Social Care Services (Procurement)
The next item of business is a debate on motion S4M-00854, in the name of Jackie Baillie, on the procurement of social care services.
10:27
How we care for the old, the vulnerable and the young is considered to demonstrate the essential character of a society, its values and its beliefs. The provision of social care is an essential service to our older people, those with learning disabilities, physical disabilities and mental health problems. At its best, it is about providing care and support to help people to live independent lives. It plays a key role in sustaining people in their own homes, in their own communities, without the need for more formal care.
Social care is provided by local authorities, the voluntary sector and the private sector. We all know about the pressures facing local government, with an average 5.5 per cent real-terms reduction in its budget this year. Nowhere is that financial pressure more evident than in the social care budget.
Local authorities are facing real challenges, such as increased demand set against a backdrop of tightening budgets. We need to be creative about how we do things and how we deliver good outcomes for people and design services to meet their needs and aspirations. There are some positive examples of that, yet they are few and far between.
What appears to be happening across local authorities is a race to the bottom in the procurement of social care, driven solely by cost, and the inevitable sacrifice of quality. Let me be clear: that is not just happening this year; it has been going on for some time. We need only consider what is happening with employment conditions among voluntary sector care providers to see the truth of that. For the past three years, 79 per cent of staff have had no cost of living increase equivalent to local authority rises; 57 per cent of them have had pay freezes. Sixty per cent of voluntary sector care providers have made cuts to their training budgets. Only 15 per cent have any link to public sector pension arrangements.
If members need any more convincing, they should consider what is happening at Quarriers today. Ninety-day redundancy notices have been issued to all staff, front-line staff have been asked to take a 23 per cent pay cut and changes have been made to terms and conditions. Quarriers is not alone: that is happening across the social care sector. I welcome the Unison members from Quarriers who are in the public gallery today and remind members that those front-line staff are being asked to take a 23 per cent pay cut, which, on a modest salary, is staggering. Although I do not want to comment on industrial relations at Quarriers, it is clear to me that the problem that is being experienced there lies with the procurement system.
Local authorities are questioning the hourly rates of care employees of other organisations—interfering, in effect, in the internal pay arrangements of provider organisations. Surely, we should seek to commission services on the basis of the outcomes that are delivered and on quality, rather than on the volume of service that is delivered boiled down to an hourly rate. What does the kind of cut that is being experienced at Quarriers do to staff morale? We would all do well to pause and think. We all agree that the quality of care is of primary importance and that that quality is delivered by people: by families, by friends and by social care staff. In my experience, the people who work in social care are well motivated and care passionately about how they do the job and the people whom they work with, who are often the most vulnerable in our society. We all value what they do—we have said so many times in this chamber. They are at the very heart of ensuring the quality of care that we all care about so much; yet, we choose to reward them by cutting their terms and conditions and slashing their pay.
There is one central truth in all this: we cannot get good-quality care on the cheap. In the past few years, local authorities have increased their charges for services to make up the shortfall in social care budgets. I have some sympathy with the principle that, when people have sufficient resources, they should be asked to make a contribution. However, the approach across Scotland is piecemeal. We have a postcode lottery of care, with different eligibility criteria, different costs and 32 different ways of doing things, which creates an inherent lack of fairness in the provision of social care.
Let us consider the illustration that was provided to members by the Learning Disability Alliance Scotland for further evidence of that. The criteria for charging vary widely. Argyll and Bute Council considers 100 per cent of somebody’s income; across the water in Inverclyde, only 25 per cent of income is considered. How about the hourly rates for home care, which is just one social care service? A picture is painted of wildly different costs in that, too. In West Lothian, home care is £7.76 an hour, but in Angus it is £22 an hour—three times the amount. How is that fair? The guidance on the procurement process has been revised, but the opportunity to do it differently was missed. There are risks in our approach: the unforeseen costs, the disruption to service continuity and the real anxiety for the people who are being supported, their families and their carers. Even leaving those things to one side, it is increasingly clear that the guidance is being ignored in practice and that there is a need for stronger enforcement mechanisms.
The Scottish Government and the Convention of Scottish Local Authorities have published guidance on eligibility for social care. However, frankly, that is being used in local authorities as a rationing system to deny people with needs access to social care, as only the most critically ill and those with the highest needs are getting services. Where is the focus on prevention now? I know that the Scottish Government and COSLA intend to review care charging, but members will forgive me for being slightly impatient. I have been raising the matter for almost three years and voluntary organisations have been doing so for a lot longer—we are nothing if not persistent. It is becoming boring, but every time that we raise the issue, we are told that COSLA and the Scottish Government are going to sit down and review care charging. If they were on performance-related pay, they would take a salary cut for that kind of approach.
Let me resist the temptation to apportion blame, because doing so would not serve us well. I acknowledge that local authorities are struggling to do the best that they can with increasingly limited resources. I want to look ahead. We must urgently ensure that our social care provision is the best that it can be, and I believe that that ambition is shared across the chamber. It is therefore not good enough for the Scottish National Party to sit to one side and say that responsibility lies with the 32 local authorities. The Scottish Government must provide a lead; it must provide a coherent framework that brings together all the different strands of social care—setting minimum expectations across the country, but at the same time stimulating innovation at local level.
The framework could include how to promote choice and independence, and I commend the Government for introducing a bill on self-directed support. The Government knows that it will enjoy the support of members on this side of the chamber for that bill. The framework could also ensure consistent criteria and fairness in the determining of care provision and charging. The framework could focus on prevention and early intervention, not just on crisis, and it could set out a new form of commissioning based on outcomes and quality, not on volume and unit price.
Scotland is not such a vast country that we should experience such wide variation and injustice in the provision of social care. Whether a person lives in Dumbarton or Dunbar, in Dingwall or Dumfries, they deserve a care system that supports them to live as independently as possible and which offers access to the best-quality care possible. The basis of the system, and how much people pay for it, must be fair.
Today’s debate is about people, standards and quality of care. I am therefore disappointed that the cabinet secretary is unable to be here with us, given her personal commitment to the issue. I am astonished that the planning minister is leading in this debate for the Government, and I hope that the Government is not sending a signal that it is more interested in producer interests than in vulnerable people receiving a service.
This task is not for local authorities alone. This is a task for the Scottish Government, and it needs to get on with it. There is no room for complacency. We will contribute; we will feed in ideas; and we will push the Government to do more, as it would expect us to. Above all, this chamber must ensure that our system of social care is overhauled so that it is fair and available to the most vulnerable in our society.
I move,
That the Parliament notes the 5% real-terms cut to the local authority settlement by the Scottish Government; further notes the demographic and financial challenges facing local government in the delivery of social care; recognises that these financial pressures have resulted in substantial reductions in service, with some care providers proposing changes to staff terms and conditions and pay cuts of up to 23%, leading to unprecedented industrial action; further notes the increasing postcode lottery of care, with differing criteria for eligibility and charges across Scotland; believes that the procurement of social care is characterised by short-term decisions based on reducing the cost of existing services rather than having a focus on the improvement, development and redesign of services to provide long-term value for money; further believes that quality and continuity of care is of primary importance and cannot be achieved on the cheap, and calls on the Scottish Government to bring forward a framework for social care to ensure consistency and raise standards for the benefit of some of the most vulnerable people in society.
We have quite a bit of time in hand, so I will be able to be generous with those who wish to speak for a little longer than the allocated time. I call Aileen Campbell, with a generous seven minutes.
10:37
I thank Jackie Baillie for raising such an interesting yet critical issue during this period of imposed austerity for Scottish public expenditure.
Although I note the sentiments in the motion that was lodged for debate by the Labour Party, I have suggested an amendment to it. I hope that the amendment will be accepted: it attempts to reflect the broad consensus on the need to improve care for all vulnerable people and to provide a system that works in all cases. I also note Mary Scanlon’s amendment and fully understand the sentiment behind it, but I do not feel able to support it at this time. This debate is complex enough without adding in charging for residential care, which requires much more thought and further debate.
To answer Jackie Baillie’s point, I am leading in this debate as I am not only the planning minister but the local government minister. She cited local government a number of times, so it is entirely appropriate that I should answer. That illustrates this Government’s commitment to working across sectors—in particular, across health and social care.
Does the minister not accept that a signal is perhaps being sent that the Government is reflecting producer interests in this debate?
I think that we are sending a clear signal that this Government has a joined-up approach, and we are reflecting the importance of local government in the debate.
Let me be clear from the outset that, despite the overall £1.3 billion funding cuts imposed by the United Kingdom Government, the total funding package of £11.5 billion has maintained local government’s share of the overall Scottish budget in 2011-12. I also want to make it clear that, despite the tightening of funding, this Government will do what it can to ensure that every vulnerable person receives the highest level of social care, and that the appropriate structures and regulations are in place to ensure that they receive that care.
We are working with the public and key partners to develop a compelling vision for the care of older people in Scotland now and into the future—a vision of fully integrated care, and a vision that sees our increasing older population living longer, healthier lives, and staying for as long as possible in their homes or in the community.
Over the summer, I have been lucky enough to visit a number of inspiring projects across the country, which serve to illustrate how people’s lives can be changed for the better when public services do what they can to work in partnership and take innovative approaches to the delivery of health and social care.
In South Lanarkshire, I learned about a very important project between the council and NHS Lanarkshire, which was focused on reducing falls and their associated hospital admissions. The project’s early success has led to it being rolled out widely around all council care homes and to it being looked at furth of South Lanarkshire. In Highland, I visited Nairn hospital, which is a multi-use facility that has been jointly commissioned by the council and NHS Highland. Those projects underlined to me how much more we can achieve when we work together, but they also underlined to me that people who use such services care about the service and its quality, not about who delivers it. What is important is the person, not the way in which we structure our organisations.
We need to provide better services, with better outcomes, for more people, using resources that will be under pressure for some time to come. Audit Scotland’s review of community health partnerships made it clear that a voluntary approach towards the integration of health and social care has not delivered fast or far enough. We therefore need to drive up efficiency and productivity, and we need to accelerate the integration of health and social care delivery, which will help to ensure the sustainability of high-quality care. We are ensuring that we speak to people—key stakeholders—about how we do that. We want to build on the systems that are already working well and not get diverted into reforming structures for the sake of change.
I hear what the minister is saying, but there has been a joint futures unit in the Scottish Government since we set it up in 2001 to integrate care. Is that unit still in existence? What is it doing? Where is the compelling vision coming from in practice?
We are taking forward that joint approach. The cabinet secretary will provide further detail later. As I said, we have been speaking to key people, but we must accelerate progress on shifting the balance from acute hospital settings to the community and get better at early intervention. I think that that goal is shared across the chamber.
We have established a £70 million change fund as bridging finance to help make those shifts. That has driven the integrated approach and I am sure that it is of interest to Richard Simpson.
The need for change is urgent and non-negotiable, so we are examining a range of options for how health and social care services can be reconfigured and integrated so that they can meet many more people’s needs.
We are working with partners to reshape radically the provision of care for older people. That will prioritise delivery of the care, compassion, support and dignity that they need and deserve. That reshaping cannot be driven by short-term needs to reduce expenditure and there must be a strategic approach to joint commissioning.
Johann Lamont (Glasgow Pollok) (Lab) rose—
To that end, we are developing proposals to help partnerships develop joint commissioning strategies; we asked them to work on those strategies together with third sector and independent sector organisations as part of the change fund guidance for 2012-13.
The reshaping also requires us to enhance the role that people can play themselves, with support, to play a fuller part in their own care. We see the importance of giving people as much flexibility as possible in how they manage their care arrangements.
Bill Walker (Dunfermline) (SNP)
Does the minister agree that we are trying to make a virtue out of financial necessity—a financial necessity that has been forced on us not only by the coalition Government in London but by previous Labour Governments? Through their gross economic mismanagement, we are now in the position of doing the best that we can by looking at all the most efficient ways of doing things. There is no good in Labour members jumping up all the time to intervene, when the key is to make the best of what we have in a situation that was caused by Labour’s inefficiency in the past.
The member makes a very good point: the cuts that have been imposed on the Parliament were started by Labour and have been continued by the coalition.
What is driving forward the change is the need to ensure that we work in partnership together to ensure that the person is the focus of the changes and that we work innovatively together.
Some people have packages of care that are funded by the local authority and the health service, and we need to ensure that they have the opportunity to shape their care package in a way that meets their needs. Self-directed support will require far greater emphasis on commissioning strategies that focus on outcomes for individuals. Block contracts may have provided some security for providers in the past, but such contracts and the constraints on monitoring them have not necessarily empowered citizens.
We are supporting providers to adapt to the change in culture and approach. This year, we are allocating £1 million to help providers to build their capacity to deliver self-directed support.
The future shape of the way in which we provide care in the community raises very timely and legitimate questions about who should provide that care. The Scottish Government procurement directorate and the joint improvement team developed social care procurement guidance, which was published in September 2010, following consultation with a wide group of internal and external stakeholders. It emphasises that decisions on procurement should rarely be taken on price alone and that there should be greater emphasis on the quality of services provided.
Will the member give way?
I am in my last minute, and I have taken three interventions already.
It is important that public bodies and service providers work together to find innovative ways to provide services to make the best use of available funds and maintain quality services. I have attempted to outline how this Government will respond to that question.
Care for people is, rightly, an issue that is high on the public and political agenda. I intend to ensure that we treat our people with respect, compassion and dignity and provide them with the care that they deserve. However, we must go further in joining up service delivery if we intend to do that.
I move amendment S4M-00854.2, to leave out from first “notes” to end and insert:
“notes that, despite cuts to the Scottish Budget by the UK Government and the previous Labour administration, local government funding in Scotland has been significantly protected compared to local government funding in England; welcomes the commitment of the Scottish Government to continue to improve care for older people by maintaining free personal care and improving the integration of health and social care to help ensure long-term sustainability of high quality care; believes that local authorities should have due regard to the Scottish Government’s guidance on the procurement of care and support services, which was co-produced by a reference group involving all key stakeholders’ interests and which sets out guiding principles for use by local authorities as a framework for evaluating local practice; further believes that, in accordance with the guidance, local authorities should promote the achievement of positive outcomes for service users and carers through the delivery of good quality, flexible and responsive services and ensure that continuity of care and the importance of a skilled and competent workforce are fully taken into account, and further notes COSLA’s intention to tackle variation on charging via its fundamental review of the cost of care.”
10:46
I thank the Labour Party for giving us this opportunity to debate the procurement of social care services. Given the amount of information that I have on the care of the elderly, I will focus my comments on those care services, in the knowledge that similar procurement and pricing procedures are used for all vulnerable people who are in need of social care.
The briefing paper from the Learning Disability Alliance, which Jackie Baillie quoted from, was very interesting. As she said, it highlights the fact that the hourly rates for care at home range from £7.76 in West Lothian to more than £22 in Angus, which is three times more. It also says that, in Highland, the hourly rate is more than £15 per hour, which is £5 more than it is in neighbouring Moray. There is no doubt that there is a postcode lottery for care, and we need to focus on improvement, development and redesign of services to provide long-term value for money and, as important, to raise the quality standards of care.
Jackie Baillie said that she has raised those issues for three years. I have been raising the issue of the postcode lottery in relation to care home fees since 1999, and my persistence has not paid off—yet.
The postcode lottery with regard to care is true, with 7 per cent of care homes for the elderly in West Dunbartonshire being given the highest grading, compared with 70 per cent in Highland and 69 per cent in Inverclyde. Quality matters—let us not all get caught up with the issue of the costs and the fees. Several councils have no care homes in the weak or unsatisfactory categories, but up to 35 per cent of homes in certain council areas are in those categories.
Not only is there disparity between the gradings of care homes, but there are huge differences between the fees of those who self-fund their care and those who do not. As responsible parliamentarians, we need to do something to incentivise people to save for their old age but, with the way that things are at the moment, there is no incentive. I will give a few examples relating to council-run homes, which I obtained through a freedom of information request. In South Lanarkshire, a self-funding client pays £474 a week to be cared for in a council home. That rises to £552 a week in North Lanarkshire, £650 a week in Fife and East Lothian and £843 in Dundee—a difference of £369 between the lowest and the highest mainland councils.
The costs of care differ widely, too. They range from £474 in a council-owned and council-run home in Midlothian to more than £900 in one in Angus—a difference of 91 per cent. In the independent and voluntary sector, councils pay £474.16, in agreement with COSLA. For the same quality of care and support, a self-funding client in the same home can pay £950 a week—twice as much. How can it be fair that two people in the same care home receive identical care, with identical quality standards, when one has to pay twice as much as the other is funded?
We should ask why councils charge self-funders up to 78 per cent more in one area than in another, and so much more than they pay to fund a place in the independent and voluntary sector. How can there be a difference of 91 per cent in the costs of providing care between one mainland council area and another?
There is another postcode lottery in relation to self-funding clients. As they are self-funded they are placed instantly in a care home, while others—through no fault of their own—must wait for funding packages from local authorities and are labelled as bed-blockers, the numbers of whom are rising week by week. That is why we are seeking a review of the charges. There is nothing complex in it: anyone with basic mental arithmetic could compare those figures.
In March 2010, there were 39,150 places in care homes for the elderly, with 33,900 residents. In simple terms, we have 5,209 empty beds out there, yet the cost of emergency admissions to our hospitals is one of the largest health budgets. Those homes could be better used for respite care. If we were to concentrate on delivering high standards of care to people in their own homes, there would be many fewer emergency hospital admissions and less need for long-term stays in homes.
It need not cost more to improve, develop and redesign services. If a general practitioner and a pharmacist visited a care home more regularly, medication could be reviewed and potentially reduced. With the right skills, knowledge and training, much more effective personalised and appropriate care could be provided.
I find it quite upsetting that 75 per cent of elderly people in care homes are on psychoactive drugs, perhaps because they have become agitated in one instance. If our elderly people are constantly on those drugs, we are not serving them well.
Will the member give way?
I am afraid that the member is over her time.
I move amendment S4M-00854.1, to insert at end:
“and calls on the Scottish Government to review the system of charges for care home places whereby, at present, self-funders pay considerably more than those placed and funded by a local authority.”
10:52
I welcome the staff of Quarriers who are sitting in the gallery. I ask the First Minister and the Cabinet Secretary for Health, Wellbeing and Cities Strategy to speak to them today after First Minister’s questions about the impact that social care procurement has on the lives of the staff and the service users to whom they provide excellent care, and to step in to help everyone who is involved in the current pay and conditions dispute between the management and Unison. Those people represent the damage that is being done to our social care services throughout Scotland.
As many members know, I have been very vocal on the situation that the Quarriers staff and service users face. I understand the financial pressures that are forced on the organisation by local authorities, but I cannot stand back and allow the staff to bear the brunt of cost cutting that procurement has led to.
Like many others in the chamber, I strongly believe that local authorities have been using the procurement process to lower costs, and that there has been little focus on quality of care when services are retendered. Social care services provide essential care to the most vulnerable people in Scotland, and they require well-trained and qualified staff. Such services are a lifeline to many in society, and must not be provided on the cheap.
I will give members an example of how cuts to the third sector are harming the care of the elderly, the disabled and the vulnerable. This case, which was brought to my attention by Epilepsy Scotland, involves a young girl who is legally blind with no verbal capacity and has two or three full-blown seizures every night. She was formerly receiving weekly support, and is cared for by her mother while her father serves in Afghanistan. Her funding and care were not renewed, and the choices support was withdrawn.
That has had a huge detrimental impact not only on the girl’s wellbeing and care, but on her mother, who is a full-time carer with no respite. SNP members will howl and moan when I say that the problems of the economy and budgets were not caused by that young girl or other service users like her, but local authorities should be ashamed of the treatment of service users and the third sector as they cut budgets throughout Scotland.
The procurement process has its merits, but its advantages are being exploited to bring cuts to social care. When a local authority believes that care is insufficient, it is right to retender that service, but retendering is being done to cut costs. If we continue to retender services—particularly those that provide the greatest level of care—we will have a system that forces the third sector to its knees and in which competition is less about care and more about how low we can go. That will be a race to the bottom.
I call on the Scottish Government to introduce a minimum five-year term for social care contracts that are well funded, allow the organisations involved to plan for the longer term and give employees job security. Increasing the terms of contracts is essential for the stability of organisations such as Quarriers and for the quality of services that our vulnerable service users deserve.
Local authorities must consult the third sector and trade unions more to deliver a clear procurement system that has care—not cost—at its heart. A distinct approach must be taken—that can be done by consulting other bodies.
In previous years, many organisations in the third sector have taken massive steps to survive.
Will Mary Fee take an intervention?
I am sorry—I do not have time.
Operating costs have been reduced hugely through cuts to staff pay and changes to terms and conditions, for example. If we continue to make cuts, carers will become demoralised and the level of care will suffer.
In February, the director of the Coalition of Care and Support Providers in Scotland wrote to The Herald to highlight that
“more than 80%”
of its members
“have been unable to”
provide pay increases that
“match the cost of living increases awarded by councils to their staff during the same period”.
Why has the Scottish Government allowed local authorities to cut the budgets to organisations that care for our elderly, disabled and vulnerable, while the wages of top managers and chief executives have increased?
The cuts that have been enforced on the third sector are short-sighted and based on cost cutting, not improvements to the care that councils tender.
Will Mary Fee please wind up?
The organisations that deliver our social care must not be attacked further. I call on the Government to protect organisations, staff and service users alike.
10:57
I declare an interest, as I worked in the social care sector for more than 30 years. As a member of the third sector, I was very much involved in working with a local authority on service procurement.
I applaud Jackie Baillie for not apportioning blame—thank you, Jackie. That was reassuring to hear.
We must consider what is essential in procuring services for our people who require social care across the board. Having sat round the table to look at procurement, I do not believe that quality is compromised. One of my duties as a service manager was to ensure that the quality of care was never compromised, regardless of the cost-cutting exercises that the local authority sometimes imposed.
It is right that every local authority tries to get the best value that it can from organisations with which it has contracts for care provision, because spending from the public purse must be held to account. However, we should never ever compromise on the quality of care.
There will always be examples of care that has been removed or of care that is inappropriate to the need. That comes down to basic assessment, which is essential to ensuring that we provide the care that an individual requires. That care is a moving thing. We cannot think that doing an assessment one week means that it is done for the next two, three or four years. Requirements constantly move and need to be monitored.
That is why it is important that all our people in social care have the appropriate training. It is disturbing to hear that many organisations in the public, private and third sectors are reducing their training budgets. However, many of them are starting to be innovative and to share training costs and are providing appropriate training, which is to be applauded.
We need minimum standards for qualifications. The work that is being done by the Government in collaboration with the Association of Directors of Social Work and the CCPS, and across the third sector, needs to ensure that the national standards and the guidelines that were set in September last year are being met. I note with concern the suggestion that the guidelines are not being adhered to in some authorities. If guidelines are not being adhered to, those authorities should be brought to account. We must ensure that we do not compromise social care in 2011. It should never be compromised at any time, because we are dealing with the most vulnerable in society.
The other day, we welcomed the Cabinet Secretary for Health, Wellbeing and Cities Strategy to the Equal Opportunities Committee. She told us that outcomes and preventative care are extremely important and gave assurances about ensuring that we support our carers. The infrastructure has to be in place. Many vulnerable people in society these days are supported by carers, who are often unsung heroes and who are the heart of care. We must ensure that they are supported so that they do not become the people who require care.
I reassure Dr Simpson that the joint futures approach still happens, although a lot of dialogue still goes on. I was certainly a member of joint futures committees in the Grampian area.
I ask the member to come to a conclusion.
I do not believe that we should compromise quality at any time. I thank the Labour Party for bringing the motion to the Parliament.
11:01
I, too, welcome the debate and, knowing full well Jackie Baillie’s integrity and intent on the questions, I am particularly happy to participate in it. However, Labour’s motion shows that party to be one of many opinions although, thankfully, most of them are of short duration. The motion is well meaning but misguided. There is the usual attempt—I wait for the guffaws—at a selective rewriting of the recent history of financial management by the current London Government and the previous Labour Government. I have yet to hear how Ms Baillie would cope with the existing financial situation in Scotland and what that would mean for social care.
Does the member accept that the Scottish Government’s amendment is factually inaccurate because, actually, the Scottish Government budget rose year on year under Labour and the most recent resource budget that was received rose again in real terms, from £25.2 billion to £25.9 billion? I look forward to the apology and correction.
No apology is needed, because Ms Baillie knows that the local government financial settlement for 2011-12 is exactly the same as it was for last year. The impact of inflation means that we will have to continue to seek change and efficiencies to improve care for the elderly and other vulnerable dependants in our society.
As the motion points out, there is significant demographic change and a significant financial challenge. However, that does not mean that the principle of the quality of care necessarily needs to be prejudiced. The motion claims that the current financial pressures
“have resulted in substantial reductions in service”.
Jackie Baillie mentioned Quarriers, which she knows is slightly mischievous, because other care companies that operate in Scotland are having similar discussions, but they are having them outwith Scotland and with less focus. I am sure that, as Mary Fee and I have done, Ms Baillie has spoken to the staff, management and unions. The charge that they would countenance such a reduction in service will lead to anxiety among those to whom the service is provided. That denigration is not at all helpful. We must achieve a compromise settlement, but the motions that have been lodged on the issue have not been particularly helpful in resolving what is a difficult situation.
The motion that my colleague Mary Fee lodged encouraged Quarriers to go to the Advisory, Conciliation and Arbitration Service, which is the national organisation that encourages conciliation and arbitration. What was unreasonable about that?
I am sure that Mary Fee knows as well as I do that direct discussions between management and the union were going on at that time, although I accept that there was resistance to going to ACAS at one stage. However, they did go to ACAS, of course. I am saying that we should be circumspect in debates such as this, as getting involved is not particularly helpful.
Last week, I said that change is constant. We must recognise that, in the current financial situation and environment, there must be change across a range of care provision and procurement. That is why we announced a £70 million agenda for change programme. That was not a short-term decision; the programme is a long-term one for the integration of health and social care services through lead commissioning and a partnership with the local authorities.
Will the member give way?
I am sorry, but the member is over his time and he must come to a conclusion.
I would like to see from Labour an explanation of its national care programme. Where are the operational, financial and service details? What are the planned outcomes?
We need to grasp the change that confronts us, and ensure that we secure the care service and care provision. We do not need shibboleths, although they may be well meaning.
11:06
I think that we all agree that the Parliament faces a significant challenge in ensuring that the most vulnerable in our society are given the dignity, care and support that they need and deserve. We need to face up to the difficult demographic changes and falling budgets, which are creating real pressures. Irrespective of who is to blame, that is the situation that we are dealing with. Just last week, in his evidence to the Health and Sport Committee, the architect of free personal care, Lord Sutherland, compared our approach to that significant challenge with our approach to global warming. There has been a lot of planning and there have been many calls for investment, but we still have not seized the issue. We have heard about that this morning.
I am pleased that we have the opportunity to focus on at least one key area: procurement. That area is not part of the Health and Sport Committee’s on-going inquiry into regulation, but it continues to raise its head regardless. We know from our constituencies, wider experience and even personal experience that the pressures go right across the board. Wherever care is delivered—whether in the public sector, the private sector or even in the third sector—the pressures and issues have been present for some time.
Will the member give way?
I am sorry, but I do not have enough time, as we have under four minutes.
In the public sector, there was a stark example in April 2009 of the consequences when we get procurement wrong. A “Panorama” programme exposed the delivery of services in the country in a very bad light. It showed that we had a system in place in which our elderly people were being humiliated and mistreated in their own homes. That was a wake-up call to many people. I see members shaking their heads, but the experience was horrible. The programme forced the Local Government and Communities Committee, which I convened at the time, to look at e-procurement practices—the reverse auctions that drove prices down to the bottom. Thankfully, the Scottish Government intervened after the inquiry to end those practices altogether.
Low pay and the high turnover of staff are problems in the private sector. What about continuity? How can people’s skills be developed in that situation? A situation has been delivered that is lowering standards.
In his evidence last week, Lord Sutherland spoke about care homes in Edinburgh that have difficulties in recruiting workers during August. It seems that we live in a country where it is more lucrative to hand out flyers during the festival than it is to provide vital care for the most vulnerable in our society.
If that is the reward that we attach to this difficult job, it can be no surprise that concerns are raised about standards. In the third sector, the Coalition of Care and Support Providers in Scotland showed this week that 79 per cent of the workers who provide these valuable services have not been awarded a cost-of-living pay rise for three years—it is the lowest-paid people who are delivering these services—and 57 per cent of the organisations that deliver care have implemented pay freezes. We realise the necessity of training people to understand the situation that they are working in, yet 60 per cent of the organisations in the third sector that are delivering that care for us are cutting their training budgets.
There are very real consequences of all that. It is not just about the hard facts and figures in the budget; we are dealing with people. They are the victims of the squeeze on social care. If we do not value the people who deliver these care services, we devalue the care that we provide to those vulnerable people.
11:11
It is a pleasure to follow my colleague on the Health and Sport Committee, Duncan McNeil; I particularly welcome his impassioned contribution.
Ensuring the long-term provision of good-quality social care for members of our society is one of the biggest challenges that the Parliament faces. The wellbeing of people who require social care is a fundamental issue and the decisions that we take in this place will most certainly affect future generations. We must work together constructively across the chamber to strengthen and safeguard the sustainability and quality of social care services.
We face a number of challenges, of which we are all well aware: the integration of health and social care; the need to ensure that quality and not just price is the driver in the procurement process; and the need for a robust system of regulation with a strong voice for the public and with service users at its heart. There is an opportunity, through the proposed social care (self-directed support) (Scotland) bill, to empower many more people who wish to commission and receive care that is customised to fit their individual needs.
We are well aware, too, of the demographic shift: by 2031, the number of people aged over 65 in Scotland is expected to rise by 62 per cent. That figure alone testifies to the fact that there will be more people with long-term conditions and complex needs who will require to be cared for.
Therefore it is clear that health boards and councils have no choice but to work together more closely and effectively. Ultimately, we want a situation where more older people can access care packages faster. We want to see cuts in delayed discharges and, as Mary Scanlon said earlier, we want to address unplanned emergency admissions. The national health service, local authorities, the third sector and the private sector all have a crucial role to play in delivering social care services.
The Scottish Government is up for the challenge—if you will pardon the pun—which is why it has allocated £70 million through the change fund, which was established to bring about greater integration of services. The establishment of a lead commissioning implementation group backed by £2 million over the next financial year is taking this agenda forward.
Lord Sutherland said:
“Lead commissioning provides the best and quickest way of achieving an integrated care system, and ... avoids the need for new legislation and wholesale re-organisation, which means improvements can begin to be made straight away.”
Will the member give way?
I have only four minutes; I apologise to the member.
It would be a mistake to assume that large-scale structural change, as has been advocated by others, provides a silver bullet in meeting these challenges. Creating a new nationwide bureaucracy would make no difference to those who require services.
The Association of Directors of Social Work, which represents senior social work managers in local authorities, has sounded a note of caution about taking a top-down approach. It states:
“We need to provide the very best care that we can for the people in our communities that need our help. We do not believe that this can be achieved through nationally driven integration.”
There is a need for an integrated system that can cut through red tape and focus directly on people’s needs.
We need an open system in which members of staff can freely and confidently report shortcomings in the system and contribute to the improvement of services. However, without a radical culture change that leads to staff feeling comfortable about submitting complaints, we will not see progress.
As has been said, the Scottish Government and COSLA have published guidance to ensure that quality is at the heart of the procurement process. The development group and the work programme that arises out of it aim to identify and disseminate good practice. I recognise the challenges that face Unison members who are employed by Quarriers and welcome their presence in the gallery. I acknowledge the constructive approach that Unison has taken in seeking an acceptable solution.
I would be grateful if the member could conclude.
The false belief that people with learning disabilities, our older people and others with complex healthcare needs are somehow a burden to society has to change. Their contribution to society is invaluable and it is our duty to guarantee their wellbeing throughout their lives for the benefit of the whole of society.
11:16
I suppose that I should declare an interest, given that Jackie Baillie described councils as providers. As a local authority councillor, I am a member of such a provider.
It is right that we do not talk about the specifics of the Quarriers situation. All that I will say on that is that I believe that continuity of care is paramount, regardless of the outcome of the discussions between the trade unions and management in that dispute.
Jackie Baillie said that she would not allocate blame but then spent a few minutes doing so. Furthermore, the allocation of blame is there in black and white in the motion, which says that the Scottish Government is responsible and sets out what it should do. There is some legitimacy to that but, although I was interested in what both Opposition parties had to say, it was what they did not say that was telling.
Mary Scanlon pointed out the pressures that exist with regard to delayed discharges, but she did not indicate that the level of delayed discharges is lower under the Scottish National Party Government than it was under previous Labour-Liberal Executives.
Mary Fee commented on the dispute at Quarriers and expressed her support for the workforce, but she did not mention that, back at Renfrewshire Council, she voted to close a newly built care home, which has been described since as a mistake. It was a mistake at more than one level.
Jackie Baillie described quite eloquently some of the pressures on local government and care provision, but she failed miserably to tell us about the national care service that the Labour Party proposed at the election.
It is astonishing the number of SNP members who have mentioned the national care service. Perhaps they misunderstand the fact that the motion is about social care procurement now; it is about the services that are provided to the most vulnerable people in Scotland now; and it is about voluntary organisations that are going to the wall now.
I am amazed that the Opposition spokesperson does not see the relevance of the Labour Party policy of a national care service to the procurement of social care. It is important that, if Labour or the Conservatives have any ideas about how to reduce the pressures, they bring forward their proposals. All that we have had is crocodile tears and empty rhetoric.
Despite the doom-mongering that we have had from the Labour Party, the world that I am aware of is not as bad as Jackie Baillie makes out, and the inspection agencies would agree. It is an insult to the professionals in this country to say that they put cost before quality, human lives and the support of our most vulnerable. It is an insult to social work, to managers and to many organisations to suggest that it is only cost that matters.
Will the member take an intervention?
I have taken one intervention and I am three quarters of the way through my time.
Great work is being done by the Scottish Government on increased integration and collaboration, and shared services. Sir John Arbuthnott’s work on the Labour policy of the national care service was pretty weak, but at least it has led, in the west of Scotland, to good work on social collaboration, which will ensure that we can address the demands on services and the pressures that we face.
Why say, when we involve the third sector, that it is social care on the cheap? Sometimes third sector organisations address need that would not otherwise be met, in partnership with the health service, local government and others. That is an extremely constructive way forward. How dare you describe the third sector’s support as policy delivery on the cheap. The UK cuts of the UK Government are difficult to manage, but we are weathering the financial storm and are innovating every day of the week to ensure that people get the services that they require. You have no credibility when it comes to Glasgow City Council, for instance. If it wants to improve working people’s working conditions, why has the Labour Party not increased the minimum wage or implemented the living wage where it is in administration?
Can we have some quiet until the member concludes his speech, please?
Finally. I know that the Labour Party does not like accurate facts on social care, but I will give you another. There may be 32 variations in charging policy but, unless we have a unitary charging system, there will be variations. That is what local democracy is about. You either let the councils decide or you set a national charging policy. If that is the Opposition’s position, so be it, but so far it has not said anything concrete about what it believes.
I remind members that they should address their remarks through the chair.
11:21
I thank the Labour Party and Jackie Baillie for giving us the opportunity to debate this important subject. I am disappointed that she has not yet put her hat in the ring to be Labour leader. However, there is still time and I look forward to seeing it happen in due course.
A number of important points have been raised and I have only four minutes. First, a very important point was made about the amount of care that third sector charities and voluntary groups provide. As Jackie Baillie pointed out, there is a sorry tale throughout the third sector of, for example, pay cuts, poor packages, reductions in hours and poor pension provision. We understand that local authorities face serious budget pressures, notwithstanding what the Government has said. However, we are concerned that local authorities are too ready to protect their own in-house services at the expense of the third sector, which often bears the brunt of the cuts.
There is often a disconnect between councils and the voluntary sector. As the Coalition of Care and Support Providers in Scotland said in its briefing for the debate, we need better
“Recognition and respect for the third sector as an engaged partner, not just a contracted supplier”,
and the funding to those arm’s-length bodies should not be the first port of call when there are cuts to be made.
On Friday, I was at a question time in Perth for the local voluntary sector. It came out strongly in the contributions from the voluntary sector representatives who were there that they feel that councils are too ready to make cuts to their voluntary sector services rather than cutting in-house. COSLA and the Scottish Government need to take that point on board.
In Perth and Kinross, in Murdo Fraser’s region, the change fund has helped to enhance service delivery and provision. That has involved local government working with the third sector.
That may be the case, but that is not the message that I got on Friday at the conference for the Perth and Kinross voluntary sector, which is extremely concerned at cuts coming down the line.
Charging has been at the core of the debate. Learning Disability Alliance Scotland has referred to dramatic increases across council areas in charges for some of the most vulnerable people in society, leaving them worse off.
We have heard a lot about postcode lotteries. That brings us to a serious issue on which Derek Mackay touched in his speech: localism against national standards. If we believe in a localist agenda and in local democracy, of course we must recognise that local authorities have the right to set different charging rates. At the same time, there is no contradiction in saying that there should be nationally set standards and parameters, as well as local flexibility. Indeed, in its amendment, the Government talks about
“COSLA’s intention to tackle variation on charging via its fundamental review of the cost of care.”
That is a sensible way forward and there is no contradiction between that and promoting localism.
Mary Scanlon talked a lot about funding arrangements. We all trumpet free personal care, which is treated with a certain degree of irony by people who pay large sums of money to be in full-time residential care. There has always been a discrepancy between the high cost of council-run homes and those in the third sector or private sector, but Mary Scanlon raised another serious issue: the disparity between self-funders and those who are funded by local authorities. Under COSLA arrangements, those who are funded by local authorities pay £474 a week, but some self-funders can be paying up to double that amount. There is a moral hazard there: how can we expect people to save for their old age when they are being penalised as a result? The amendment in the name of Mary Scanlon simply calls for a review. That is a sensible suggestion, and I am disappointed that the minister is not prepared to accept it.
11:25
This has been an interesting debate. It started off being about procurement, but it has gone into a range of areas around social care.
It is important to properly recognise the financial environment in which the debate is taking place. The Scottish Government’s budget has been cut by £1.3 billion. That was started by the previous Labour Administration at Westminster and it has been accelerated by the current UK Government.
Does the minister recognise that the resource departmental expenditure limit to the Government has increased in real terms from £25.2 billion to £25.9 billion? That means that there was an increase to the Scottish Government’s budget in every year of the Labour Government.
The eight years of Labour’s Administration in the Scottish Executive led to a year-on-year decrease in the percentage of the Scottish Executive’s overall budget going to local government. This Government has protected the share of the overall budget for local government, and increased it when it could.
That is the financial environment in which the debate is taking place. We must also recognise that a substantial amount of money is spent on social care every year—£1.18 billion. Purchasing social care is not like purchasing paperclips. It is about providing the care that people need to support them in their most vulnerable situations, so it is important that it is high quality and flexible.
To get greater consistency in the social care procurement process, the Government issued procurement of care and support services guidance to all local authorities in September last year. I recognise that it is early days for that guidance, and some members, such as Dennis Robertson, are concerned about whether it is being properly adhered to. However, Audit Scotland is considering the guidance as part of its investigation into the commissioning of social care and will report on it in January. That will show us clearly where local authorities are not adhering to the guidance, so we will be able to look at the matter in more detail. It is important that we do not call for a review or a new framework now when more than 100 different organisations were involved in developing the guidance over a two-year period. We should not simply throw that out and say that we need to do something else. We need to see what the Audit Scotland report comes out with early next year and then consider what further progress needs to be made.
Some members referred to the integration of health and social care and the central importance that that has in improving people’s experience of how their care needs are properly met. That is not a new thing. Jackie Baillie might be new to the issue of the integration of health and social care and the variation in charges, having come to it during the past three years, but Mary Scanlon is right to say that it has been going on for almost 20 years. Jackie Baillie became involved in the issue when she went into opposition, but she was not interested enough to do something about it when she was in government.
Will the minister give way?
I will finish my point. The Government is determined to drive forward the integration of health and social care in a way that has not been achieved for the past 20 years, so that people can receive care as they wish to receive it.
The member might recall that my involvement came about three years ago when constituents raised the issue of charges for care in my constituency. A constituent in Argyll and Bute paid £300 a week for exactly the same service that was being delivered in West Dunbartonshire for £30 a week. The Government has done nothing for the past three years.
I am surprised at that, because the variation in charges has existed for almost two decades and not just for the past three years. Derek Mackay was right: what was Labour’s big idea to address the issue of health and social care integration? It was a national care service, involving a super-quango of 180,000 people stripped out of local government and the health service. However, Labour has gone all quiet about that now because it realises that no one supports the idea.
On the issue of providers, I welcome the staff from Quarriers who have come to listen to the debate. I am more than happy to meet them later on today and have a discussion with them, if they get in touch with me. I recognise that real change is taking place in the sector, which different organisations must address. I encourage Quarriers and Unison to work as constructively as they can together to resolve their differences.
I accept that there is variation across the country in charges for the provision of social care. However, what is important is that we take action to address that issue, which is exactly what COSLA is doing. It will report in November on how it intends to take that forward. The variation in charges for care homes has been around for a long time. Currently, we are working with COSLA and the sector on our national plan on payments for care homes to address the issue of charge variation. That occurs for a variety of reasons, but it is extremely important that we address the issue.
The Scottish Government is determined to ensure that we integrate health and social care and that we get quality care for people who need it. We will continue to take the necessary action to ensure that that happens.
11:31
The debate has been a bit like the curate’s egg: there have been some very good speeches from members of all parties, but others have been—frankly—somewhat below standard.
We need to start by looking at similar situations overseas. For example, Sweden went through its banking crisis in the 1990s, a consequence of which was, we now know, a significant deterioration in care of the elderly. That is what this Parliament faces, and it is the Government’s responsibility. You must make the choices that you must make within the budget that you have.
We cannot accept your amendment, because there is a factual error in it. It states that the budget to the Scottish Parliament decreased in the last two years. That is just incorrect.
In a good speech, Jim Eadie talked about the efforts to achieve joint futures—I think that Dennis Robertson also referred to that.
The member referred to a factual inaccuracy in our amendment. Will he clarify which factual inaccuracy he is referring to, because I am afraid that the budget cuts to the Scottish Government—not to the Scottish Parliament—started under the previous United Kingdom Labour Administration?
There was no reduction in the budget for Scotland in the last two years of the Labour Administration. That is a fact.
Turning to the question of integration, I will not get into the debate about the national care service just now, because that is for another day. However, I have to say to you that your suggestion that we wanted to create a super-quango is completely and utterly erroneous. If you looked at our manifesto, you would see that it was all about local democracy and community health partnerships. So, I think that you just—
Dr Simpson, can I remind you to speak through the chair and not to use “you”?
Sorry—my apologies, Presiding Officer.
To return to the question of integration, Perth and Kinross was the first area to integrate services back in 2001, but it has just been given a change fund to achieve integration for the second time. The community health partnerships in Glasgow attempted to achieve integration, but they fell apart. Our point is that there have been attempts by us—and I am sure that there have also been attempts by this Government—to integrate, but they simply have not been successful. In the current climate, the attempt is even less likely to be successful, unless it is underpinned by a new commissioning framework.
Will the member give way?
I am sorry—I do not have time to take any more interventions.
Although the third sector is critical to how we move forward, the lack of a true partnership with it is extremely evident. Dennis Robertson mentioned the 60 per cent cut to training budgets and Duncan McNeil referred to the 79 per cent of the third sector that has been subject to a pay freeze. Such cuts are hugely significant to the sector.
Other colleagues have already dealt with the issue of Quarriers but, after 150 years, the organisation is clearly facing a difficult situation if its dedicated staff feel that they have to go on strike. However, it is not alone. Epilepsy Scotland has reduced its monthly running costs by about 30 per cent from £90,000 to £60,000; even though every single member has taken a pay cut, it is still in very grave difficulties because of the cuts that have been imposed. The cuts range from the 5 per cent that has been imposed on local authorities to more than 20 per cent. Why should the third sector have to bear much more of those cuts than other areas?
Despite what Derek Mackay might have said, the cuts to the local authorities are quite real; indeed, Mr Mackay must know that. However, they vary across the country. Argyll and Bute is facing a 7.3 per cent cut, while Stirling and Clackmannanshire, which are quite different councils, are getting the same level of cuts. That is just not fair.
Mary Scanlon’s comments about the variation in charges are absolutely valid.
Will the member give way?
I am sorry—I just do not have the time to take an intervention. Because the minister ran over by a minute and a half, my own time has been cut.
Members: Aw.
The massive variation in charges has been going on for a long time and we accept that the issue needs to be looked at closely as part of the overall examination of the situation. However, as Jackie Baillie pointed out, there are substantial variations in charges between authorities that are very close to each other. The hourly rate in Angus, for example, is £22.10; in Glasgow, around £16; and in West Lothian, £7.76. Those variations are huge. The Welsh Assembly has capped charges and I suggest that the chamber look very carefully at doing the same. We should not stop all localism, Mr Mackay—[Interruption.] I am sorry for addressing Mr Mackay, Presiding Officer. [Laughter.] We should not stop all localism but charges need to be capped because some of them have become quite excessive. [Interruption.]
Excuse me, Dr Simpson, but I must ask Mr Swinney and Mr McNeil to stop talking to each other across the chamber.
I would welcome it if they were going to have a sensible conversation—but I doubt it. I have to say, though, that Duncan McNeil welcomed the Government’s ban on reverse tendering; however, it has not gone far enough. There is still a race to the bottom. The promotion of low pay is bound to affect quality and such a situation cannot be tolerated. If we are going to ensure dignity in the care of our elderly, we have to provide decent pay, conditions and training, and that can only happen through the introduction of a new framework.
In the minute that remains, I stress that we must have a new contract with the third sector. The Government has said that that will be introduced through its change fund, but the fact is that the third sector is really suffering. If the Government does not recognise that now, it will reap a significant reward for that later. After all, in the care home sector, the number of trained nurses has fallen from 34 per cent to 25 per cent. How can that happen without a change in quality? It simply cannot because the complex needs of those who go into care homes are increasing, not decreasing. We must examine the issue very carefully.
We do not deny the financial difficulties of the situation. Nevertheless, the time has come to open up the debate and introduce a new national framework that respects and has a genuine partnership with the third sector.
I commend our motion to the chamber and welcome Mary Scanlon’s amendment.
That concludes the debate.