plans for a major programme of concessionary bus fares for Scotland's pensioners, enabling older people to have greater independence and quality of life. Today I have set our plans to invest in and to transform the care and support given to Scots in their old age.

Many thousands of older people in Scotland and their families will benefit from these measures. Many thousands of older people in Scotland will be able to lead more active and fulfilling lives. Many thousands of older people in Scotland will get the care that they need, when they need it and where they need it. We want to see people living longer and living independently. That will be living proof of the place of older people at the heart of a modern Scotland.

The minister will now take questions on the issues raised in her statement. I intend to allow around 30 minutes for questions, after which we will move on to the next item of business. A large number of members have indicated that they wish to question the minister on her statement this afternoon, so I ask members to keep their questions—and the minister to keep her answers—as concise as possible.

That might be a challenge for the minister.

I warmly welcome the measures that the minister has announced this afternoon—as far as they go. However, will she confirm that she has turned her back on the central recommendation of the Sutherland report, which is that personal care should be provided free for people who, due to the frailties of old age or because they suffer from illnesses such as dementia, require essential help with washing, dressing or toilet needs? Furthermore, does she agree that she has denied equity both to the 7,000 people currently paying for care in residential homes who will continue to be means-tested and face the prospect of selling the family home to pay for their own care and to the 25,000 older people currently paying for their own care in their own homes?

We have waited 18 months for a response to the Sutherland report. Will the minister finally acknowledge the overwhelming body of opinion in Scotland and come back to the Parliament quickly with a clearly defined time scale for the full implementation of the Sutherland report, which is what elderly people and the organisations that represent them want? Or is she happy to confirm herself to be a minister in a Government that is quite simply not prepared to listen?

It is interesting to see that, although the SNP might have a new health spokesperson, we still have the same old tired approach every time we discuss the real issues and challenges facing Scotland.

Answer the question.

Does Nicola Sturgeon agree that today's package of measures represent the biggest investment and change in home care ever for older people in Scotland? [Members: "Answer the question."] Does Nicola Sturgeon agree that free nursing care provided in all settings for Scotland's pensioners will benefit many people and develops fairness and equity in a practical way?

Answer the question.

Order.

Does Nicola Sturgeon agree that the measures introduced today will benefit tens of thousands of older people in Scotland and will make a real difference to their lives?

My statement today makes clear not only the measures that we are introducing both to improve the quality of life for tens of thousands of older people in Scotland and to implement the royal commission report, but the principles and basis on which we have acted. As I said in my statement, 7,000 people will benefit from one specific measure that will be introduced. We have reached a very clear and honest decision about why we have gone down this particular road, and I suggest that Nicola Sturgeon thinks again.

On a point of order, Presiding Officer. Given that you asked for brief questions and answers, could you please direct the minister to give some brief answers?

If Nicola Sturgeon cares to read today's statement, she will not only receive the answer to her question, but see the real difference that we are making for older people in Scotland. I have yet to hear what the SNP would do for older people, how the party would pay for its policies and how those policies would make a difference. We are making a difference.

Like Nicola Sturgeon, I welcome the fact that the minister has addressed issues such as variations in home care charging and disregard of the value of a person's home for the first three months. Furthermore, I welcome the advance notice of the ministerial statement and thank Murdo MacLeod of Scotland on Sunday for the opportunity of reading the ministerial statement in advance.

The Sutherland commission was set up because the current long-term care system was not working. I will use that system as a benchmark: 10,000 people are currently waiting for assessment; 10,000 have been assessed and are waiting for care; and the care plan and care needs of many more thousands are totally different because councils cannot afford to provide the services. In the light of those facts, does the minister agree that the figure of 7,000 that she mentioned is grossly misleading?

Many elderly people go into care due to council cuts and end up in blocked beds because councils cannot provide a care package. In many cases, people must wait a year for occupational therapists. At the weekend, I heard that people were waiting nine months for care and repair schemes. I have used that as a benchmark to measure what has been proposed today.

Do the minister's recommendations stand up to challenges under the European convention on human rights? Does the minister agree that personal care falls under the internationally recognised definition of nursing care for the frail and elderly?

Will the minister explain the statement on page 7 of her statement, that free personal care "would not be right"? Why should we discriminate against people with Alzheimer's? Sutherland's second key recommendation was a single budget and a single point of entry. Why is the minister not funding personal care and why has she not accepted the single budget, as recommended by Sutherland?

On the local authority loans, what criteria will be used and how will they be paid back? When the chief nursing officer makes her recommendations to the minister, will she accept them? Will she give a promise to fund the recommendations?

Finally, if the Health and Community Care Committee decides to recommend the funding of personal care from general taxation, will the minister accept the recommendation of that cross-party committee?

I am pleased that Mary Scanlon has welcomed the measures that I announced. It is a pity that her question was a little confused, like the system of care that we inherited from the Tories and are now trying to make better. The answers to many of the questions that Mary Scanlon has raised were in my statement. It is somewhat galling that Opposition members complain about the length of ministerial responses, when they ignore in their pre-written questions and speeches what has been said in the statement. Moreover, many of the problems and weaknesses that Mary Scanlon identified are precisely the problems that our measures are designed to resolve.

Reference was made to the need to invest in local authorities to provide services. I repeat: the package that I have outlined sees a rise in the additional resources allocated to local authorities to look after older people to some £60 million by the third year of the spending review. That sits alongside Jack McConnell's announcement that the local authority settlement this year will see a 10.5 per cent increase above inflation. We are acting; we are making a difference.

Mary Scanlon is wrong in the words that she put into my mouth. Let me repeat what I said in my statement. I said:

"We agree with the principle of equity that underpins the recommendation, but we also believe that, to make the change at this time, when so many wider needs exist for tens of thousands of older people, would not be right."

All that any Government can do—and this is what this Government has done—is to be true to its principles, to be honest about its priorities and to act in the best interests of the people whom it represents. That is what today's statement does.

Many of the measures that were outlined in the minister's statement are extremely welcome. The minister announced that all nursing care will be provided free of charge and that Scotland's chief nursing officer will report to her by the end of the year on arrangements for assessment and effective care delivery based on need.

I have been taken aback to hear of some of the services that are delivered by home helps, for example, which presumably are not officially classed as nursing care. Will the minister give an assurance that the definition of nursing care will be wide and will include all the elements of care that most people would class as nursing care?

I have put in place the work that I announced today under Anne Jarvie, the chief nursing officer, because we want to take forward the implementation of free, universal nursing care in a way that is effective and that assesses need effectively. Much of what I announced is about removing barriers and demarcations in the provision of care. The last thing that we want to do is to introduce new barriers or new demarcations in extending the delivery of care to people across Scotland.

We also want to ensure that people with all conditions—including conditions such as Alzheimer's disease that affect the mind as well as the body—are considered properly in the work that will be done. I will not pre-empt the outcome of that work, because we want it to be performed jointly with the nursing profession and others who have an interest, but I believe that the principles I outlined, and the mechanisms that we are putting in place to progress it, will give us an outcome that is effective and demonstrably fair.

Before I call the next speaker, I ask members to try to ask single rather than multiple questions. That would help us to get through the questions more quickly.

I welcome the fact that older people have been made such a priority by the Executive.

How many older people will benefit from the package? Following on from Nora Radcliffe's question, I welcome the fact that nursing care will not be defined in terms of who does the job. However, will the minister say anything further about how the needs of people with dementia will be taken into account?

In addition to my statement, a detailed written response is being produced today. Members can find further information in that response on some of the issues that have been raised.

It has been on our minds, not only in the development of today's announcement, but in our work on health and community care in the past year, that we must work to extend, improve and develop services for dementia sufferers. We are giving additional support to the centre for dementia services in Scotland. The director of that centre sits on an NHS modernisation board. As I said earlier, the needs of older people—including dementia sufferers—will be at the heart of our Scottish health plan.

In addition to the work that will be done on the definition of nursing care, I hope that, across our work in the NHS and our community care policy, further and tangible improvements will be made in the months and years ahead. I look forward to working with the groups that are active in this area.

We welcome any restoration of the 30,000 home-care hours that have been cut by the Labour Government since 1998 and the fact that the cuts that led to a disgraceful 10,000-person waiting list for aids and adaptations are to be addressed. However, does the minister agree that the announcement will neither end the disgrace of elderly people having to sell their homes or use their savings for their care, nor help the 25,000 or more people who have to pay for personal care in their homes?

Further to Nora Radcliffe's question, will the minister clarify whether nursing-type duties that are carried out in the person's home—not in residential care, which the minister talked about in her statement—such as the changing of a catheter or the giving of medication by a home help will be carried out free of charge or will they continue to be charged for?

If the Health and Community Care Committee comes out in favour of full implementation of the Sutherland report, will the minister ignore the months of work that that committee has done or will she respond with a time scale for full implementation?

Many of the measures that I outlined today will address precisely the sort of issues that Shona Robison has raised. People will be supported with home-care services in their home by the granting of a free four-week period to all older people who are assessed as needing it when they return home and by examination of the charging arrangements for home care across Scotland. Those are practical measures.

I will not prejudge the outcome of the Health and Community Care Committee's inquiry. That would be wrong, and I have made clear that we will consider the committee's findings carefully. I have also made clear the basis on which we have made the policy and spending decisions in my statement today.

It is dishonest for members to promise the world without saying how they would deliver and pay for it; they promise everything and deliver nothing. Once again, I am saddened that the SNP tells us it will do things that we know it cannot do, and makes promises that cannot be kept. I am not prepared to do that to Scotland's older people.

Like many other members, I welcome thoroughly the vast majority of what the minister has said, with one obvious exception. We have heard some good things, for example about the doubling of the money that we will put into community care consequentially. What the minister said today will make a real difference to tens of thousands of old people.

I welcome a move towards joint working by 2002—that is ambitious—and I look forward to hearing how the minister, the Convention of Scottish Local Authorities and others will develop that proposal.

The minister said that we will legislate as necessary to remove any remaining obstacles to effective joint service delivery. Does the minister agree with me—and with the overwhelming number of councils, health boards and others from whom we have taken evidence—that having different charging systems for health and social work is an obstacle? Will she give a commitment to revisit that issue, especially with regard to charges for personal care in people's homes? I take on board the good things that the minister said today about tackling some of those matters.

Will the minister give a commitment to reconsidering charges for personal care in people's homes if COSLA tells the minister that charging differently for health services and social care services at home is too great an obstacle to delivering the joint working that she, I and everybody else in the chamber wants?

Margaret Smith is right to highlight the many anomalies and inequities that exist in the current system, and I am determined for us to work hard to remove them. She is also right to say that our programme is ambitious, but that is as it ought to be.

The work on home care charging—both the work that was undertaken by COSLA and that which we were involved in—addresses not only the levels of charging, but the way in which assessments are undertaken. All that work will go some way towards addressing the concerns that Margaret Smith raises.

There are many good examples in Scotland from which to learn and on which to build. For example, there is the Government-funded pilot project in Perth and Kinross, which has contributed to delivering a fully integrated service. Health boards and local authorities in many parts of the country are taking significant and frequently innovative steps to achieve effective integration. The work of the joint futures group has involved looking closely at how that has developed across the country. We will accelerate that work in the light of today's announcement, to ensure that effective joint working becomes a reality throughout Scotland as soon as possible.

In remote rural areas, it is extremely expensive to deliver care in the community. When the money for the proposals is disbursed, will the minister take special cognisance of the difficulties of delivering care in the community in rural areas?

The specific care in the community needs of rural areas are under discussion in relation to the formula that is applied to local authorities.

I want to make a wider point: we have made a clear commitment to give older people greater independence, and to give them the choice of remaining at home when they want to do so. That is important for older people in any part of Scotland, but it is particularly significant for rural areas, because the transfer into care or into a home can often involve a move of many miles, away from friends, family and community. I hope that the impact of the changes that we are introducing will be particularly tangible and beneficial for older people in rural areas.

It is unfair for the minister to attack the Opposition parties for promising everything without showing how they will pay for it. If she had attended last week's debate, she would know that we all proposed different ways of doing that. Now that the minister has abandoned the provision of personal care as described in the Sutherland report, will she confirm that, under her nursing care proposals, a person will not receive assistance with the management of problems associated with mobility, washing, bathing or dressing unless he or she pays for it?

Does the minister accept that the abandonment of the principle of providing free personal care means that she is punishing unfairly all those who have saved and contributed to pensions during their lifetimes? I would like specific answers, but I know the minister finds them hard to come by. How much of the additional £30 million she announced for this year is new to the moneys announced in the spending review in July? Is the £5 million that will be released this week part of the £30 million, or does it come from the NHS modernisation fund that was announced years ago?

I did not think that I was such a shrinking violet that Ben Wallace would not have noticed me during last week's debate. I assure him that I was here and that I listened very carefully. I am pleased that the measures we have announced today act on many of the points that were raised during that debate.

The resources that I announced today have not previously been announced. The £5 million that was announced today for aids and adaptations was not previously announced. We looked into our budget to see whether we could identify additional money that was available now to make an impact on the backlog of requirements for aids and adaptations. The additional money that I have announced for local authorities sits alongside, and is part of, the overall package of measures that Jack McConnell announced in his spending review plans. The resources are real and additional, and will deliver real results. I hope that we can move on a wee bit in the Parliament and—instead of the dancing on the head of a pin that goes on—recognise that what has been announced today is radical, right and will deliver results.

The minister's statement will have an impact on staffing levels. What plans does she have for ensuring the availability of a pool of appropriately trained staff to implement the reforms that she has outlined today?

Irene Oldfather is right to highlight the fact that the changes and investment that we make in health and community care must centre on the people who deliver that care. Much of the wider work that is being progressed in health and social care is about investing in the work force, not just by employing and training more people, but by giving staff the skills and training that they need.

It will of course be for local authorities to determine the staffing that will be required, but other relevant work is also being done in the Executive and the NHS. For example, work on the public health nursing function will consider the work of health visitors and the role of district nurses. I hope that we can join up our thinking and actions to consider those services not as separate categories, as happened in the past, but from the point of view of the person who is receiving the care. The recipient does not care which service delivers the care, so long as it is the right care, in the right place, at the right time and of high quality. That is our goal.

The minister has made some welcome announcements today. I have a personal interest—I hope that my grandmother in Govan, who is 84 and has been waiting for six months for a shower to be installed in her home, may now get that shower as a result of the extra money that has been announced. If she does not, I will let the minister know.

The minister said that she, and the Executive, believes in equity. She went on to say that it is not yet the right time to implement an equitable system when it comes to paying for personal care. Is the minister saying that she cannot afford to do so? Is that why she is not implementing in full the recommendations of the Sutherland report?

The poverty audit that was released last week by Alistair Darling said that 100,000 more pensioners are in poverty now than were in 1997, when Labour came to power. Does the minister accept that that finding is a result of the means testing of pensioners? The minister's proposals will continue a means-testing system that has been discredited.

The Sutherland report did not advocate the abolition of the means test. The means test, under the proposals, will continue, but there are recommendations for it to be applied more equitably and fairly. We are taking that forward.

We have said that the specific recommendation on personal care would not be the right use of resources at this time, given the levels of need across Scotland. The changes that we have made will benefit tens of thousands of pensioners. I hope that, in the months and years to come, those changes will benefit not only Tommy Sheridan's granny in Govan, but my mum in Musselburgh, and the aunties and uncles, grannies and granddads, and mums and dads that we, and the people who depend on us, all have.

We are moving to the final five minutes for this item, so I ask members to keep their questions brief.

It looks as though my member's bill on dementia and personal care will have to continue—with cross-party support, I hope.

I want to be constructive. The minister talked about independence and choice, and there is much in her speech to be commended. As she is aware, during the past four years of new Labour, the percentage of the over-75s who are being helped to live at home has decreased by one sixth to just under 13 per cent. That is not a good record. Day care centres play a central role in sustaining older people at home and in their community, yet they struggle to get funding from local authorities and—for goodness' sake—from the lottery. Can the minister reconcile, on the one hand, a laudable commitment to give priority to maintaining the elderly in their homes, with, on the other hand, no commitment to require local authorities to provide day care centres and no commitment to funding them?

The whole essence of the partnership with local government that I set out today is that we are making a step change not just in the services that are delivered, but in the way that central Government works with local authorities and the way that local authorities work with the national health service. That change will ensure that we do not just keep measuring inputs to different areas, but that we get better at agreeing the outputs—the results that are required.

I know that Christine Grahame takes a keen interest in this subject, and she will know that the needs of a local population vary greatly and must be determined at a local level. Putting in place joint working arrangements, as we have done today, and putting in place the additional funding that I announced today, will make it all the more possible for all the providers of care—not only statutory agencies, but voluntary bodies—to work together to meet needs at a local level. It will be all the more possible to be true to a promise that has often been given in the past but has never yet been delivered on—to shift the balance of care back into people's homes.

I counted eight elements in the package—clearly, the Executive has had to make some hard choices. As the funds are not available to implement the Sutherland report recommendations on free personal care and the minister announced today that the chief nursing officer will undertake work on a definition of free nursing care, will the minister publish the remit for that work? Will she also ensure that the resulting free care element does not discriminate against mentally ill patients, wherever that care is delivered? I am thinking about people who have a severe and enduring mental illness, dementia of all types including Alzheimer's, learning disabilities, and the terminally ill. If the minister could give us that reassurance, it would move us significantly towards the equity and fairness to which the Executive stated last week it is committed.

I am happy to reassure Richard Simpson that the work that is being done by the chief nursing officer, and other work that is being done right across health and community care, will continue to ensure that those who are mentally ill are given the services, the attention and the recognition that they deserve. The remit for the chief nursing officer's work has not yet been set, but I will be happy to publish it when it is. I will also be happy to publish the outcomes of that work.

I want to correct the point that Richard Simpson made at the beginning of his question. It is not the case that the Executive has not made funds available today; the Executive has made the same—arguably, more—funds available today as would be required simply to introduce all the recommendations of the royal commission report. We have exercised choices about the most effective way of using those resources to deliver maximum benefit to the maximum number of people across Scotland.

Eight members still wish to speak. However, the debate has overrun by five minutes and we must move to the next item of business.