Community Care and Health (Scotland) Bill: Stage 3
We come to stage 3 proceedings on the Community Care and Health (Scotland) Bill.
I will make my usual announcement about the procedures that are to be followed. We will deal first with amendments to the bill and then move on to the debate on the motion to pass the bill. For the first part, members should have copies of the bill—that is bill 34A—as amended at stage 2. They should also have the marshalled list, which contains all the amendments that have been selected and the groupings, which I have agreed.
As we have just discussed during Fiona Hyslop's point of order, members will be aware that there is a revised marshalled list, which has been made available today. If members do not have the revised documents, which are distinguished by having the word "revised" printed on them, copies are available at the back of the chamber.
I think that members are familiar with the procedure by now and I do not need to read through it. Each amendment will be disposed of in turn. When we reach a series of Executive amendments that have already been debated and that are consecutive in the marshalled list, I will invite the minister to move them en bloc, unless any member objects.
I will now hand over the chair to Mr Tosh.
Section 5—Local authority arrangements for residential accommodation outwith Scotland
Amendment 1 is grouped with amendments 2 to 17. I invite the minister to move amendment 1 and speak to the other amendments in the group. Members who wish to speak in this part of the debate should press their request-to-speak buttons now.
Amendments 1 to 17 are minor technical amendments to ensure consistency of drafting, style and clarity in the bill.
I move amendment 1.
Amendment 1 agreed to.
Section 8—Amendment of 1968 Act: assessment of ability to provide care
The next amendment for debate is amendment 18, in the name of Shona Robison, which is in a group on its own.
Amendment 18 is intended to put the same onus on national health service bodies as on local authorities; first, to identify carers in their area and secondly, to provide information to carers and, in particular, information about their right to an assessment of needs.
The Health and Community Care Committee heard many carer organisations outline that the NHS has a long way to go before it supports carers effectively. That is what carers have said. A recent survey of carer organisations across Scotland, which was carried out by Carers Scotland and the Coalition of Carers in Scotland, found that carers regard the NHS as remote, inaccessible and sometimes intimidating. The survey found that the NHS can resist carer involvement, that carer consultation is done badly and that carers feel undervalued. A study of hospital discharge found that 72 per cent of carers had poor experiences of hospital discharge and that only 61 per cent of carers were consulted when hospital discharge of the person being cared for was planned.
Hospital discharge practice is not referred to in legislation, but only in guidance. Quite frankly, that is not sufficient. The strong message coming from carers is that guidance has had its day and that they now want statutory duties to ensure action. The Scottish Executive's carers legislation working group strongly recommended the introduction of such duties.
The evidence shows that unless statutory bodies proactively inform carers of their rights, carers do not take up assessments. One year after the passing of the Carers (Recognition and Services) Act 1995, 82 per cent of carers had not asked for an assessment.
NHS services are integral to providing support to Scotland's 620,000 carers, but so far they have largely failed to do that. The NHS is often the main point of contact for carers. It makes sense to use that point of contact to support and inform carers of their rights. That will happen only if NHS bodies have a duty to do it.
I move amendment 18.
When I first saw Shona Robison's amendment 18, I was minded not to support it—not because I do not agree with the principles outlined in the amendment, but because I thought that amendment 19, in the name of Janis Hughes, was more comprehensive. However, I have just discovered the minister's amendments to Janis Hughes' amendment—I am sorry if that sounds complicated.
Will the minister clarify whether, under his amendments, consideration will be given to the evidence that Carers Scotland has produced of NHS bodies' overlooking and ignoring carers? Will he assure us that account will be taken of the guidance to the Carers (Recognition and Services) Act 1995, which has yet to be amended?
The carers organisations tell us that far more carers are in contact with the NHS than with social services. It would be tragic if carers working with local authorities were given support, advice and information that other carers did not get. I apologise for speaking about amendments 19 and 19A, but those amendments will influence how we vote on amendment 18. Amendment 19A states that the Scottish Ministers may require any health board to prepare and submit to them a carer information strategy for:
(a) informing carers who appear to the Board to be persons who may have rights under section 12AA of the 1968 Act or section 24 of the 1995 Act that they may have such rights; and
(b) ensuring that information about such rights is available free of charge to carers."
I ask the minister to identify which persons with rights under section 12AA of the 1968 Social Work (Scotland) Act are to be supported. Are we talking about only a section of people, or are we saying that the carers of all those who leave NHS care will receive the same advice?
Does the minister wish to respond now, or does she wish to wait until she sums up the debate on amendment 18? It is not necessary for her to speak more than once, but she can choose to do so.
I will wait until I sum up the debate, Presiding Officer.
I support amendment 18. As Shona Robison said, amendment 18, if agreed to, would place an onus on NHS bodies to provide information to carers about their right to local authority assessments for care services. That is a similar duty to that which is already imposed on local authorities.
NHS services play a crucial role in ensuring that carers get the support that they need, in the right form and at the right time. However, the Health and Community Care Committee heard powerful evidence that the NHS has a poor record of engaging constructively with carers. Having said that, I recognise the many examples of good practice that exist in Scotland, but the NHS has no systematic approach to ensuring that it engages properly and beneficially with carers.
Shona Robison said that strong evidence exists to show that, unless statutory bodies proactively inform carers of their right to secure assessments, carers will not take up that right or obtain assessments. The Executive's argument at stage 2—I dare say that it will be repeated today—is that the matter would be better dealt with in guidance, rather than in primary legislation. That point is superficially attractive.
When the committee considered the bill at stage 1, I was struck by the evidence of carers organisations of their past experience of guidance issued under similar legislation. In their widespread experience, local authorities and health service bodies—which are addressed in amendment 18—do not uniformly follow such guidance. The carers organisations referred specifically to the Carers (Recognition and Services) Act 1995, under which guidance was issued. However, their evidence was that NHS bodies have not followed or implemented that guidance and that therefore carers are not benefiting from the provisions of the 1995 act.
I appeal to the Executive not to repeat the mistakes of the past. The bill, which is a good piece of legislation, gives us an opportunity to put NHS bodies under the same obligation as local authorities. In so doing, we will ensure that carers will be able to gain access to the services that they need. The evidence heard by the committee suggested that the best way in which to achieve that aim would be to incorporate that obligation in the bill, rather than to put it in guidance. I urge the Executive to support amendment 18.
I also express my support for amendment 18, which seems to be a reasonable amendment. Earlier today, together with other MSPs, I held discussions with carers. The people whom we met are on the front line, caring for others, including relatives. From my discussions with them, I believe that they would like to support an amendment to the bill along the lines of amendment 18, which would place a statutory duty on the national health service to inform the carer about his or her rights.
Sometimes, the health service, rather than local authority social work services, is the first to come into contact with a carer and the cared-for person. In such circumstances, it would be reasonable for the NHS body—I presume that it would be either the local health board or the NHS trust—to take the necessary steps to ensure that the carer is aware of his or her rights. For example, a general practitioner or community health visitor may visit the home.
At present there seems to be a lack of co-ordination, because some people—including GPs and community health visitors—might feel that it is not their job to inform carers of their rights, but that of social work services or whoever. To clear up any such confusion, it would be better to include in the bill a statutory responsibility for the national health service body to be proactive in that respect.
When the minister sums up, she might want to refer to amendment 19, which Janis Hughes lodged. The Executive seeks to amend—indeed, to dilute—amendment 19. I hope that Mary Mulligan will explain to us in detail how the Executive intends to deal with the problem in a way that will ensure that community health visitors, general practitioners and other health service personnel who visit people in their homes, and are perhaps aware of their needs initially, inform the carers of their rights.
I would be grateful if, when she sums up, the minister would explain a few points to the Parliament. First, amendment 18 suggests that the NHS would have a duty to provide information to the carer. If that duty applies to local authorities, will the minister explain why the same duty could not apply to the NHS? There must be reason for that and I would like to hear what it is.
Secondly, if the Executive's objection to amendment 18 is that it imposes a duty on the NHS to provide information to carers, will the minister explain why the Executive objects to the imposition of such a duty on the NHS, when it does not object to the imposition of such a duty on the local authorities?
Finally, if the Executive recommends amendment 19 as an alternative to amendment 18, will the minister explain briefly the difference between the amended version of amendment 19 that has been lodged by the Executive—amendments 19A to 19G—and amendment 19? Is the difference that if amendment 19A is agreed to the "carer identification strategy" mentioned in amendment 19 will disappear? Will the minister comment on that?
I recognise why Shona Robison lodged amendment 18; I am sure that all members recognise that. We all share her view that the NHS has a vital role to play in identifying and supporting Scotland's carers. I think that we would also all agree that although the NHS is addressing the carers agenda, its performance on that is not as consistently good as we would like it to be.
NHS staff in many different settings—in GP practices, in the community or in a hospital—are uniquely placed to identify that someone is acting as a carer for another person. It will often become clear when treating a cared-for person that they depend on a carer for support. On other occasions, a carer will be the patient.
It is clear that the NHS is already moving to improve its response to carers through a wide range of initiatives. The initiatives include the involvement of GP practices in programmes to identify carers and to offer information to them; the development of professional quality standards for GPs; the overarching development of clinical standards, which affect every aspect of care for patients; and the development of single shared assessment processes.
However, the Executive recognises that there is a strong view in the Parliament that a statutory obligation on the NHS would reinforce current good practice. In the face of that widespread view, we are ready to help to make that happen in a sensible and meaningful way. We recognise and endorse the objectives that underlie amendment 18 and the spirit of what it seeks to achieve. Carers who come into contact with the NHS will not always be the same carers that a local authority knows about. It is important that staff in the NHS make the most of their contact with cared-for people and their carers to help as many carers as possible to get support.
Amendment 18 would provide the NHS body with a duty to provide information to the carer. Amendment 19—which I originally supported—would require a health board to
"provide a copy of its carer identification strategy to any person who requests it."
However, many people may be unaware that such a strategy exists. They may be too traumatised or too emotional to ask for it. Perhaps only the most assertive and best informed will get the information that they need while others may be left out. Is not the minister concerned about that?
I will deal with the points that Mary Scanlon made in her earlier contribution, but I want first to concentrate on amendment 18. Let me say why we cannot support amendment 18; later, I will deal with how the various Executive amendments to amendment 19 will address the very points that Mary Scanlon has made. If Mary Scanlon bears with me, I shall come to those points.
Amendment 18 has serious legal flaws. For that reason, I urge members not to agree to it. If amendment 18 was agreed to, it would introduce a function for health bodies into the middle of section 12 of the Social Work (Scotland) Act 1968, which concerns social work services. The result would be muddle, which would be confusing for users and might create legal anomalies.
Amendment 18 does not give the context in which health bodies would perform their duty to inform carers of their right to an assessment. Section 8(2) of the bill places a similar duty on local authorities, which is directly linked to the local authorities' duty to provide community care services for the cared-for person. In amendment 18, neither the cared-for person nor the carer has any link with the NHS body and its existing functions. Although the amendment's intentions are clear, it would not produce a legally meaningful result.
Amendment 18 also overlaps significantly with the duties that section 8(2) would place on local authorities. That would create a situation in which both a local authority and an NHS body would be obliged to inform the same carer of his or her rights. Amendment 18 provides no scope to avoid or ameliorate such duplication. Duplicating such functions and responsibilities is at odds with our joint-working agenda and is more likely to lead to confusion and wasted resources than to improved support and information for carers.
I thank the minister for giving way. Carers Scotland has advised that far more carers are in contact with the NHS than with social services. Quite often, carers do not get in touch with social services until things have reached a fairly desperate stage. Does the minister accept that?
I accept that there are carers who are not involved with social work services. That is why we seek to amend amendment 19, so as to ensure that we place a statutory duty on health boards to recognise that fact.
None of what I have said means that a statutory duty of the kind that amendment 18 seeks could not be placed on the NHS. However, such a duty would need to be introduced in a way that made legal sense. We believe that amendment 19—as amended by Executive amendments 19A to 19G—is better placed to achieve the ends that we all seek. An amended amendment 19 would place a duty on the NHS that would be in the correct legislative context of the NHS's relationship with patients and carers.
Amendment 19 states:
"The Scottish Ministers may require any Health Board to prepare and submit to them a strategy"
It does not state that ministers must require health boards to prepare and submit strategies.
In addition, Janis Hughes's amendment 19 lists the things that the strategy must contain, including information for carers about their rights. The Executive's amendments to amendment 19 would blow a hole right through it, making it almost worthless.
I am still sure that amendment 19 will provide the solution that we all seek. It will provide support for carers, who have previously been known only to the NHS but will now be made known to the local authorities for the purposes of support and assessment.
Amendment 19, subject to the Executive's amendments to it, places a duty on the NHS in the correct legislative context of the NHS's relationship with patients and the people who care for them. It also offers a wider and more flexible approach to achieving the objective of amendment 18.
For the reasons that I have set out, and in order to make law that is logical, meaningful and clear in purpose, I urge the Parliament to reject amendment 18.
Some pertinent points have been made. The minister will have to go some way towards reassuring members that the Executive's amendments to Janis Hughes's amendment 19 are not a watering down of that amendment to make it meaningless.
I feel that the identification of carers is a critical element of the process and that a situation in which carers have to request information is less than satisfactory, so I will press amendment 18.
The question is, that amendment 18 be agreed to. Are we agreed?
No.
There will be a division.
For
Adam, Brian (North-East Scotland) (SNP)
Aitken, Bill (Glasgow) (Con)
Campbell, Colin (West of Scotland) (SNP)
Canavan, Dennis (Falkirk West)
Crawford, Bruce (Mid Scotland and Fife) (SNP)
Cunningham, Roseanna (Perth) (SNP)
Douglas-Hamilton, Lord James (Lothians) (Con)
Elder, Dorothy-Grace (Glasgow) (SNP)
Ewing, Dr Winnie (Highlands and Islands) (SNP)
Ewing, Fergus (Inverness East, Nairn and Lochaber) (SNP)
Fabiani, Linda (Central Scotland) (SNP)
Fergusson, Alex (South of Scotland) (Con)
Fraser, Murdo (Mid Scotland and Fife) (Con)
Gallie, Phil (South of Scotland) (Con)
Goldie, Miss Annabel (West of Scotland) (Con)
Hyslop, Fiona (Lothians) (SNP)
Johnstone, Alex (North-East Scotland) (Con)
Lochhead, Richard (North-East Scotland) (SNP)
MacAskill, Mr Kenny (Lothians) (SNP)
MacDonald, Ms Margo (Lothians) (SNP)
McGrigor, Mr Jamie (Highlands and Islands) (Con)
McIntosh, Mrs Lyndsay (Central Scotland) (Con)
McLeod, Fiona (West of Scotland) (SNP)
Morgan, Alasdair (Galloway and Upper Nithsdale) (SNP)
Mundell, David (South of Scotland) (Con)
Neil, Alex (Central Scotland) (SNP)
Paterson, Mr Gil (Central Scotland) (SNP)
Quinan, Mr Lloyd (West of Scotland) (SNP)
Reid, Mr George (Mid Scotland and Fife) (SNP)
Robison, Shona (North-East Scotland) (SNP)
Scanlon, Mary (Highlands and Islands) (Con)
Scott, John (Ayr) (Con)
Sheridan, Tommy (Glasgow) (SSP)
Sturgeon, Nicola (Glasgow) (SNP)
Swinney, Mr John (North Tayside) (SNP)
Wallace, Ben (North-East Scotland) (Con)
Welsh, Mr Andrew (Angus) (SNP)
White, Ms Sandra (Glasgow) (SNP)
Young, John (West of Scotland) (Con)
Against
Alexander, Ms Wendy (Paisley North) (Lab)
Baillie, Jackie (Dumbarton) (Lab)
Barrie, Scott (Dunfermline West) (Lab)
Boyack, Sarah (Edinburgh Central) (Lab)
Brankin, Rhona (Midlothian) (Lab)
Brown, Robert (Glasgow) (LD)
Butler, Bill (Glasgow Anniesland) (Lab)
Chisholm, Malcolm (Edinburgh North and Leith) (Lab)
Craigie, Cathie (Cumbernauld and Kilsyth) (Lab)
Deacon, Susan (Edinburgh East and Musselburgh) (Lab)
Ferguson, Patricia (Glasgow Maryhill) (Lab)
Finnie, Ross (West of Scotland) (LD)
Fitzpatrick, Brian (Strathkelvin and Bearsden) (Lab)
Gillon, Karen (Clydesdale) (Lab)
Godman, Trish (West Renfrewshire) (Lab)
Gorrie, Donald (Central Scotland) (LD)
Grant, Rhoda (Highlands and Islands) (Lab)
Gray, Iain (Edinburgh Pentlands) (Lab)
Henry, Hugh (Paisley South) (Lab)
Home Robertson, Mr John (East Lothian) (Lab)
Hughes, Janis (Glasgow Rutherglen) (Lab)
Jackson, Dr Sylvia (Stirling) (Lab)
Jackson, Gordon (Glasgow Govan) (Lab)
Jamieson, Cathy (Carrick, Cumnock and Doon Valley) (Lab)
Jamieson, Margaret (Kilmarnock and Loudoun) (Lab)
Jenkins, Ian (Tweeddale, Ettrick and Lauderdale) (LD)
Kerr, Mr Andy (East Kilbride) (Lab)
Lamont, Johann (Glasgow Pollok) (Lab)
Livingstone, Marilyn (Kirkcaldy) (Lab)
Lyon, George (Argyll and Bute) (LD)
Macdonald, Lewis (Aberdeen Central) (Lab)
Macintosh, Mr Kenneth (Eastwood) (Lab)
MacKay, Angus (Edinburgh South) (Lab)
Maclean, Kate (Dundee West) (Lab)
Macmillan, Maureen (Highlands and Islands) (Lab)
Martin, Paul (Glasgow Springburn) (Lab)
McAllion, Mr John (Dundee East) (Lab)
McAveety, Mr Frank (Glasgow Shettleston) (Lab)
McCabe, Mr Tom (Hamilton South) (Lab)
McConnell, Mr Jack (Motherwell and Wishaw) (Lab)
McLeish, Henry (Central Fife) (Lab)
McMahon, Mr Michael (Hamilton North and Bellshill) (Lab)
McNeil, Mr Duncan (Greenock and Inverclyde) (Lab)
McNeill, Pauline (Glasgow Kelvin) (Lab)
McNulty, Des (Clydebank and Milngavie) (Lab)
Muldoon, Bristow (Livingston) (Lab)
Mulligan, Mrs Mary (Linlithgow) (Lab)
Munro, John Farquhar (Ross, Skye and Inverness West) (LD)
Murray, Dr Elaine (Dumfries) (Lab)
Peacock, Peter (Highlands and Islands) (Lab)
Peattie, Cathy (Falkirk East) (Lab)
Radcliffe, Nora (Gordon) (LD)
Raffan, Mr Keith (Mid Scotland and Fife) (LD)
Robson, Euan (Roxburgh and Berwickshire) (LD)
Rumbles, Mr Mike (West Aberdeenshire and Kincardine) (LD)
Scott, Tavish (Shetland) (LD)
Simpson, Dr Richard (Ochil) (Lab)
Smith, Elaine (Coatbridge and Chryston) (Lab)
Smith, Iain (North-East Fife) (LD)
Smith, Mrs Margaret (Edinburgh West) (LD)
Thomson, Elaine (Aberdeen North) (Lab)
Watson, Mike (Glasgow Cathcart) (Lab)
Whitefield, Karen (Airdrie and Shotts) (Lab)
Wilson, Allan (Cunninghame North) (Lab)
The result of the division is: For 39, Against 64, Abstentions 0.
Amendment 18 disagreed to.
Section 8A—Amendment of 1995 Act: matters to be taken into account in assessment of needs of child affected by disability
Amendment 2 moved—[Hugh Henry]—and agreed to.
After section 9
Amendment 19, in the name of Janis Hughes, is grouped with amendments 19A, 19B, 19C, 19D, 19E, 19F and 19G.
Amendment 19 seeks to address an omission in the bill with regard to the identification of carers. After hearing powerful evidence at stage 1, the Health and Community Care Committee was persuaded that identification and recognition of carers was lacking in the bill. In the stage 1 debate, I spoke about the evidence from, amongst others, Carers Scotland and in particular from my constituent Isobel Allan. After discussion, the bill was amended to take account of local authorities identifying carers and providing them with information and assistance. However, no such onus was placed on health boards. I lodged an amendment at stage 2 to address that and the Executive agreed to consider the matter prior to stage 3. In the meantime, I was not comforted by words from the Executive and decided that I had to lodge an amendment at stage 3.
The Executive has recognised the role that general practitioners in particular can play in identifying carers and offering them information. I am further convinced of that by several key initiatives across the country, such as the practice accreditation scheme. However, although good practice will always be out there, we must ensure that all carers are offered the same provisions, regardless of where they live and what local schemes are in place. That is why I am keen to see enshrined in legislation a duty on all health board services to identify carers. The GP or practice staff are often the only contact with the carer, so they are in a prime position to identify the carer's needs.
Recently, I have become aware of the valuable work that is being done in that respect by the Princess Royal Trust for Carers, which works with a range of GP practices across Scotland. So far, the trust has identified more than 6,000 hidden carers who might otherwise not have been identified. Another example of the work of the Princess Royal Trust for Carers is its collaboration with the Royal Pharmaceutical Society in pilot schemes to place information in prescription bags to help identify and inform carers. That demonstrates that there is willingness—on the part of carers organisations and the Executive, too—to seek out those who care and to provide them with the assistance that they desperately need and deserve.
I have made my views clear and I know that the rest of the Health and Community Care Committee share my views as set out in amendment 19. The important point for the carers organisations that made representations to us is the need for health boards to have parity with local authorities. We have recognised that local authorities have a duty to recognise and identify carers and to provide them with information, and we think that it is necessary to put the same onus on health services.
I recognise that the Executive's manuscript amendments, although they are not exactly what we had planned, will be a step forward. However, what I have heard so far from the minister today does not convince me that we will actually be providing the carers in our communities with the service that they deserve. I want to hear much more from the minister before we come to a conclusion. I hope that the minister will address the points that I have raised.
On behalf of carers across Scotland, I move amendment 19.
I am grateful to Janis Hughes for explaining so clearly her reason for lodging amendment 19. During the course of the bill, we have discussed at length how carers can be supported better, and in particular, the role that the NHS can play. I have already made it clear that the Executive is committed to working with the NHS to ensure that carers are recognised and supported.
I have also made clear our belief that staff throughout the NHS are working hard, in a wide range of ways, to improve the ways in which they help carers. I mentioned some of those ways in our discussions on amendment 18. Examples are the involvement of GP practices in initiatives to identify and offer information to carers; the developing professional standards for GPs; the overarching development of clinical standards that affect every aspect of health care services; and the development of new, single, shared-assessment processes.
It is clear that the NHS is committed to playing its part in looking out for carers. Across the health service, carers and their needs are on the agenda and we are already engaging with the NHS to raise them further up that agenda. However, it is also clear that there is a strong view that legislation is needed to underpin and complement what the NHS is already doing. The Executive recognises that concern and is willing to help achieve that underpinning. Amendment 19 is intended to deliver that objective. However, we believe that the amendment has a number of flaws that need to be remedied before it can become law.
We have therefore lodged amendments 19A to 19G, which are designed to ensure that amendment 19 translates into clear and workable law that will make a practical difference to the carers.
Presiding Officer, I should like to apologise to the Parliament for lodging amendments 19A to 19G so late in the day. We recognise the extent of the support for a statutory duty of some kind on the NHS, but we believe that amendment 19, as lodged, has serious technical and policy flaws. Rather than rejecting the amendment on those grounds, we believe it is better to lodge amendments to make amendment 19 workable and acceptable. I hope that the Parliament will accept amendments 19A to 19G in the constructive spirit in which they are offered.
I emphasise that it is not the Executive's intention to use the recent changes to standing orders to lodge manuscript amendments at stage 3 regularly. I hope that manuscript amendments will be the exception rather than the rule, but in this case, they are justified. Indeed, I suspect that the changes to standing orders were intended for such a scenario.
Amendments 19A to 19G are intended to amend amendment 19 to achieve a number of things. Our amendments make clear which carers a health board is expected to inform—that is, those carers who appear to the health board to qualify for assessment. That will make amendment 19 consistent with other references to carers in the bill, and with other legislation. Importantly, it will also ensure that health boards target their efforts to those carers who are likely to have the greatest need for support.
The Executive amendments also substitute the word "information" for "identification". The objective of amendment 19 is that health boards should give information to carers with whom they have contact. The substitution gives practical effect to that key objective. It should be clear that we wish health boards to have a duty towards carers with whom they are in contact, and that we are not asking health boards to seek out or find carers with whom they are otherwise not in contact.
Amendments 19A to 19G will enable ministers to specify to health boards the extent of their strategies. That will enable ministers to allow boards to minimise duplication of effort with local authorities and other agencies that are involved in supporting carers. Without that change, there is a risk that health boards could end up duplicating work that has already been done by local authorities and others. I am sure that members will agree that that would be a waste of precious NHS resources, which we have to prevent.
We believe that all our amendments 19A to 19G are necessary to allow amendment 19 to become good law that works and makes sense in practice. I have explained the purpose of the amendments and the improvements that they will make, and I ask members to vote for them. However, I make it clear that the Executive will not be able to support amendment 19 if amendments 19A to 19G are not accepted. Without the changes, amendment 19 will not be sufficiently clear and will not translate into good law and practice that helps carers. I hope that what I have said makes it clear why the Executive would not support amendment 19.
I finish by reminding members of how much is happening throughout the NHS to better support Scotland's carers. I have made it clear that staff across the full range of NHS services are working hard, with real results, to improve the ways in which the health service supports carers. That work—with GPs and other health professionals, through clinical standards, and in a range of other ways—is firmly embedded in the way that the NHS works, and will carry on delivering results for carers. We will ensure that carers continue to be directly and closely involved in all that work. Carers are already on the NHS's agenda.
Will the minister give way?
I am just finishing.
I am convinced that the health service is changing in ways that will bring the real and lasting results for carers that we all want to see. I urge the Parliament to support amendments 19A to 19G, and to support amendment 19, as amended by those amendments.
I move amendment 19A.
Given that amendment 18 was not successful, I am happy to support amendment 19 in the name of Janis Hughes, although I would rather that it was not watered down by Executive amendments. However, what is important this afternoon is that we include something in the bill that will be of benefit to carers.
I was minded to support the Executive's amendments 19A to 19G, but as Janis Hughes said, the minister's contribution was not as persuasive as it could have been and left a lot of unanswered questions. We need a number of assurances. In particular, health boards have to be monitored in their implementation of any information strategies for carers. An assurance should be given that if those strategies are not seen to deliver what is required for carers, and change does not happen, further steps will be taken to address the matter with health boards. I hope that we will be given that assurance this afternoon.
I am grateful to the minister for apologising for the lateness of the Executive amendments. I hope that she appreciates that the seeking of clarification is based upon the lateness of the amendments.
I support the ability to give GPs more information to give to carers. I also support Janis Hughes's point about the valuable work of the Princess Royal Trust for Carers, which found 6,000 hidden carers. I do not think that that work even covered all of Scotland; it was limited to certain areas. That proves that the Parliament is right to be concerned. By finding 6,000 hidden carers, the trust has proved that there are many carers who do not know who to contact, and who are not getting the support, advice and assistance that they need.
I commend the work that the minister is doing with the Clinical Standards Board for Scotland and the Scottish Consumer Council to produce the new mark 2 patients charter. However, I seek clarification. We started this afternoon with Shona Robison's amendment 18, which sought to place a duty on the NHS to provide information to carers. Janis Hughes has asked for a strategy to identify carers in health board areas. I do not want health boards to duplicate a register that is held by local government; I can appreciate that argument.
Janis Hughes's other point concerned
"ensuring that advice and information about those rights is available free of charge to any … carers and to carers living elsewhere … in the Health Board's area."
I am all right with that, apart from my reservation about duplication with local government. Will the minister confirm that the Executive's proposals, as set out in amendments 19A to 19G, will apply to all carers whose cared-for person has been in recent contact with the NHS? Will the proposals apply to everyone who has passed through the doors of the NHS who does not have contact with local government? Will the minister confirm that everyone will receive that level of advice, support and information?
Amendment 19A refers to
"carers who appear to the Board to be persons who may have rights under section 12AA of the 1968 Act".
I am unfamiliar with that act. Will the minister confirm that the amendment covers everyone who passes through the NHS, or say whether it is exclusive?
Janis Hughes's amendment 19 and Shona Robison's amendment 18 incorporate something of the spirit of the Health and Community Care Committee's discussions about carers and of the need for further recognition of the central role that carers play in the provision of care. Many carers have told many members that they have had a poor experience when policy has been left to guidance. It is important that the bill contains a provision on strategies.
Like many of us, many carers access services through the NHS's primary care services, rather than through social work departments. Many carers would not consider themselves carers. They see themselves as mums, dads, sons, daughters, family members or friends. They would not label themselves carers. They may prefer not to have anything to do with social work and to try to struggle on with the situation, but it is likely that they will have access to and contact with the health service, usually through their general practitioners. The health service, as well as local authorities, must enter into the duty to inform, engage with and form a meaningful partnership of care with carers.
A key point that Isobel Allan of Carers Scotland made was about the need for access to information. She said:
"carers do not get out all that much."—[Official Report, Health and Community Care Committee, 24 October 2001; c 2068.]
One consequence of not getting out much is not having access to information. One place that carers might get out to is their GP's surgery. GPs must have a duty to give access to information and to play their part in the wider strategy. Their part must involve more than handing a carer a leaflet and shooing them out of the door. I would like to hear more about how the minister expects the giving of information to be developed into a strategy and a partnership with social work departments and others.
I note that health boards will be required to consult on the strategy. That will be important in ensuring that patients, carers and partner organisations can make proposals for developing such a strategy most effectively. I do not think that any member wants duplication to occur, but having carers slipping through the net, as they do at present, is worse than duplication.
It might be worth while monitoring implementation of an information strategy as part of a health board's performance assessment. I would like to hear from the minister about that.
Amendment 19 acknowledges the work of carers in partnership. As the minister and Janis Hughes did, I acknowledge the continuing non-statutory work that is performed in the health service, the work involving the Royal College of General Practitioners, the Clinical Standards Board for Scotland and GP practices throughout Scotland and the good work that the Princess Royal Trust for Carers has done on carer identification and information.
Such work can go only so far. The bill must contain a provision on strategies, which is why I was happy to support Janis Hughes's amendment 19. If I receive answers to my questions, I believe that I will be happy to support amendment 19 as amended. It will represent a step forward. We may end up having to go further in other ways that involve the initiatives that are being developed throughout the NHS. We must do all that we can to ensure that carers do not slip through the net between social work and the health service.
The fact that amendments 19A to 19G were lodged at the last minute makes it difficult for any member to grasp the full significance of what the Parliament has been asked to agree to. That is a serious matter. Given that the Scottish Parliament does not have a revising chamber, there will be no opportunity after today's stage 3 debate for members to understand fully what we are being asked to voice support for. If this is a precedent, it is a bad precedent for the Executive to be setting for the Parliament.
I support fully amendment 19 in its original form. When the minister introduced her amendments to amendment 19, she said that she thought that the amendment had a number of technical and/or policy flaws. I understood the minister's objection to amendment 18, which was technical. Amendment 18 was flawed, as it would have given two different authorities the same duty to inform people.
I am not clear about the minister's objection to amendment 19. Is it the result of a similar technicality or is it about policy? As I understand it, the Executive's objection to amendment 19 is that it requires the production of a carer identification strategy. Most of the Executive's amendments to amendment 19 remove the references to a carer identification strategy and replace them with references to a carer information strategy. The difference is important. It is one thing to be required to provide information to carers that an authority knows about, but a completely different thing to be asked to produce a strategy to identify carers that an authority does not know about. Is the minister arguing that that is not the role of the NHS? Is she arguing that the NHS should not be required to identify carers whom it does not know about? Is that not appropriate for the NHS to do?
If that is the minister's argument, what is her response to the references that have been made to the on-going Princess Royal Trust for Carers focus on carers initiative? The initiative involves the trusts and GP practices in the national health service working to identify carers. If it is good for that initiative to go ahead in some areas of the NHS, why is it not good enough for it to go ahead in other NHS areas?
Debates such as this should take place at the earlier stages of a bill, rather than at stage 3 when the Parliament is asked to support something that MSPs—most of whom have not followed the progress of the bill in any detail—do not understand fully. I do not understand the minister's argument and I am a member of the Health and Community Care Committee. The minister's summing up is absolutely critical to persuading the Parliament that the Executive's amendments to amendment 19 are necessary at all.
I associate myself whole-heartedly with John McAllion's opening and closing remarks. The late lodging of the Executive's amendments to amendment 19 has placed every member of the Parliament in an extremely difficult position. The amendments are substantial and we are being asked to support them without adequate opportunity for scrutiny or debate. The Executive has set an extremely bad precedent; the late lodging of its amendments to amendment 19 is an example of how not to pass legislation.
I do not want to rehearse all the arguments that other members have made this afternoon. Suffice to say that I support Janis Hughes's amendment 19 on the exactly the same basis that I supported amendment 18. I am concerned that, on face value, the Executive's amendments appear to water down the impact of Janis Hughes's amendment 19.
The Executive's amendments remove the references to a carer identification strategy, but how can information be provided to people if their existence is not known about? That is a potential weakness of the amendments. The minister will have an opportunity, in summing up, to try again to reassure us that that would not be the practical effect of the Executive's amendments.
As Shona Robison said, the SNP is interested, in the spirit of compromise, in securing in the bill a provision that will offer a step forward for carers. For that reason, we are minded to support the Executive's amendments. If we did not support them, we would be putting in jeopardy the passing of amendment 19, and that would be to the detriment of carers.
The minister has a job to do to answer some of the many points that have been made and the questions of concern that have been raised throughout the chamber. We need to know that, in practice, the amendments will not constitute a watering down of the intention of Janis Hughes's amendment 19. As Shona Robison said, we need to know that efforts will be made to monitor the effectiveness of the implementation of amendment 19. That would ensure that the provisions of the amendment have the desired effect. If the minister can answer those points, the SNP will give its support to the Executive amendments to amendment 19.
The will of the Health and Community Care Committee was formed after hearing a wealth of evidence from carers organisations about the importance of having a provision such as a carer identification strategy in the bill. It is crucial that the committee's will be heard. I urge the minister to address all the points of substance that have been raised and to persuade us that supporting the Executive's amendments is the right thing to do.
I support some of the points that have been made, particularly those made by John McAllion. As I am in no way an expert on health, I want the minister to explain to me in English that I can understand why I should vote for her amendments. At the moment, I do not see why I should do so at all.
I understand that amendment 19 is about the identification of carers. I have visited one of the offices of the Princess Royal Trust for Carers—doubtless other members have done the same—and it is quite clear that one of the main problems is that many people in the community do not know that they are carers and that, as such, they can receive help.
It is important to identify carers, but the Executive is obviously against doing so and I would like it to explain why. Amendment 19F refers to a "carer information strategy" and "revised carer information". Does the carer information strategy include the identification of carers? If so, why is the Executive so concerned to remove reference to the identification of carers from the bill? If, on the other hand, the carer information strategy does not include the identification of carers, what on earth is it all about?
Not for the first time, I listened with great respect to my good friend John McAllion's comments. I sincerely hope that the Executive will listen more attentively to what he had to say than did the chief whip at Westminster, who tried to dismiss him—and indeed Malcolm Chisholm—as being simply oppositionist.
I also listened with great respect to Janis Hughes. The Parliament should listen with the same respect to what she has to say on the subject. I believe that, in a previous incarnation, she was a member of the honourable profession of nursing. That was before the electorate of Rutherglen relegated her to a less honourable profession. That said, we are grateful for her comments. The Parliament is enriched by members such as Janis Hughes, who has given years of service to the NHS and can now tell us about that experience in parliamentary debates.
Amendment 19 is worthy of support and I have no quarrel with the Executive's proposal to change carer identification to carer information in the title of the proposed new section. If a strategy is to be effective, it must not only identify carers and their needs, but ensure that carers receive information about their rights. However, I am concerned that the overall effect of the Executive amendments to amendment 19 would be tantamount almost to wrecking the amendment.
Does the member share my concern that carers need to be identified before they can be informed? The Executive proposes a move from a carer identification strategy to a carer information strategy, but we need to know who carers are before we can give them information.
We should have both: we should have identification and then information. What is the point of identifying carers unless there is a subsequent effort to give them information about their rights, the assistance that is available to them and so on? That said, I have no serious quibble about simply changing the title from carer identification strategy to carer information strategy.
I am gravely concerned about the effect of the rest of the Executive amendments to amendment 19, which would be to blow a huge hole in amendment 19. That is especially true of amendment 19A. Amendment 19 stipulates what the contents of the strategy should be and states that any health board should submit a strategy for:
"(a) identifying carers living in the Health Board's area;
informing such carers about their rights … and
ensuring that advice and information about those rights is available free of charge to any such carers and to carers living elsewhere who care for persons living in the Health Board's area."
If the Executive had its way, it would sweep all of that out of amendment 19. We would have a strategy—which would be called an information strategy rather than an identification strategy—but there would be no definition in the bill of what the strategy would contain. It is incumbent on the minister to tell us in summing up exactly what the Executive proposes should be contained in the strategy and why the Executive is so reluctant to ensure that the contents of the strategy are written into the bill. The Parliament should not leave things solely to the discretion of a health board or the Scottish Executive. If the strategy is to be meaningful and delivered effectively, its contents should be written into statute.
I ask members to support amendment 19 and to reject the Executive amendments.
I whole-heartedly support amendment 19. I base my support on the evidence taken by the Health and Community Care Committee. I also recognise that a lot of innovative work is going on in community care.
I must take exception to something that Dennis Canavan said with regard to nurses. Although I was not a nurse, I know that community care is not just about health care professionals. A lot of voluntary organisations work in partnership with primary care teams and GPs. I congratulate the Princess Royal Trust for Carers centre in Kilmarnock, which has been involved in significant innovative work through its focus on carers initiative for GPs. The trust and GPs have together identified 800 hidden carers in East Ayrshire, which also takes in my colleague Cathy Jamieson's constituency. In another area, the trust has worked closely with what many people think of when they talk about the health service—the hospitals. The hospital discharge pack that the Princess Royal Trust for Carers has provided has helped to identify a further 500 carers.
I understand from Malcolm Chisholm that the GP accreditation scheme will include aspects of working in partnership with other agencies as well as the way in which GPs identify and deliver information to carers, irrespective of age. The minister may want to confirm that in summing up. I know that individuals, including constituents, will have told ministers that they have come across general practitioners who are not interested in that aspect of community care. That concerns the committee.
When we took evidence, the committee decided that we should pursue the matter further. It is only right and proper that the Executive should address amendment 19. The Executive says that there is a partnership approach and that there is a duty on local authorities. I accept that, but I think that we need to tell those working in the broader health care world that they also need to play their part. If we find that the legislation that we are passing today is not sufficient in that respect, we reserve the right to come back and make it an absolute duty.
I support everything that Janis Hughes and Margaret Jamieson, who are fellow members of the Health and Community Care Committee, have said. It is sad that amendment 18 was disagreed to, because it sought protection for carers. Amendment 19 also seeks protection—I back that fully. I remind the minister that, of the more than 600,000 carers in Scotland, about 80,000 are well over pension age. There are also many child carers, but we do not know how many. It is therefore all the more important that we protect carers—as well as the cared for—as much as we can. That was the Health and Community Care Committee's unanimous intention. I appeal to the minister not to water down the proposals any further.
I would like everybody to be clear about where we go from here. I am about to call the minister to wind up on amendment 19A, after which I will put the question on amendment 19A and the other amendments to the amendment. Following that, Janis Hughes will have the opportunity to sum up on amendment 19, whether or not it is amended. I invite Janis Hughes to respond to what has been said about amendments 19A to 19G.
I thank Dennis Canavan for his kind remarks, although I have not practised as a nurse for some years. I hope that he never has to avail himself of my resuscitation skills because I might be a bit rusty. [Laughter.]
On a serious note, I share the concerns of members about the manuscript amendments. It is not an appropriate way to conduct legislation. Had we had more time to discuss the issues we may have been in a different position. However, we must move forward with what we have got. I hope that the Executive will take on board my concerns for future legislation.
I hope that when the minister sums up, we will hear further comments, particularly on the points raised by Margaret Smith and others. It is important for us to recognise the work and needs of carers. In the spirit of moving forward and ensuring that something is enshrined in legislation, it is my inclination to accept the manuscript amendments. However, I should say that I am going down that road because of other things that we have heard today and that I have heard over the past couple of weeks, while I have been considering the matter.
Initiatives at the Princess Royal Trust for Carers—which was mentioned by Margaret Jamieson—and other initiatives by GPs, local health care co-operatives and health care professionals throughout the country show that there is willingness to be involved in helping to inform and identify carers. On that basis, I am prepared to accept the Executive's amendments, but I emphasise my hope that we will not be put in a similar position again.
I will try to respond to the points that I managed to note down. I start with Shona Robison's first contribution, on how we will monitor any strategy that is developed. I assure the member that there is no question of our not wishing to do that. I have tried to say to members today that we are all looking for the same outcome. If the intention is to provide support for carers, there is no way that we can sit back and allow a strategy not to deliver it.
Will the minister respond to Margaret Smith's suggestion that monitoring implementation of the information strategy should become part of the performance assessment framework for the NHS?
There will be a number of strands to the framework, but that suggestion would require a new piece of legislation.
Mary Scanlon referred to hidden carers. She will accept that that area needs to be handled sensitively. It is not necessarily the case that the NHS will do that alone—it can work in collaboration with organisations such as the Princess Royal Trust for Carers, which has the flexibility to adapt to local situations. Mary Scanlon mentioned how successful that organisation has been at adapting; we wish to build on that success in the future.
I assure members that our amendments use the definition of carers that is used in the bill, which is that carers are those who give regular and substantial caring.
Margaret Smith asked whether information will be available through GPs and how that will happen. Provision of information will be brought about as part of the strategy that the health board must produce under the bill. I expect that to happen in collaboration with other parties, including carers and carers organisations. In that way, we will be able to ensure that the information is delivered in the most appropriate way.
I support and commend the work of the Princess Royal Trust for Carers. I would like to think that everyone in Scotland has the opportunity to be registered or acknowledged as a carer. Does the minister agree that the guidance to the Carers (Recognition and Services) Act 1995 was supposed to provide NHS engagement with carers? Is she aware that research by Audit Scotland in 2001 showed that only 15 per cent of carers of older people had been asked if they needed support? Is the minister concerned that although there is a lot of good practice and guidance, it is not being adhered to or implemented?
There is good guidance and there is evidence to prove that it is beginning to be taken up in the community. There will be an increase in the number of people who are recognised as carers. The bill will support that through the duty on local authorities and the duty that we are seeking to place on the NHS.
In the light of the proposed changes, will ministers exercise the power that the proposed new section introduces by requiring health boards to produce strategies? Will the form of the strategy include key issues related to the identification of carers? A number of members who have not been involved in the debate, including me, are not clear about the Executive's view on the matter.
As I said, I expect individual health boards to work out the strategies, so I do not want to be prescriptive. I have said on a number of occasions that our ultimate aim is to support carers. That aim will have to be built into the strategy.
John McAllion raised concerns about the removal of the term "identification". One difficulty with identification is that it has a number of legal interpretations. We do not want to leave the matter open to legal interpretation. As I said to Mary Scanlon, another point is that identification is best done outside the NHS by those who are more flexible, focused and aware of local situations. That is why we want the strategy to involve organisations such as the Princess Royal Trust for Carers in identifying carers. We do not want to put a duty on the NHS to identify carers other than the carers who are presented to the NHS under the bill. In the past, carers who were in contact with the NHS found that there was nothing to support them. Carers who are in contact with the NHS should be given the information and support that they require. That would make a huge difference to their experience of the NHS.
Will the minister give way?
I must move on. I might take an intervention at the end of my speech.
That brings me back to the point that Donald Gorrie and Dennis Canavan raised about identifying carers. I stress that this is about identifying carers with whom the NHS is in contact. We are not asking NHS bodies to go out and seek carers. We are saying that when they meet carers—be it in a GPs surgery, the community or a hospital—they should offer them the support and information that they need. That will make the strategy more relevant to each carer.
Will the minister give the chamber an assurance that, under the Executive's proposals, the health board information strategy will include informing carers about their rights under section 12AA of the Social Work (Scotland) Act 1968 and section 24 of the Children (Scotland) Act 1995 and ensuring that advice and information about those rights is available free of charge to all carers in the health board area? If the answer to that is yes, why on earth is the Executive reluctant to include its own policy in the bill?
As I have said on a number of occasions, we are asking each health board to develop its own strategy. I cannot imagine a situation in which we would not expect the strategy to include that kind of information.
Margaret Jamieson asked whether the GP accreditation scheme will include how GPs address the needs of carers. It most certainly will; that scheme is already being built up.
I feel the need to offer assistance. An argument can be made for the Executive's amendments, in order that we pass good law this afternoon, but I do not think the minister is making that argument at all well. I point out to her that the things that Dennis Canavan asked her to confirm as being included in the bill are included in amendment 19A. Why can she not give straight answers to straight questions? Perhaps that would produce more clarity.
If Nicola Sturgeon listens, she will hear that I am trying to answer the questions that have been asked.
I acknowledge members' concerns about the lateness of the amendments. I apologise for that.
Will the minister give way?
No, I am finishing.
I urge the chamber to support amendments 19A to 19G. They are important to turn the good intentions that underlie amendment 19 into clear and workable law. I assure Dennis Canavan and others that there is no intention to water down amendment 19. Amendments 19A to 19G clarify the responsibility that would be placed on health boards. They establish a reasonable burden that will yield results and ensure that resources and information are targeted at those who can benefit from them—the carers.
Subject to amendments 19A to 19G being made, I am happy to support amendment 19 and ask members to join me in supporting it. However, without those amendments, amendment 19 remains well intentioned but is unclear and ineffective. If it remains unamended, I ask members to resist it.
The question is, that amendment 19A be agreed to. Are we agreed?
No.
There will be a division.
For
Adam, Brian (North-East Scotland) (SNP)
Alexander, Ms Wendy (Paisley North) (Lab)
Baillie, Jackie (Dumbarton) (Lab)
Barrie, Scott (Dunfermline West) (Lab)
Boyack, Sarah (Edinburgh Central) (Lab)
Brankin, Rhona (Midlothian) (Lab)
Butler, Bill (Glasgow Anniesland) (Lab)
Campbell, Colin (West of Scotland) (SNP)
Chisholm, Malcolm (Edinburgh North and Leith) (Lab)
Craigie, Cathie (Cumbernauld and Kilsyth) (Lab)
Crawford, Bruce (Mid Scotland and Fife) (SNP)
Cunningham, Roseanna (Perth) (SNP)
Deacon, Susan (Edinburgh East and Musselburgh) (Lab)
Elder, Dorothy-Grace (Glasgow) (SNP)
Ewing, Dr Winnie (Highlands and Islands) (SNP)
Ewing, Fergus (Inverness East, Nairn and Lochaber) (SNP)
Ewing, Mrs Margaret (Moray) (SNP)
Fabiani, Linda (Central Scotland) (SNP)
Ferguson, Patricia (Glasgow Maryhill) (Lab)
Finnie, Ross (West of Scotland) (LD)
Fitzpatrick, Brian (Strathkelvin and Bearsden) (Lab)
Gibson, Mr Kenneth (Glasgow) (SNP)
Gillon, Karen (Clydesdale) (Lab)
Godman, Trish (West Renfrewshire) (Lab)
Grant, Rhoda (Highlands and Islands) (Lab)
Gray, Iain (Edinburgh Pentlands) (Lab)
Henry, Hugh (Paisley South) (Lab)
Home Robertson, Mr John (East Lothian) (Lab)
Hughes, Janis (Glasgow Rutherglen) (Lab)
Hyslop, Fiona (Lothians) (SNP)
Ingram, Mr Adam (South of Scotland) (SNP)
Jackson, Dr Sylvia (Stirling) (Lab)
Jackson, Gordon (Glasgow Govan) (Lab)
Jamieson, Cathy (Carrick, Cumnock and Doon Valley) (Lab)
Jamieson, Margaret (Kilmarnock and Loudoun) (Lab)
Jenkins, Ian (Tweeddale, Ettrick and Lauderdale) (LD)
Kerr, Mr Andy (East Kilbride) (Lab)
Lamont, Johann (Glasgow Pollok) (Lab)
Livingstone, Marilyn (Kirkcaldy) (Lab)
Lochhead, Richard (North-East Scotland) (SNP)
Lyon, George (Argyll and Bute) (LD)
MacAskill, Mr Kenny (Lothians) (SNP)
Macdonald, Lewis (Aberdeen Central) (Lab)
MacDonald, Ms Margo (Lothians) (SNP)
Macintosh, Mr Kenneth (Eastwood) (Lab)
MacKay, Angus (Edinburgh South) (Lab)
Maclean, Kate (Dundee West) (Lab)
Macmillan, Maureen (Highlands and Islands) (Lab)
Martin, Paul (Glasgow Springburn) (Lab)
McAllion, Mr John (Dundee East) (Lab)
McAveety, Mr Frank (Glasgow Shettleston) (Lab)
McCabe, Mr Tom (Hamilton South) (Lab)
McConnell, Mr Jack (Motherwell and Wishaw) (Lab)
McLeish, Henry (Central Fife) (Lab)
McLeod, Fiona (West of Scotland) (SNP)
McMahon, Mr Michael (Hamilton North and Bellshill) (Lab)
McNeil, Mr Duncan (Greenock and Inverclyde) (Lab)
McNeill, Pauline (Glasgow Kelvin) (Lab)
McNulty, Des (Clydebank and Milngavie) (Lab)
Morgan, Alasdair (Galloway and Upper Nithsdale) (SNP)
Muldoon, Bristow (Livingston) (Lab)
Mulligan, Mrs Mary (Linlithgow) (Lab)
Munro, John Farquhar (Ross, Skye and Inverness West) (LD)
Murray, Dr Elaine (Dumfries) (Lab)
Neil, Alex (Central Scotland) (SNP)
Paterson, Mr Gil (Central Scotland) (SNP)
Peacock, Peter (Highlands and Islands) (Lab)
Peattie, Cathy (Falkirk East) (Lab)
Quinan, Mr Lloyd (West of Scotland) (SNP)
Radcliffe, Nora (Gordon) (LD)
Raffan, Mr Keith (Mid Scotland and Fife) (LD)
Reid, Mr George (Mid Scotland and Fife) (SNP)
Robison, Shona (North-East Scotland) (SNP)
Robson, Euan (Roxburgh and Berwickshire) (LD)
Rumbles, Mr Mike (West Aberdeenshire and Kincardine) (LD)
Scott, Tavish (Shetland) (LD)
Simpson, Dr Richard (Ochil) (Lab)
Smith, Elaine (Coatbridge and Chryston) (Lab)
Smith, Iain (North-East Fife) (LD)
Smith, Mrs Margaret (Edinburgh West) (LD)
Stevenson, Stewart (Banff and Buchan) (SNP)
Sturgeon, Nicola (Glasgow) (SNP)
Thomson, Elaine (Aberdeen North) (Lab)
Watson, Mike (Glasgow Cathcart) (Lab)
Welsh, Mr Andrew (Angus) (SNP)
White, Ms Sandra (Glasgow) (SNP)
Whitefield, Karen (Airdrie and Shotts) (Lab)
Wilson, Allan (Cunninghame North) (Lab)
Against
Aitken, Bill (Glasgow) (Con)
Canavan, Dennis (Falkirk West)
Davidson, Mr David (North-East Scotland) (Con)
Douglas-Hamilton, Lord James (Lothians) (Con)
Fergusson, Alex (South of Scotland) (Con)
Fraser, Murdo (Mid Scotland and Fife) (Con)
Gallie, Phil (South of Scotland) (Con)
Goldie, Miss Annabel (West of Scotland) (Con)
Gorrie, Donald (Central Scotland) (LD)
Harding, Mr Keith (Mid Scotland and Fife) (Con)
Johnstone, Alex (North-East Scotland) (Con)
McGrigor, Mr Jamie (Highlands and Islands) (Con)
McIntosh, Mrs Lyndsay (Central Scotland) (Con)
Mundell, David (South of Scotland) (Con)
Scanlon, Mary (Highlands and Islands) (Con)
Scott, John (Ayr) (Con)
Sheridan, Tommy (Glasgow) (SSP)
Wallace, Ben (North-East Scotland) (Con)
Young, John (West of Scotland) (Con)
Abstentions
Brown, Robert (Glasgow) (LD)
The result of the division is: For 88, Against 19, Abstentions 1.
Manuscript amendment 19A agreed to.
Manuscript amendments 19B, 19C, 19D, 19E, 19F and 19G moved—[Mrs Mary Mulligan]—and agreed to.
I call on Janis Hughes to wind up on amendment 19 and to indicate whether she wishes to press or withdraw the amendment, as amended.
As I have already stated, I accept the amendments to amendment 19. I wish to press amendment 19, as amended.
Amendment 19, as amended, agreed to.
Section 10—Payments by NHS bodies towards certain local authority expenditure
Amendment 3 moved—[Hugh Henry]—and agreed to.
Section 12—Delegation etc between local authorities and NHS bodies
Amendments 4 to 6 moved—[Hugh Henry]—and agreed to.
Section 13—Transfer of staff
Amendment 7 moved—[Hugh Henry]—and agreed to.
Section 14—Scottish Ministers' power to require delegation etc between local authorities and NHS bodies
Amendments 8 to 15 moved—[Hugh Henry]—and agreed to.
Section 20—Regulations
Amendments 16 and 17 moved—[Hugh Henry]—and agreed to.