Community Care
The next item of business is a debate on motion S1M-2839, in the name of Mary Scanlon, on community care, and one amendment to that motion. I invite members who wish to speak in the debate to press their request-to-speak buttons now. So that everybody is quite clear about speaking times, 10 minutes will be provided for the opening speech.
I am pleased to debate the motion today, given the historic and unanimous decision of the Parliament to implement free personal care for the elderly. We need now to show that same unity of spirit and commitment in order to ensure that all those who are eligible for free personal care are given an assessment of needs and eligibility; that all elderly people are treated equally, which the Regulation of Care (Scotland) Act 2001 will help to achieve; that care provision is funded equally and that the funds that are allocated for the care of the elderly are used for that purpose. I hope that the debate will help to address those issues.
We are all familiar with the figures for bedblocking, or delayed discharge. The latest figure is that there are 3,138 delayed discharges. Since the start of the Parliament, the figure has almost doubled. More than 3,000 people are receiving inappropriate care in a hospital setting when they have been assessed as needing care in the community. Of course, some of the figures relate to the elderly, but bedblocking also applies to people who have mental illnesses and to the disabled. The average cost of a care home place is about £300 per week and that of an acute hospital bed is about £1,000 a week. Therefore, if only 1,400 patients were given the care packages that they need, that would free up beds to allow more people to have operations and treatments, reduce waiting lists and free up £1 million to be spent more appropriately on national health service care.
We cannot even blame the Scottish Executive for not addressing the problem of bedblocking and councils' inability to fund care in the community. Since the start of the Parliament, £54 million has been allocated to that purpose. According to the Minister for Health and Community Care's press release this week,
"Previous initiatives to tackle delayed discharge have simply not delivered".
According to the care development group, grant-aided expenditure for the home-based elderly and services for the elderly in care homes was £603 million, but budgeted expenditure throughout local authorities equalled £540 million. In other words, £63 million that was allocated for the elderly was diverted to other council budgets.
We have often been told—including by Sir Stewart Sutherland at the Health and Community Care Committee—that money is diverted to children's services. Given the imminent implementation of free personal care for the elderly and the undoubted unmet need and eligibility for care, surely it is time to examine whether children's services are adequately funded. The Convention of Scottish Local Authorities stated recently that 50 per cent more is spent on children's services than is earmarked for them. I am not making any judgments—I do not know enough about those services. However, if free personal care is to work, we must examine children's services and other social work services to determine whether they are adequately funded, so that the budget for care of the elderly is not raided year on year to supplement other services that receive inadequate funding.
This week, another £20 million was—despite the failures of the past—given to local authorities to alleviate bedblocking. However, this time, the £20 million comes with the threat of the hit squad. I now realise why there are two Deputy Ministers for Health and Community Care—Mrs Nice Guy Mary and Big Shug from Paisley. They are heading up the bovver boys hit squad. I say to Hugh Henry that if the hit squad works, I will support him.
Let us examine the current state of services and their ability to deliver free personal care. For example, 100 residential care homes closed last year. According to the Executive's community care statistics, the number of residents in residential homes has fallen by more than 1,000 since 1998; the number of beds in residential homes has fallen by 946 since 1997; the number of people receiving home care fell by more than 11,000 between 1998 and 2000; the number of people seen by health visitors has fallen by 49,800 since 1997; the number of clients seen by district nurses has fallen by 13,300 since 1999; and more than 2,500 fewer elderly people attended day centres between 1997 and 1998. I ask the ministers how we can promise to deliver free personal care at home when the service has been slashed in recent years.
We then come to funding. Any mention of the independent sector is often dismissed as putting profits before care. Today, I will concentrate on the examples of the Salvation Army and the Church of Scotland.
The Salvation Army was running eventide homes long before much of the provision that we have today existed. On Monday evening, I visited the excellent facility at Davidson House in Edinburgh and was given the following figures, which relate to the situation even after the new settlement from 1 April. The cost to the Salvation Army of providing care is £334 per week per person and payment to it as a result of the settlement will be £304. The Salvation Army will therefore subsidise by £30 a week each person who depends on council contributions for care. The Salvation Army's subsidy comes from door-to-door collections, moneys that are raised by its bands and other fundraising activities. That money could be used to help missing persons and homeless people or to develop other services. If the not-for-profit sector cannot manage to finance care, how can we expect other voluntary and private sector organisations to do so?
Mary Scanlon has described a long-standing problem that the Scottish Executive is addressing. Will she take a minute or two to describe what the previous Conservative Government did to support the sector to which she refers?
The Conservatives put the whole sector in place and listened to it. The Labour party was originally against that. The Parliament is unanimous in wanting free personal care. I initiated the debate not to score political points but because I feel strongly that if we address the issues, free personal care will be the success that people expect it to be on 1 July. If we do not address them, we will all have failed.
As we prepare to implement free personal care, can we justify funding a place in a local authority home by £83 a week more than we fund a place with the Salvation Army or the Church of Scotland? Using the budget for care in the community, we could place far more people in the independent sector—council places cost £83 a week more per person.
In a similar vein, I spoke this morning with a Church of Scotland representative, who confirmed that the church has losses of £3.4 million a year or, more accurately, that the church provides £3.4 million in subsidy to run its 34 residential homes. The representative said that even after the new settlement in the next financial year, the church's losses are likely only to be cut from £3.4 million to £2 million. That subsidy is and has been taken from the church's reserves, but they will eventually run out. I ask the minister whether we should ask why—in a modern, caring Scotland—we expect organisations such as the Church of Scotland and the Salvation Army to subsidise from their funds long-term care for the elderly, when council homes have no such worries.
Self-funding clients or patients often pay more for the same care. Is that justified when the regulations and the quality standards are the same? Is it equitable for patients to receive the same services in relation to accommodation, food, laundry and so on and yet pay different amounts? That needs urgently to be addressed. Is it fair, just or acceptable that a different pricing structure from that for council patients applies to self-funding patients?
I will end with a quotation:
"I support the greater diversity of provision and more freedoms for local services to improve care for patients and seek a new common purpose shared across health sectors with a relentless focus on better health outcomes and less inequality".
I am sure that ministers and Labour members fully agree with that statement, because it is from a speech by Tony Blair.
I move,
That the Parliament notes the unequal funding support between local authority and independently run care homes; regrets the exceptionally high levels of delayed discharge within Scotland's hospitals; believes that the action plan to tackle delayed discharge will not solve the problem until health and social work budgets are unified, and urges the Scottish Executive to implement the recommendation of the Royal Commission chaired by Sir Stewart Sutherland to unify these budgets within a single organisation and put in place systems to ensure that funds allocated for community care are actually spent on such services.
The main thrust of the Conservatives' motion, which Mary Scanlon chose wisely to ignore, is that delayed discharge problems cannot be solved without full implementation of a supposed organisational recommendation of the Sutherland report. I remind members what Sir Stewart Sutherland said on pages 84 to 86 of his report:
"The Government's proposals … are attractive in that they seek to work with the grain of current organisational structures, and do not threaten the upheaval and disruption of a wholesale reorganisation."
That is precisely the approach that we are adopting. Sir Stewart also said:
"We welcome the proposed legislation which would enable budget pooling to take place in a way that is not currently possible."
That is precisely what we did in the recent Community Care and Health (Scotland) Bill. The new power to delegate functions and pool budgets will create, in effect, a single budget in a single host organisation.
Will the minister give way?
In a moment. I have much to get through.
We do not support—neither did the Health and Community Care Committee—enforced delegation of functions from local authorities to the national health service. That support is the Conservatives' position, as described at the Health and Community Care Committee a few weeks ago, although Mary Scanlon wisely chose not to mention that today. That position is a curious interpretation of jointness, but we are not in the business of derailing joint working through such an approach.
We want a genuine partnership to which both parties can commit and we want results, not restructuring. However, we have gone further than the full range of permissive joint-working powers in England by insisting on joint resourcing and joint management for all community care services, beginning this year with older people's services. At minimum, agencies must by April 2003 have aligned budgets and joint management for older people's services. They must by 1 April 2002 set out the budgets that are to be included and the management arrangements that are to apply. While we are taking action to make joint working work, the Conservatives are determined to talk it down. That is the core message of their motion.
The motion refers to three other issues: care homes, delayed discharge and local government expenditure. We have made an unprecedented financial contribution to care homes and we have ensured that a tripartite group was established to address long-standing funding problems. Last autumn, we announced an immediate investment of £17.5 million to deliver an instant £10 a week for care home owners. That helped to kick-start talks that led to a recommended fee increase to which all have signed up.
From 1 April, we will invest another £24 million. In addition, we will honour a commitment to backdate to July last year one third of the increase that was identified by the review group. That represents another £11 million, which brings to £35 million the total that we will invest from 1 April this year. The overall Executive commitment to care home owners since last July stands at more than £50 million. That is but one important strand of the biggest-ever investment in older people's care services.
Shona Robison was first to ask to intervene. I will take Murdo Fraser's intervention later.
The Executive's action plan suggests that only one local authority and NHS partnership will have pooled budgets. Does the minister agree that that is inadequate?
Aligned budgets can achieve a great deal. West Lothian, which is a bit ahead of the game, has had an aligned budget for some time. As a result, it has reduced its delayed discharges by 60 per cent. We should not underestimate what aligned budgets can achieve although, in due course, many others will want to move on to pooled budgets.
Another strand to our investment in services for older people deals with delayed discharges—most of the people who are affected by that are older. We are the first Administration to count those figures, which means that the comparison that Mary Scanlon made with 1999 was nonsense. We believe in transparency and we want to know the facts as a foundation for action. The true figure for delayed discharges is just over 2,000, because everyone accepts that people should be counted at the six-week point.
We are ring-fencing new money for delayed discharges to ensure that the local authority and NHS board partnerships spend the money on people coming out of hospital—particularly those in the acute sector and those who have been delayed for the longest time. We have identified deliverable improvements that are to be made in each area and we are putting in place additional and robust arrangements for monitoring performance. We will ensure that that money is used only for delayed discharge. That is why, although we are releasing £5 million immediately to kick-start action, we will issue the rest of the money only when we are sure that the targets have been set and that they are achievable. We will certainly take action if partnerships fail to perform.
Will the minister give way?
I do not have time.
Our first main target can hardly be clearer. By April 2003, we expect to show evidence that 1,000 extra people who have experienced delayed discharge have moved into more appropriate forms of care. The key to that is care being delivered in the most appropriate setting and in many cases, that means home. Mary Scanlon should remember that when she quotes figures for places in residential care. In many cases, support at the pre-admission stage through rapid response teams and other preventive initiatives will mean that some older people do not need to go into hospital in the first place.
I have only one more minute, so I must address the last part of the motion on ensuring that funds that are allocated for community care are actually spent on such services. There have been problems in relation to services for older people. As Mary Scanlon reminded us, those problems were highlighted by the care development group report. However, let us consider the funding streams: £24 million for care homes—money that will be targeted specifically on care home fees; £20 million to deal exclusively with the problem of delayed discharge; and let us not forget the ring-fenced £250 million over two years for free personal and nursing care.
We should also remember a fourth funding stream. One hundred million pounds was announced in October 2000 and we should remember in particular the £24 million this year, rising to £48 million in April 2003, for rapid response teams, intensive home support, more short breaks and shopping and maintenance services. That money is being distributed on the basis of outcome agreements, which means that it, too, will be spent on older people's services. Therefore, we are once again taking action while others talk of structural upheaval. This is the biggest-ever investment in older people's care services and we shall ensure that it is spent on improving the lives of older people throughout Scotland.
I move amendment S1M-2839.1, to leave out from "notes" to end and insert:
"acknowledges the progress that is being made towards joint resourcing and joint management of older people's services; looks forward to further developments in the Joint Future agenda; welcomes the provision of significant extra resources for dealing with the problems of delayed discharge and care home fees, and recognises that such resources are part of the biggest ever investment in care services for older people."
I begin by referring to the poll produced yesterday by Help the Aged and Scottish Gas, which highlights the widespread age discrimination within society and within our public institutions—including the health service. At the beginning of a debate that is, in essence, about the care and treatment of our older people, it is important to say that, despite the existence of awful terms such as bedblocking, we must reassure older people that the core of our desire to resolve the problem is the need to provide the best and the most appropriate care for older people. This is not about portraying older people as a burden on society.
I became a community care manager back in 1997. If at that time someone had asked me to write an analysis of the problem of blocked beds, it would not have been dissimilar to the analysis of the problem in the Executive's action plan.
Five years ago, the problems were as clear as they are today: a lack of funding for local authorities to place people in residential and nursing homes; a contraction of the number of care home places available; a lack of staff to carry out assessments; and well-established institutional barriers between the NHS and local authorities. All those problems have led to an increasing number of elderly people being inappropriately trapped in acute hospital beds. This is not rocket science. If the same, growing problem was so apparent to all and sundry five years ago, why has it taken five years to even begin to do something about it? The pace of getting to grips with the problem has been ridiculously slow.
The problem has now reached crisis point, with one in 10 NHS beds blocked to those needing medical treatment. As I have said, the Executive's analysis of the problem, as contained in the action plan, is sound—albeit that it tends to underplay the role of the reduction of care home beds and the inadequacy of community care services in creating the crisis. However, the action plan is poor on solutions.
Many of the action points are vague, with yet more references to better partnership, stronger liaison, more co-ordination, and a review of this and a review of that. All of that is worthy, but it is the same language that we have seen time and again. It is time to stop asking for change. It is time to break down the barriers between local authorities and the NHS and to tell them what must and will be delivered—because a laissez-faire attitude will not deliver the change that the Executive has rightly identified in its own action plan as being required.
For example, we are told that
"A review of the funding regime between Local Authorities and NHS Boards around the care of older people needs undertaken to consolidate and accelerate the Joint Future agenda."
Excuse me for saying so, but I thought that that was already under way. It sometimes appears to me—and I am sure to others—that it is easier to analyse the problem than to take action.
I want to make it absolutely clear—as I did in my speech—that we are taking decisive action in a new way on the distribution of money. Plans will be required and the money will be handed over only once those plans have been approved. There will be strict monitoring of the money. The review that has been referred to is, of course, something else. What we are doing will make big inroads, but if it does not solve all the problems, it may be that other options will have to be considered. However, the money will make a big difference.
I am not taking issue with that; I am taking issue with the pace of change, which is far too slow.
The action plan reveals that joint agreed discharge policies and protocols are not in place, that there is no national model agreement or framework, that only one local authority and NHS partnership will have pooled budgets and—to cap it all—that neither the NHS nor local authorities share the Executive's view of the importance of setting up a system to deal with bedblocking. That is an admission of lack of progress.
After all the debates about bedblocking in this chamber and after all the reports written by numerous working groups, I would have thought that we would have made more progress than we have. The key service providers do not even agree the basics of establishing a system to deal with the problems. That has to be changed.
Let me be clear: we welcome the additional £20 million that has been announced for delayed discharge, but it smacks of crisis management and short termism, with the stated ambition being to reduce the number of blocked beds to 2,000 by next April. That ambition is limited by any stretch of the imagination. We must raise our sights.
A number of things must be done. We agree with the need for new models of care, which the SNP has been advocating for some time now. First, there is a need to expand rehabilitation services, giving people more support to leave hospital and better preparing them to return home. Secondly, we need more intermediate care beds—to stop elderly people being admitted to acute beds in the first place and to be able to move them out sooner. Thirdly, we need to resolve the issue of resource transfer. We must ensure that there are resources to establish adequate community care services. If we are honest, we will admit that those services are not there. I say to Mary Scanlon that the policy was established under a Conservative Government. It was established to fail, and we are suffering the repercussions now.
I am not taking issue with the Executive's intentions as outlined in the action plan, which I think are broadly in line with our own thoughts. What I am taking issue with is the lack of progress and the slow pace of change. I want to see far more intervention on the part of the Executive to make things happen. At the next debate on community care in the chamber, I want to hear from the Executive what progress has been made on the issues discussed here today, and not what the problems are, which we all know very well already.
I welcome the opportunity to speak in yet another community care debate. It remains an important issue with several facets, as we have heard already.
I believe that the Executive has a good story to tell on the investment that it is putting into the area and on the importance that community care now has on the national political agenda. The Executive has acknowledged many of the difficulties in the system and is now committed to tackling them on a number of fronts.
Mary Scanlon's motion is on the need for partnership in community care. It focuses on three key areas—care home fees, delayed discharge and joint working.
Most members will have been aware for some time of the problems in the care home sector. Members of the Health and Community Care Committee became more aware of discrepancies between the public and independent care home sectors when we worked on the Regulation of Care (Scotland) Act 2001.
Indeed, during the bill's passage last year, Dr Richard Simpson raised that issue in an amendment. Historically, councils might have been able to argue strongly that they provided a better service with better-trained staff. However, with the passing of the act and the introduction of national care standards, we are trying to level the playing field for everyone who provides care home facilities. There is now no justification for the kind of funding gap that other members have alluded to or for the continuing need for subsidy, particularly for the voluntary sector.
During discussions on the Regulation of Care (Scotland) Bill, there was real concern about the level of fees that bodies would be expected to pay. However, the main financial question was the bill's impact on service providers through increased training and fabric and infrastructure costs and changes. Although many providers raised that point, particularly in the voluntary sector, it had to be set against the historic level of discrepancy. Hugh Henry and Shona Robison are right. The situation has not arisen overnight; it has been building for two decades.
We are keen to ensure that the burdens placed on care home operators and local authorities are not so great as to threaten the current number of beds. Care homes are closing down, and there are particular local reasons for that. For example, in Lothian, the care home sector is experiencing real problems because of the cost of property and the employment market.
Although it is clear that a discrepancy still exists and that much more work needs to be done on that matter, I welcome the fact that negotiations with care homes have been settled successfully, with the Executive and COSLA providing a further £27 million. It means that, since last July, the Executive has spent £50 million on finding a solution to the problem. Care home owners will now see a substantial increase in the level of fees of anything up to a further £38 a week. It is also important to note that a tripartite group involving the Executive, COSLA and the independent sector will be set up to ensure continuing dialogue on this. Furthermore, the Executive has agreed that, from April 2003, the level of care home fees recommended by the review group will be met in full.
Does the member accept that, even with the new funding package, it is likely that bodies such as the Church of Scotland will still have to consider closing down nursing homes and reducing the number of available beds?
Financial difficulties will undoubtedly continue. However, the Executive is committed to meeting the gap in full by 2003 and the Executive and COSLA have committed themselves to continuing discussions and to addressing the issue in a new spirit of partnership. I hope that the Church of Scotland and other bodies will acknowledge that there is now a mechanism to allow them to discuss the problem and to find a way out of it. That partnership is critical, not just for the costs of care, but for the provision of quality services and for ensuring that the links that Shona Robison mentioned between the acute sector, community care, people's homes and the care home sector exist. All the partners involved must speak to each other.
As a result, I particularly welcome Joe Campbell's comments in the press last week that Scottish Care would work closely with the authorities to assist hospitals with the blocked beds crisis. Although delayed discharge is not a new problem, it is a difficult one, and I welcome the minister's announcement of an extra £20 million package for local authorities and the NHS to tackle it. As the minister pointed out, each area of the country will be asked to come up with detailed plans for the money, which will be tested against the area's ability to reduce the impact of delayed discharge and to deliver effective care packages for the 300 people who have been waiting for a year or more.
The issue is all about tackling the problem of having 2,000 people in the wrong place and getting the wrong kind of care. That situation is wrong for them, the health service, the taxpayer and the system as a whole. If one in 10 hospital beds is—for want of a better word—blocked, that has a major impact on all aspects of the service from accident and emergency right through to waiting times.
I agree with Malcolm Chisholm. Initially, the Health and Community Care Committee saw the arguments for one body developing joint working. However, when we came to consider the Community Care and Health (Scotland) Bill, we felt that there was flexibility in the system that the Executive has since introduced. We also realised that the Executive will take action if joint working is not implemented voluntarily. With that new focus on delivery, outputs and monitoring what councils and health boards are doing in those areas, the committee—and I—were happy to allow joint working to proceed in that manner.
Mary Scanlon's motion not only lacks vision, but shows a lack of understanding of the real world of community care in Scotland today. I am at a loss to understand where Mary has been for the past few years. She was a member of the Health and Community Care Committee when the committee considered the Community Care and Health (Scotland) Bill, the Regulation of Care (Scotland) Bill and during the committee's own inquiry into community care in Scotland.
The unification of budgets into a single organisation was not—and is not—a favoured option by all who provide care. Instead, partnership working and pooled budgets are favoured. As the committee discovered during some of its visits, those measures provide scope for innovative work that delivers quality provision for our older citizens.
Let me address the Tory claim that there is unequal funding support between local authority and independently run care homes. Before anyone says anything, I should declare an interest as a member of the public sector trade union Unison. For many years, I represented local authority Unison members, whose terms and conditions are determined by collective bargaining at a Scottish level. Although those employees do not have the highest hourly pay, they have an occupational sick pay scheme, a pension scheme, access to training and the opportunity to join a trade union and freely express views without fear of dismissal. Unfortunately, many staff employed in the independent sector do not have such employment conditions.
Will the member give way?
No, I will not. Until there is evidence that respect for staff in the independent sector matches that for staff employed by local authorities, we should resist the one-sided cry for parity. We must open the books, agree the level of profit, demonstrate partnership and enter into meaningful service level agreements with agreed outcomes for older people. We must not use our older people as pawns.
Does the member agree that if the voluntary and independent sectors—including the examples that I have mentioned of the Church of Scotland and the Salvation Army—were given the same funding as local authorities, they could pay their staff at council levels? That is the inequity.
In the real world, the discussions involved Scottish Care, which does not include anyone from the independent sector in its membership. The member should not try to pull the wool over our eyes and say that the issue concerns only the independent sector; it is fundamentally about the private sector. [Interruption.] Yes, it is—Mary Scanlon's motion is all about the private sector.
It is about care for the elderly.
Order.
If the private sector wants to be honest with us, it can let us see its books. Mary Scanlon should not fudge the issue and hide behind the claim that the issue is all about care for the elderly.
The Tories conveniently forget that they were the instigators of community care.
The Labour party has been in power for five years.
Mary Scanlon should wait a minute. This situation is historical. The Tories forget that they never funded community care fully and that they encouraged the unplanned growth of the independent sector. We are now trying to resolve the difficulties that we inherited from them and their cronies.
The Tories also created bedblocking.
Will the member give way?
No. Sit down.
The Tories have the cheek to condemn the action that the Executive has taken from day one to work in partnership with all those involved in providing care. The joint working to address blocked beds is beginning to make a difference. In Ayrshire and Arran, health, local authority and home care providers in the independent sector are working in partnership to reduce the number of blocked beds. A rapid response team is working with health service staff in the acute and primary care hospitals. The staff are from a varied group of employers, but they have the common aim of ensuring that patients are discharged appropriately, with the assistance necessary to prevent readmission.
At the other end, protocols have been agreed to address the need for admission. General practitioners, district nurses, home helps, occupational therapists and social workers work in partnership—something that the Tories know nothing about—to sustain older people in their own homes, thereby preventing admission. They do not need restructured organisations to deliver services. We need to allow the staff to get on with the job and to support them as they deliver quality services to our older people.
In case the Tories still suffer from amnesia, let me remind them that the Executive has provided much investment, financially and in delivering quality services to older people. Lest the Tories forget, we have also introduced fully funded free personal care. The Tories choose to consider all of that as unimportant. The least that they could do is be honest and recognise the improvements that have been made in care in the community. I support the amendment in Malcolm Chisholm's name.
How do I follow that? I do not want to get into a slagging match with any party; I just want to get the best deal possible for the elderly. The onus is on the Executive to deliver care for the elderly.
I am the convener of the cross-party group on older people, age and aging. I congratulate Donald Gorrie on his appointment as depute convener of the group—I am sure that he will do a good job. As the convener of the group, I have a particular interest in community care and care of the elderly. Everyone in the Parliament should have an interest, as hopefully we will all grow old and receive the care that the Parliament supports.
Various parties have bandied about the subject of community care. I take issue with what Labour members have said. The contribution of the previous speaker in particular was not helpful to the amendment or to Labour's cause. We do not need such speeches in the Parliament, especially when we are discussing care for the elderly.
Yesterday, at the cross-party group's annual general meeting, we had an interesting speaker from Ireland, Sylvia Meehan, who is the president of the Irish senior citizens parliament. Throughout her life she has championed equality, not for just women, but for elderly people. She talked about how Ireland is dealing with care and help for the elderly and is making elderly people more independent. She mentioned joined-up thinking between health services, hospitals and communities, so that elderly people can live their lives in relative security, in the knowledge that they have health services on their doorstep. I found that interesting. She also mentioned a helpline for elderly people.
What emerged from her speech and from a discussion that I had with her later was that the Irish Government funds all of that, without quibbles. The Irish senior citizens parliament was pushing forward its ideals and the Government was listening. As we all know, Ireland is an independent nation. Is that why it has a different approach? It did not need to wait for permission from another Government to implement its proposals. That may tell us something about the difference between Ireland—an independent nation—and Scotland, which has devolution.
The SNP, along with other parties, has campaigned throughout for the full implementation of the Sutherland report. We will continue to do so, and to monitor any backsliding by the Executive on the implementation of free personal care. Sutherland enshrined the values of free personal care—for example, that older people are an important part of society. Our approach to long-term care should be to enable older people to lead fulfilling lives, not only in care homes, as was mentioned before by Margaret Jamieson, but in their own homes, with personal care to back that up. That is an important point. The funding system for long-term care—which is what Mary Scanlon's motion is about—should provide opportunities for older people to lead their lives the way they want to. As politicians, we should listen to that.
It is important that there is unified and joint working. We should not keep quibbling about which local authority should be responsible. Older people—and I—do not care how it is done. We just want the money to be made available and for the health boards, local authorities and the Parliament to work together to ensure that care is delivered, regardless of whether it is delivered through a partnership—the buzzword—or whether it is unified. We must have joined-up working. As politicians, we have a duty to everyone in Scotland to ensure that every section of our society is treated fairly. We must ensure that personal care and unified budgeting are implemented as quickly as possible.
On Monday, I met representatives of the Alyth and district Alzheimer's carers group—a group of people who care for elderly relatives with dementia. Many are elderly themselves, and live with a spouse who is unable to feed themselves, bathe, go to the toilet or even get in or out of bed. In many ways, the caring is a labour of love. It would be an easy option for those carers to put their loved one into full-time care, but they would rather care for them themselves in their home, and will go on doing so for as long as they are able. I was encouraged to hear the minister praise people who care in the home and say that that is a model to be encouraged.
Time does not permit me to recount individual stories, but the carers in Alyth and district are clear that they are inadequately supported by the social services. What they are looking for is quite simple: respite day care, together with residential respite care for the occasional weekend, and a week or two a year to have a holiday. For those who are literally devoting their lives to the task of caring, that does not seem too much to ask. However, the services are just not there. What respite residential care is available is often many miles away, entailing a long journey to visit relatives.
The irony of the situation is that, by caring in the home, those carers are saving the taxpayer thousands that would have been spent annually on residential care. They want to care at home, and will continue to do so for as long as they can, but without support some have no alternative but to give up. The burden then falls on the taxpayer. Even if we disregard the human cost and consider the matter purely in cash terms, it makes no economic sense to reduce services to carers. Services are not only failing to improve, they are reducing.
The situation in Perth and Kinross is covered in the recent Scottish Health Advisory Service report, of which I have a copy. In Perth and Kinross, under the care together project, primary care, health and social work have come together. The Conservatives warmly endorse that approach as a step in the right direction. However, there are still many problems to resolve. The SHAS report makes disturbing reading. It says:
"Specialist services for older people have recently been reduced at Perth Royal Infirmary as a result of financial pressures. Six assessment and rehabilitation beds were closed. We found over half of the remaining beds occupied by people whose discharge was delayed either by a lack of an available bed in a nursing home or by lack of funding. An unacceptable number of people still remain in a delayed discharge situation, some of whom have been in hospital for over 12 months waiting for discharge."
That confirms the points made by my colleague Mary Scanlon. The report goes on:
"In Pitlochry, where NHS continuing care beds have closed, older people are moving out of their community away from friends and family as there are no nursing home beds available locally."
Referring to the situation in Blairgowrie, the report says that there will be a reduction in the number of beds, so
"there will be no NHS continuing care for the frail elderly."
I could go on and read further from the report, but that gives a flavour. There will be a reduction in the number of beds throughout the area, while bedblocking will reduce still further the number of beds that are available. That is the reality in Perth and Kinross.
We have heard a lot from the Executive about how the situation is improving. If the minister were to come with me and speak to people on the ground, he would find that that is not the impression that the people in Alyth are getting. We hear self-congratulatory talk from the minister, but the carers of Alyth know that the situation is not improving. The Scottish Health Advisory Service report says that the situation is not improving; everyone knows that it is not improving, apart from the Executive. People look back to the days of the Conservative Government and see that services were better under a Conservative Government. Under the Labour-Liberal Democrat coalition, services are being withdrawn and beds are being blocked. Despite its self-congratulatory amendment to the motion, the Executive is failing Scotland on health and community care. I support Mary Scanlon's motion.
Judged by the Swinney test, Shona Robison's contribution to the debate got nul points, like the Norwegian entry in the Eurovision song contest. If she was supposed to mention independence, independence, independence, she failed to do so. However, battling Sandra White managed to mention it, so I suppose that one out of two is quite good.
It is interesting to note that, in the area of elderly care, where a number of technical and resource issues need to be addressed seriously, the SNP's response is to talk about constitutional change. The SNP would rather talk about what happens elsewhere than about the substance of the issue. We need to talk about the substance of the issue and how we are going to make progress. It is not enough simply to say that the pace of change is not fast enough. We have to ask how change can be secured more effectively. That is where the debate should lie and that is what we must discuss.
I welcome the fact that the Conservatives have brought the matter to the debating chamber, because it allows us to address some important issues. However, it is pretty dishonest of them to hide behind the Salvation Army and the Church of Scotland, when their concern is, in reality, about the private residential home sector and companies such as Westminster Health Care, Four Seasons Health Care, Southern Cross Healthcare Services and Ashbourne, which have put their fees up time after time.
I used the example of the Church of Scotland because it has 34 homes in Scotland. Does Des McNulty not feel that that is relevant? If the not-for-profit sector cannot survive, how does he expect the rest of the voluntary and independent sector, which have no such reserves, to survive?
I am happy to talk about the not-for-profit sector, but the Conservatives need to make it absolutely clear that their specific concern has consistently been how the private sector can expand. There is a real issue about how private sector companies are operating in elderly care. Margaret Jamieson mentioned the driving down of wages. One of the private sector's biggest complaints about the present scheme is that private companies might have to pay minimum wages. That just underlines the way in which things have operated in the past.
Does Des McNulty accept that private care home owners and operators, many of whom are individuals—rather than large companies—who live in the homes themselves, would be delighted to give their staff better terms and conditions, but that they simply cannot afford to do so under the present settlement?
Companies should pay their staff appropriate wages and should charge realistic fees, but profit taking and the whole process of bidding and bargaining in the sector must be examined. Ministers who are responsible for administering budgets in that area must consider those matters properly.
Elderly care is an important issue. Balance must be achieved between what is spent on residential care, what is spent on support for people in their homes and what is spent on the wide variety of other services that people require. Judged on that full range of services and how things have been improved, Labour's record is absolutely outstanding. The initiatives that have been introduced to support—
Will Des McNulty give way?
I have already taken two interventions.
The supporting people initiative will be introduced next year, and work has been done on housing benefit and on providing aids and adaptations to support people in their homes. The integration of social work services with housing services to provide better support for elderly people is also being developed. What is the Tories' response to that? They want to separate out the system of joint working and move it all into the NHS.
I am one of the few members in the chamber who have experience of being in local government and of being a member of a health board. Considerable progress has been made in developing the joint working agenda and it is important that that development continues. Joint arrangements do not require only pooled budgets. We also need joint working so that people can take on responsibilities for each other's services, so that those services fuse together in a seamless way to support individuals who require a variety of services.
Will Des McNulty give way?
I have already taken two interventions.
It is important to develop the joint working agenda further. A lot of professional work is going on in the sector and there has also been a lot of consultation with older people themselves to examine how services can be improved. I just wonder whether the posturing on the SNP and Tory benches adds one iota to the development of that agenda. I think that, unfortunately, it does not, but Labour members are doing a lot of work and a lot of new resources are being put into the area—far more than were ever put in during the 18 years when the Tories were in power. The difference between what is happening now and what happened then is like the difference between chalk and cheese.
We have come a long way, and I found the minister's speech encouraging. When I first started pursuing the issue of what was then called bedblocking, not all that long ago at Westminster, the Government could not provide any figures. My colleague Michael Moore MP and I had to write to all the health boards and get the figures from them, which was quite easy to do. The Government did not really recognise that there was a problem. We have come a long way, but the problem seems to have grown and we are not yet dealing with it satisfactorily.
Getting accurate information, especially about money, can be a problem. The Health and Community Care Committee commented on that problem. I was encouraged by Malcolm Chisholm's remarks—if I understood him correctly—about not ring-fencing but monitoring how well people were achieving results and giving them more money if they achieved them. That is a vital issue. We must ensure that the number of delayed discharges decreases to zero.
Figures from the information and statistics division of the Common Services Agency confirm that, in August 1998, 1,500 beds were blocked. In October 2001, 3,138 beds were blocked. That is more than double the number of blocked beds in 1998.
That is clearly a matter for concern. I deserve a little bit of credit for at least getting some figures started at Westminster. Before that, people did not have any figures at all.
I want to concentrate on carers. All the discussion so far has been about homes, which are very important, but using carers better can help to keep people out of homes. Carers must be members of the team that deals with people who are being discharged from hospital. If they are ignored, a vital resource is kept out. The whole carers enterprise is seriously underfunded by local authorities and by the Executive. COSLA estimates that there is a £20 million shortfall in funding.
Carers do not get the support that they want. Glasgow City Council has, very honestly, admitted in a report that carers assessments and reviews are not yet routinely part of social work practice in Glasgow. Carers are vital members of the team and deserve more support than they get. They should be involved in the team effort to get people out of hospital, because many people do not need to be in a residential or nursing home at all if they can be properly cared for at home. That is an important aspect of the debate, which the minister should consider carefully.
Delayed discharge and shortage of nursing home places are symptoms of a more fundamental problem that is not being addressed properly by public policy, never mind by the NHS or community care services. That is the aging of our population and our inability to keep healthy in old age.
Our health service is designed to get us through to old age, but it is proving deficient in staving off afflictions that are associated with getting old—in particular, mental health problems such as dementia that are far from inevitable consequences of aging. Despite community care planning and care management, there is evidence that the needs of older people with mental health problems are not being met and that they do not have access to the range of health and social care services that exist for physically frail older people or for younger adults with mental health problems.
The integration of health and social services in service planning and delivery for geriatric and general medical services and for services for older people with mental health problems is fundamental if we are to address adequately the needs of our senior citizens. It is axiomatic that joint working is a must, as it enables agencies to provide a level and quality of provision that they may not have the capacity to attain on their own and it encourages coherence and consistency.
It is deeply depressing that we still have not cracked basic systems failures. Instead of concentrating on how to keep older people healthy and out of institutions—whether hospitals or nursing homes—we are debating how best to solve the problem of too few hospital beds by dumping people into care beds in nursing homes. In fact, we appear to be going in completely the wrong direction. Supply of home care services is falling while demand for places in nursing homes appears to be rising considerably. That is unsustainable and the trends need to be reversed.
Nursing homes are not the answer to the long-term care question, given the problems associated with the care that is provided in those homes: variable nutritional standards, inappropriate prescribing and lack of continuity in respect of nursing staff, for example.
We need to develop early intervention programmes to keep people out of hospitals and nursing homes. Why do fewer than 40 per cent of general practitioners have specialist training in older people's needs, when most of the people whom they see are older people? Why are NHS boards not developing health promotion to raise awareness of early symptoms of dementia? Why are the boards not developing an ethos of early referral to specialists or fully funded anti-cholinesterase services that are not dependent on postcodes to stave off the onset of Alzheimer's disease? Why is evidence-based treatment not being implemented?
We need to break out of the sterile debate that we have had this morning. Developing and delivering health care services for the elderly should be our top priority.
As we have a little time in hand, I will allow Mike Rumbles to speak briefly.
Thank you, Presiding Officer. I did not intend to speak in the debate—I came here to listen to the arguments—but I have been moved to speak after the exchange of views between Labour and Conservative members on the differences between the independent sector and the public sector.
There should be equity in delivery between the public sector and the independent sector. Differentiation in the system is not a sustainable position. The Regulation of Care (Scotland) Act 2001 is in force and national standards are coming through. I do not understand why a slanging match took place earlier; nor do I understand the points that Margaret Jamieson and Des McNulty in particular made. If pay to the independent sector is not at the same level as pay to the local authority sector, it is no wonder that the same standards cannot be reached. There must be equity in provision.
That takes us slightly early to the closing round of speeches. In theory, Margaret Smith is entitled to four minutes, but I could allow her up to five minutes.
The debate has been interesting and quite a lot of ground has been covered. There has been a general welcome for the settlement of negotiations on care home fees. The way forward is for all the different sectors to talk and work together to ensure that we deliver the best possible care for older people, as Sandra White—I think—said. There are a number of mechanisms and paths by which we can do that, which change locally throughout the country. In some areas there are no care homes, while in others—Lothian, for example—there is a problem not just in paying staff but in getting staff, as unemployment in Edinburgh is about 2 per cent. We need partnerships. I hope that some problems in respect of care home staff will be consigned to the past. That issue must be discussed. I agree with Mike Rumbles. Differentiation in how we treat staff in care homes or in care standards has to be consigned to history. That too must be discussed.
Shona Robison is right to ask for action. On bedblocking, the £20 million package announced in the past few days and the action plan on bedblocking show that the Executive is serious not only about putting investment into that important issue, but about taking action. It is heartening to hear the minister talk about the need to see plans of how people will achieve aims and what we want to see on the ground. The people that members represent are sick and tired of hearing announcements that money has been made available by ministers, who have the best intentions, but of not finding differences on the ground. The Parliament and the Executive must make improvements in monitoring what is happening to money that goes into the system to ensure that it delivers what we all want. The ring fencing and monitoring of money is a step forward.
There has been substantial extra investment in community care services by the Executive—£100 million in October 2000, £48 million for community services as part of the response to the Sutherland report and free personal care for the elderly. On the BBC's recent NHS day, it was said that that was what people throughout Britain want. The elderly people of Scotland have free personal care as a result of the Liberal Democrat-Labour coalition working together and as a result of the Parliament deciding that that was a priority. We must ensure that it is delivered properly on 1 July.
There are new rights to individual assessments for carers. Murdo Fraser and Donald Gorrie were right to focus on carers. In cash terms, we get from Scotland's carers the equivalent of half of the Executive health budget. They do a phenomenal amount of work. We acknowledge their part as partners in care and we are starting to move in the right direction in respect of individual assessments, for example. We can do further work on respite care, albeit that investment has gone into that too.
The Community Care and Health (Scotland) Bill will improve matters in a range of ways, one of which is joint working. Again, outcomes are important. We do not want wholesale reorganisation; we want to give people on the ground who know their areas the flexibility to come up with solutions to suit their areas. However, it is right to try to have aligned budgets and ministerial approaches that insist on people working together. We are moving forward in that respect and taking action to make joint working work.
Given what the member said on pooled and aligned budgets, does she share my concern that it is the money in those budgets and how it is spent that counts? Does she share my concern that £63 million earmarked for care of the elderly is diverted to other budgets?
The member is right. The Sutherland report and the Health and Community Care Committee's report have identified that, in the past, money has not necessarily been spent where it was meant to have been spent. Members from all parties acknowledge that that is not a sustainable situation. Part of that recognition comes from what the minister said earlier about the monitoring and ring fencing of some of the money that is now being allocated.
One reason why members of the Heath and Community Care Committee felt able to accept the Community Care and Health (Scotland) Bill was that it sent the message that, if councils and local health boards do not work together and fail to deliver, the Executive will send in the heavy squad—whether it be Malcolm Chisholm, Hugh Henry or Mary Scanlon—and ensure that they deliver. That represents a great sea change in what we are doing. We are giving people on the ground the flexibility to do what needs to be done in their local areas while making them aware that a clear steer is coming from the Executive and the Parliament that action is required now.
The Regulation of Care (Scotland) Act 2001 introduced new national care standards in all our care homes and a new agreement on care home fees. I hope that we will be able to address some of the historical problems that have existed over two decades, irrespective of who caused them or who was in power. The important thing—the point that Sandra White made—is to determine how we can deliver the best care for Scotland's elderly. We can do that only by working in partnership with all the component parts of the network of care, including the public, the private and the voluntary sectors and all members in this chamber.
My predecessor in the chair was generous in his allocation of time; however, I ask members not to presume too much on that generosity.
It was lovely to see Des McNulty trying to be animated. It is a pity that The Scotsman's sketch writer had left the gallery before he stood up to speak. Des should keep trying. As he was speaking, I found myself asking why, if everything in the garden is so rosy, there are 3,000 blocked beds in Scotland. The record that he described as outstanding is the same Labour record that, on Tuesday, Malcolm Chisholm described as failing to deliver. Des McNulty should try harder to get on message before he treats us all to his animated speeches.
I say to the Tories that, if the situation were not so serious, it would be slightly amusing to sit here and listen to members of a party that underfunded community care for years when it was in power—the party that set up care in the community to fail—suddenly saying that the issue is a priority. Mary Scanlon talked about local councils not spending up to the limit of their grant-aided expenditure. She is right to say that that is wrong and cannot be defended. However, is she prepared to accept what the Tories spent years in government denying—that the funding of local authorities is inadequate? The cake that local authorities are being asked to allocate is too small, which is why GAE limits in older people's services are not being reached. Some honesty about the reasons for the problem would be more appropriate than criticism of local decision makers for circumstances that are outwith their control. The Tories' problem is that they have absolutely no credibility on this issue or on any issue concerning the national health service. People's memories are not that short.
I will not take an intervention now. Perhaps later.
The Scottish Executive's memory may not be short, but it is certainly selective. The action plan to tackle bedblocking, which was published on Tuesday, provides a reasonable analysis of the problem of delayed discharges. However, the report does not face up to some of the factors that are contributing to the problem. For example, it does not mention the fact that the number of residential care home places has fallen since 1999. It does not mention the fact that there are fewer care homes in Scotland than there were in 1999 or that nearly 5,000 fewer clients receive a local authority home care service than did in 1999.
The problem is that there is a lack of capacity in the sector, just as there is a lack of capacity in the national health service. We need more residential places for people who cannot return home. We need more intermediate services for people who need support before returning home—the action plan at least acknowledges that. As Adam Ingram, who raised some fundamental points, said, we need more early intervention and better rehabilitation services.
What does the action plan offer us on any of those issues? On page 10, under the heading "Action", it offers us a statement of fact:
"Local authority and NHS partnerships need to be more co-ordinated."
Yes, I think that we all agree with that. It then offers us two reviews. Reviews seem to be the Scottish Executive's favourite solution. There is nothing inherently bad about reviews, but when they are simply a fig leaf to cover a lack of action, we have a real problem. The paucity of ideas in the action plan underlines the Executive's lack of ambition. The action plan promises to reduce delayed discharges by 1,000. That will leave us with 2,000 blocked beds in the national health service—a considerably higher figure proportionately than is the case south of the border.
The problem cannot be solved until the Scottish Executive gets to grips with the underlying problem, which is the lack of capacity. In general, the NHS has shrunk, first under the Tories and now under Labour. No wonder that it is failing so many people. Reviews and hit squads—even hit squads headed by fearsome chaps such as Malcolm Chisholm and Hugh Henry—will not make a difference other than at the margins if that fundamental, underlying problem is not acknowledged.
Finally, I shall address the issue of pooled budgets, going back to my theme of the Executive's lack of ambition. Malcolm Chisholm said that aligned budgets were the minimum that local authorities and NHS partnerships were expected to achieve by April 2003. The action plan suggests that all but one local authority and NHS partnership will opt for the minimum. I do not think that the minimum is good enough. I think that, as Shona Robison said, it is time to speed up the pace of change. The people who are suffering are the old, whom the system is failing. As the minister admitted last week, previous initiatives to tackle delayed discharge have not worked. The real fear is that, unless the Executive stops tinkering at the edges and turns its attention to tackling the underlying problems, that will continue to be the case.
I congratulate Mary Scanlon on making what was, for a Conservative, a positive contribution to the debate. However, she is to some extent constrained by the history and politics of her party. Unfortunately, that came out in the debate.
It is clear from all the speeches that we have heard today that there is a recognition that the Executive is putting an unprecedented level of investment into this sector of care and that positive things are happening. Although Shona Robison and Nicola Sturgeon may not be happy about the pace of change, there is a recognition that we are moving forward and have acknowledged the problem.
Mary Scanlon raised a peculiar point. She asked how we could justify the fact that more funding is given to local authority homes than is given to the independent sector. She went on to say that, in many care homes, self-funders often pay more than those whose places are bought by local authorities do. In a sense, the logic of purchasing in the private sector—people bulk buying and using their combined resources to get a better deal—is the logic of the free market. I find it peculiar that Mary Scanlon cannot recognise that as the logic of a system that she claims so vociferously to support.
After 1 July, when free personal care is implemented, will the Executive continue to support different pricing strategies for the accommodation and hotel costs of, on one hand, those who are self-funding and, on the other, those who are assisted by the council?
We will continue to do what we have said that we will do, which is to put a huge level of investment into free personal care and to support the better pricing of care home fees. We will continue to support the right of individuals to negotiate the packages that are most appropriate to their circumstances. We will also continue to support the freedom of local authorities to negotiate at a local level prices that are appropriate to them. We are not dictating and we are not centralising; we are giving financial support where it is appropriate.
Will the minister give way?
Not just yet.
Mike Rumbles talked about some of the comments that had been made in the debate and said that differentiation was not sustainable. I thought that that was the very point that Des McNulty and Margaret Jamieson had made—in future, there should be no differentiation. If the Executive is putting in substantial additional resources, we should be quite clear in saying that we expect not just stability in the market, but the provision of better training opportunities and better opportunities for staff in the community care sector. I took from the debate not an attack on the care home sector per se, but a plea for differentiation to be addressed and for our money to be used to provide not simply additional profit, but better care and services in general.
Will the minister take an intervention?
Not just now.
Murdo Fraser rightly spoke about the needs of carers, but the name Walter Mitty came to mind when he said that services were better under the Tories. The Conservatives did not address the needs of carers. Between 1999 and 2004, the resources available to support carers will have quadrupled; from 2000-01, the Executive doubled the resources that are annually available to local authorities for supporting carers to about £10 million a year. From this year, we are providing new resources to local authorities so that they can provide more short breaks for carers and the people whom they look after. Those are the facts.
In the debate, members have recognised that the Executive has been moving and putting in additional resources. As Malcolm Chisholm indicated, Mary Scanlon seemed to ignore the motion, which she lodged. The fact that she paid so little attention to it makes it difficult to reply to the debate. What came out from her contribution was that the Conservatives continue to want to centralise. That view is shared by Scottish National Party members. They want power to be taken away from local authorities and to be centralised.
Will the minister give way?
No.
Presumably, they want it centralised in an unelected local body.
Will the minister give way?
No.
Order. The minister is in the last minute of his speech.
The Conservatives want to centralise—that is part of the continuing Tory obsession with reorganisation and upheaval. We saw what that did to the health service and we saw what it did to local authorities.
We invested £17.5 million on care homes last July. We will invest a further £24 million from 1 April. We will spend a total of £35 million from April. Our commitment to care homes now stands at more than £50 million from last July. Malcolm Chisholm mentioned the £250 million that we are spending on free personal care. We are also spending £20 million on delayed discharge. It is clear from our actions that the Executive is committed to supporting the generation of people who struggled to set up the national health service. We are repaying our debt to older people and we are acting on our promises.
We can always tell when a policy starts to go decidedly wrong, not just by the outcomes, which Labour members have of course completely ignored today, but by the way in which the party in power tries to rectify such failings.
The indications that something is wrong have been clear for a considerable time. I do not have to go over what Mary Scanlon said in her opening speech about how the outcomes for elderly people who require care are getting worse, not better. It is blatantly obvious to anyone, especially those for whom community care is intended, that what the Labour Executive and its Liberal partners have achieved is the doubling of blocked beds, numerous residential nursing home closures and a fall in the quality of care.
It is not only those results that give a clue to the current mess in which we find ourselves, but the method of policy management that we now see. The Minister for Health and Community Care's ad hoc dollops of cash and panic initiative units, which are designed to manipulate outcomes rather than to address causes, are the clearest indication that the policy needs further improvement. We in the Conservative party make no apologies for lodging a motion that seeks to bring about that improvement.
The wrangle between Scottish Care, charities and the Scottish Executive must be considered as one of the best examples of why the public lose confidence in politicians. In the past year, when the Minister for Health and Community Care and COSLA were fighting, more and more patients were being neglected and more and more care homes were closing. Is not the point that we are here to put the patients first?
A few weeks ago, Lord Sutherland expressed to me his concerns about the refusal of the Scottish Executive to go further on pooling budgets. Increasing the division between purchaser and provider will only lead to a semi-failure of Lord Sutherland's report.
Will the member take an intervention?
I will come to Des McNulty later. I do not have time to take interventions when summing up.
Lord Sutherland believes that the Scottish Executive's failure to pool budgets will be taken advantage of by the UK Government, which would like the commission's report to be shelved altogether.
In response to Mary Scanlon, Malcolm Chisholm made some interesting points. He did not mention the earlier £30 million that he released to try to solve bedblocking. The result of that initiative was an increase in bedblocking. The minister certainly made no further mention of the fact that the care development group identified a gap between grant from central Government and local authority spending. In September last year, he scoffed at us when we highlighted that issue, which he claimed was not really a problem. However, the care development group that he established has now produced figures that bear out our claim.
Did Ben Wallace not hear the last part of my speech, in which I indicated that the £24 million for care home fees, the £20 million for dealing with delayed discharges, the £250 million for free personal nursing care and the £100 million from 5 October 2000 will all go out on a new basis, to ensure that every penny of that money is spent on older people's services?
I could have asked for a better prompt.
I will now make clear why we support the introduction of pooled budgets, rather than the Executive's idea of having half the money ring-fenced in the short or long term and governed by central diktat. Those are half-hearted attempts to get the benefit that we believe pooled budgets would provide. Either we devolve the money to the people who commission the care or we do not. We need to put in place the correct procedures to ensure that the purchaser and the provider of that care do not act in their self-interest. Everything that the Executive is doing is half-hearted. There will be an attempt to ring-fence money for two years. The Executive's reports show that most local authorities have little intention of implementing some of the safeguards that it requires.
Shona Robison and Sandra White made some good points about putting the patient first. Nicola Sturgeon said, in effect, that the motion was not worth the paper that it is printed on because we lodged it. I should enlighten her: there would be no community care were it not for the Scottish Conservatives and the Conservative party more generally. Community care and the internal market, which involves people purchasing care on behalf of the patient rather than on behalf of their colleagues, exist because of previous Conservative Governments. In his report, Lord Sutherland builds on the internal market, rather than dismantling it. However, when the internal market was introduced, both the Labour party and the SNP fought against it.
Des McNulty and Margaret Jamieson made the point that pay and conditions are better in local authority homes. I am sure that many homes in the independent sector would like to offer their staff better conditions. Where will the Executive find the money to enable them to do that? Clearly, Margaret Jamieson has not read the Accounts Commission report "Care in the Balance", which found that, despite the good conditions, better pay and better training courses that are available to staff working in local authority homes, the absenteeism rate in some homes stood at nearly 60 per cent of the working year. If staff in local authority homes have such good working conditions, why are they skiving off or doing something else?
I will tell Margaret Jamieson why—because management and the safeguards that have been put in place are inadequate.
Will the member take an intervention?
The issue is more about the Scottish Executive being afraid to stand up to its Labour colleagues in local authorities than it is about implementing care for the elderly, which is what the Conservatives are all about.
I am not surprised that the usual suspects, such as Margaret Jamieson, shout "Profiteers!" She was obviously delighted to include the Salvation Army and the Church of Scotland in that charge. She also let the real issue slip: "It's about private!" she cried across the chamber. It is about Unison and it is about the private sector, which so galls Margaret Jamieson that she would put her dislike of it before the elderly, for whom outcomes under the Executive have become worse rather than better.
Come on, take an intervention.
Okay, let us have an intervention from Des McNulty; that will be all right.
It is interesting to listen to Ben Wallace talking about this issue. I did not hear him say anything when the care home providers took action against elderly people last year and withdrew services. Where was Ben Wallace then? What did he say? He purports to speak on behalf of elderly people, but he is actually talking about care home owners, for whom he stands.
I am talking on behalf of elderly people, because if the care homes had closed down and gone bankrupt, there would be no beds for elderly people. That is the reality Labour has had to wake up to—many Labour local authorities find plenty of money to fill their own homes, but no money to fill the private residential homes that have empty beds. The NHS ultimately picks up the tab and its waiting lists and times are suffering because of that. However, that is supposedly because of 18 years of so-called Tory underinvestment.
Des McNulty said that there was a lack of initiative from Tory members. The last piece of legislation on community care to be introduced by a Labour Government was in 1970. That legislation said that the onus would be on the disabled person to make their own assessment of caring needs. That was it.
Will the member take an intervention?
No, he is in his last minute.
In the 18 years of Conservative Government, we saw nothing from the Labour party except the Griffiths report opposed, the Wagner report opposed and the National Health Service and Community Care Act 1990 opposed. As a result, we are now in a position in which the Labour party tries to champion community care, but will not stand up to its local authorities, which are not ensuring that the money is spent on the elderly, as it should be.
We welcome the announcement that the funds will go some way towards meeting the increased home fees and to alleviating problems. It is regrettable that the safeguards needed are still missing and that such a crisis has developed. When we design our health policies for the future, we must remember that what counts is the patient, not the ideology, the establishment or Unison. If we do, we will be able to produce a less partisan and more mature option for health care in Scotland.