Care Homes
The next item of business is a statement by Nicola Sturgeon on care homes. The Cabinet Secretary for Health, Wellbeing and Cities Strategy will take questions at the end of her statement and there should be no interruptions.
14:55
The Deputy First Minister and Cabinet Secretary for Health, Wellbeing and Cities Strategy (Nicola Sturgeon)
My first speech as health secretary following last May’s election was to the Alzheimer Scotland/Action on Dementia conference on 6 June. In that speech, I directly addressed concerns about the quality of care that is being offered to older people in Scotland in the context of tragic care failures at the Elsie Inglis care home, the Mental Welfare Commission for Scotland’s report on Mrs V, and the collapse of Southern Cross Healthcare. In that speech I set out, for the record, my personal commitment to improving care for older people, whether that means integrating health and social care, ensuring the implementation of the dementia standards, making sure that older people are treated with care and compassion wherever they are and whatever their diagnosis, or ensuring that there is robust regulation of care services. Today in this Parliament I reaffirm that commitment.
I also made clear in that speech my belief that, in general, care services in Scotland are of good quality and respond well to the needs of older people and of the people who care for them. I reiterate that point today.
I turn to the regulation of care, specifically. I believe that the arrangements for the regulation and inspection of care homes and care-at-home services are fundamentally robust. However, when we debated the issue on 9 June, I said that I would listen carefully to all the concerns that were expressed, and that I would consider whether, in the light of recent experiences, there were any aspects of the new regulatory regime that should be strengthened. Indeed, I think it is right that we always keep matters as important as these under close review. I have now given them that further consideration and I believe that the changes that I am announcing today will strengthen an already strong system.
We continue to hold to the Crerar model: scrutiny should have a public focus and be independent, proportionate, transparent and accountable and the burden should be proportionate to the risk. However, I understand the concern about the proposed move from mandatory twice-yearly inspections to inspections at least once every two years, and I am mindful of the potential impact on public confidence at a time when we have made improving the quality of care such a priority.
For that reason, I intend to make the following changes. First, I have decided that all care homes and personal care and support services will be inspected at least once every year, rather than once every two years. Over and above those mandatory inspections, there will continue to be additional risk-based inspections. Those additional inspections are intended to address the risk that services that have previously been regarded as being of good quality might deteriorate quickly and dramatically in quality between inspections.
Secondly, the new inspection regime will be placed on a statutory basis. I will introduce regulations shortly to specify the regularity of inspection. I will also use those regulations to place in law the requirement that, in the future, all inspections of care homes will be unannounced.
Thirdly, I will continue to ensure that appropriate resources are in place to support that additional activity. As members will appreciate, announcements on spending will be made in due course. As with all budgets—and given that the new care inspectorate has replaced three pre-existing organisations—we will, of course, expect efficiencies to be made. However, let me be clear that the budget that will be set for the care inspectorate will enable the organisation to deliver the more frequent inspections that I announced, maintain its current overall staffing capacity and ensure that it has the right mix of staff to take forward the wide range of functions that have been allocated to it.
I want to take the opportunity today to say something about the formal name of the new organisation, which is Social Care and Social Work Improvement Scotland, or SCSWIS. The meetings that I have had with people working in social care and with members of the public who use services or who have relatives who use services have demonstrated to me that there is a need for better understanding and information about the role and work of the care inspectorate. A key issue that has been presented to me again and again is the name of the organisation. Although there are good reasons for the legal title of the organisation, it is not an easily useable name. On that basis, I have agreed with the chair of SCSWIS that for day-to-day business we will now call the organisation the care inspectorate. Of course, the reference to inspection does not reflect all that the organisation is responsible for—I am thinking, in particular, of its important improvement remit—but I believe that it addresses a primary concern of the public. The new informal name in no way changes the focus or functions of the organisation but is, I believe, a necessary step to ensure that the public understand the protections that the organisation provides.
I have agreed with the chair of the care inspectorate that I will support him and his team in work over the next few months to promote and raise the profile of the very important complaints process that people can use if they believe that services are not what they should be. The complaints process is a key element of the regulatory regime in Scotland and a significant protection for all service users, but it can work only if it is used, so it is our intention to ensure that people understand it and are encouraged to make appropriate use of it.
I want to give Parliament an update on progress on the restructuring of Southern Cross. As members will appreciate, the difficulties that were caused by Southern Cross’s financial problems were not of our making, but the Scottish Government has been working with the Convention of Scottish Local Authorities and other partners in the national contingency planning group to ensure continuity of care for all Scottish residents. In parallel, the care inspectorate has devoted additional time to ensuring that quality standards are maintained in Southern Cross homes and has taken action when that has not been the case.
On 7 June, Southern Cross announced that it was moving to a structured break-up of the business and that it would seek new operators for all its homes over the summer. At that time, both Southern Cross and NHP plc, the largest landlord, gave guarantees about continuity of care and promised that no homes would close as a consequence of the break-up.
Work to seek new operators is now largely complete. All homes have an identified new operator, with the exception of two for which Southern Cross is both landlord and operator. Separate arrangements are being made for those homes and they will transfer at a later date.
The process to register new operators of services has begun and the care inspectorate is liaising with regulators in the other United Kingdom jurisdictions to share knowledge and information on providers. That work will be taken forward efficiently to enable transfers of operation to be completed, but I assure Parliament that there will be no cutting of corners or reducing of standards; we must all be confident in the quality of future provision.
I recognise that until this business is complete, there will continue to be anxiety and concern, but we will continue to work with Southern Cross and the landlords, as well as with COSLA and the care inspectorate, to ensure that we get the best result for Scotland. COSLA recently launched a website that offers all interested parties up-to-date briefings on the Southern Cross situation on a home-by-home basis.
I think that all members would recognise that the experience of Southern Cross raises a wider issue—the risk to the security of provision of care services when a private operator runs into financial trouble. Although the circumstances of Southern Cross are quite particular, we must act—we have a duty to do so—to minimise the risk of care homes or other care services failing because of private providers’ financial difficulties.
Our approach to that work must reflect the diversity of the market, which includes very small local services as well as large national and UK-wide services that might involve private equity or that might, indeed, be subject to financial regulation as a consequence of listing on the stock exchange. The interaction of reserved and devolved matters means that the UK Government has an important role to play, and I will expect it to discharge that role effectively to provide protection for services that are provided to vulnerable older people.
In parallel, I have tasked officials to work with the care inspectorate, COSLA and other interested parties to bring forward recommendations on how we can provide—and be assured of—greater financial robustness in the sector. I am aware that the Health and Sport Committee is looking at the issue, and I will be interested in its recommendations, which I look forward to seeing in due course.
I hope that members will welcome the changes that I have announced. However, that is not the end of our work to improve care for older people. Over the next months, I will set out plans for the integration of health and social care for older people, for work on self-directed support and for further work on quality and standards of care. I also intend to write to all members, following next week’s spending review announcement, with further information about some of the matters that my statement has covered.
In the meantime, I will be happy to answer members’ questions.
The cabinet secretary will take questions on the issues that were raised in her statement. I intend to allow 20 minutes for questions, after which we will move on to the next item of business. It would be helpful if members who wish to ask a question were to press their request-to-speak buttons now.
The cabinet secretary and I are in complete agreement that improving the care of our older people must be a top priority. I welcome the improvements in regulation. We called for increased frequency of inspections, unannounced visits, statutory underpinning, a more user-friendly name for SCSWIS, financial monitoring of care home providers and the reinstatement of resources to the care inspectorate, so I very much welcome the cabinet secretary’s commitments.
I am sure that the cabinet secretary would acknowledge that robust inspection cannot be carried out without adequate resources. Peter Ritchie from the care inspectorate’s Unison branch gave evidence the other day to the Health and Sport Committee that the reduction in the care inspectorate’s funding over four years amounts to 25 per cent. The Government has tried to deny that, but the number of inspectors has been cut by 60 so far through early retirement and voluntary redundancy, and a further cut in numbers is expected by the end of the financial year, taking the figure to almost 100 fewer inspectors. Will the cabinet secretary commit to fully restoring the resources and staffing that the care inspectorate requires in order to ensure the best-quality care that we can provide for our older people?
I thank Jackie Baillie for her question. I am not sure that the words “complete agreement” will always feature in a Jackie Baillie question to me, so I should welcome that while I can.
There will be many matters that divide us in the Parliament and, even on this issue, there will be many areas for appropriate and rigorous scrutiny—that is what Opposition parties are meant to do to Governments. However, I hope that, on this important issue, we can also find common ground. I said to Malcolm Chisholm, when he made an excellent speech in the debate on 9 June, that I would listen carefully to the points that he made and I hope that I demonstrated today that I have done that.
I know that Jackie Baillie listened carefully to what I said about resources in my statement. I cannot go into detail because the spending review rightly comes to Parliament next week.
The care inspectorate’s budget for this year is 1 per cent down on last year’s budget. Some of that involves non-recurring funding. Future funding projections for any organisation are not confirmed until a budget is set and a spending review is outlined. The projections on which the care inspectorate was working were based on a frequency of inspection that I have changed today. I said in my statement that the funding would change to reflect that.
I also said in my statement that, when we merge three organisations into one, it would be preposterous not to expect some efficiency. The guarantee and commitment that I made to Parliament, which members will be able to scrutinise when the budget comes to the Parliament, are that the changes that I announced for a robust inspection system will be fully resourced.
I, too, welcome the cabinet secretary’s statement and thank her for advance sight of it.
I welcome the U-turn on inspection timetables. I am encouraged that the Scottish Government has rethought that in the light of experience.
On SCSWIS, it seems that changes of name are fashionable at the moment. It will make life easier for us all for that body to be referred to as the care inspectorate.
I welcome the progress on seeking new operators for the Southern Cross homes and ensuring continuity of care for residents. I declare my connection with Robert Kilgour, who is involved in that and is a supporter of my campaign. In the light of the cabinet secretary’s comments on that, will she state for the record that the Scottish Government supports the current mix of provision of care places from public, voluntary and private sector providers?
I did not mean to cause Murdo Fraser any discomfort by my statement, but I realise that I might inadvertently have done so. For the record, the change of name from SCSWIS to the care inspectorate will not be a full-scale rebranding. The organisation is fit for purpose and—unlike Murdo Fraser with the Conservative Party—I have never been embarrassed by it. I hope that that provides enough distinction between the changes that I have announced today and anything that might happen in the future to Murdo Fraser’s political party.
On his point about the mix of provision in care homes, we are where we are, and I do not expect that to change fundamentally during the next period. However, I want to make sure that we reflect on some of the consequences of part of that mix of provision that we have seen all too painfully with Southern Cross, and seek to learn from them so that we build financial robustness into the system and give the care inspectorate and Parliament the assurance of that robustness. That is important work. The Health and Sport Committee will make an important contribution to it and I look forward to bringing further thoughts and recommendations to Parliament in due course.
I also welcome the cabinet secretary’s statement. I draw her attention to the Royal Pharmaceutical Society’s pharmaceutical care and care homes working group, which is examining a number of issues around prescribing of drugs for care home residents. Given the recent media stories alleging excessive use of drugs in care homes, will the cabinet secretary undertake to consider the working group’s recommendations when it publishes its report later in the year?
That is an important question, and obviously I am aware of the recent press coverage of the issue. I will pay very close attention to recommendations that are made by organisations such as the Royal Pharmaceutical Society.
It is important to point out for the record that the standards of care for dementia state that national health service boards must ensure that:
“Systems are in place to ensure that capacity to consent to treatment”—
including the prescribing of psychoactive medication—
“is considered and appropriate documentation in place”,
in line with part 5 of the Adults with Incapacity (Scotland) Act 2000. This is an important area. The standards of care for dementia will help to ensure that people are properly treated and, of course, we will continue to listen to any expert recommendations and respond appropriately.
The cabinet secretary stated that two homes that are owned and operated by Southern Cross are unlikely to have new arrangements in place by the stated date. Which two homes are they? What are the separate arrangements for them to which the cabinet secretary referred? Can she now give an undertaking to all the residents in all the homes that continuity is going to mean that they will not have to move because of the changes that are being made?
Details on each of the homes are on the COSLA website that I mentioned earlier. I will be happy to send Richard Simpson the link so that he can see the state of play of each particular home. I spoke to the chief executive of Southern Cross yesterday and he told me that contingency arrangements would be in place for any home, particularly the two that might not transfer by the date by which the rest will have transferred.
On the second part of Richard Simpson’s question, I have given that guarantee all along: continuity and quality of care are the two things that the Government has guaranteed. The First Minister standing here at First Minister’s questions and I have given that guarantee. I hope that the update that I have given today will reassure people that continuity of care will be achieved by an orderly transfer to new providers. We will, however, continue to work with COSLA to ensure that the Government, working in partnership with local government, stands ready to ensure that older people who rely on the services are adequately looked after and catered for.
Does the cabinet secretary feel that, in addition to the welcome measures that she has announced today, there might also be a specific need in the future to regulate charges that are being levied by private care homes?
That is an important question, and I know that Graeme Dey has a particular constituency interest. As he will be aware, the charges that are applied to individual self-funding residents are private contracts between individuals and care providers. However, I want more transparency on the level of charges in order to ensure that fees are proportionate and do not penalise individuals who have higher levels of income or assets. I hope that that answer is helpful to Graeme Dey. I would be happy to discuss the matter further with him in the weeks and months to come.
The health secretary rightly highlights the need to focus on quality, but for care workers, training to Scottish vocational qualification of level 2 is essential for registration with the Scottish Social Services Council, yet only 50 per cent of staff are currently trained or in training. Will the health secretary review the time period for registration so that it is sooner than 2015 for care home staff and 2019 for care-at-home workers?
Mary Scanlon has raised this issue before and, of course, I am always happy to keep those things under review. She will be aware that it is a requirement of registration with the regulatory body that a care worker has the relevant and appropriate qualification.
She has talked before about timescales—I can understand why she raises that issue. I am sure that she will appreciate that Scotland is unique in the UK in having decided to require registration of the entire social care workforce and not just the social work element of that workforce. It is a large and complex workforce, and it takes time for those workers to gain the qualifications that will allow them to be registered. That is why the timescales are as they are. However, we take the issue seriously and that is related to our aim to improve the quality of care, so I am more than happy to continue to discuss directly with Mary Scanlon any concerns that she has in that regard.
I thank the cabinet secretary for the changes that she has brought about, particularly in relation to the frequency of inspections and the requirement that they be unannounced for care homes. However, although the care inspectorate has generally done excellent and reliable work over the past 10 years, will she continue to look at the scope and nature of inspections and, indeed, the content of the care standards? In particular, will she see what more can be done to ensure that the views, feelings and experience of users of services are taken fully into account?
Yes is the short answer. I said in my statement that I think that the changes that I have announced today will strengthen an already strong system, but we should always keep matters under review. The frequency and unannounced nature of inspections are incredibly important, but the quality and intensity of inspection matter, too. One of the other issues that Malcolm Chisholm raised in a speech in June was about the care inspectorate talking to service users and taking into account their views. That is an important part of the process. We will therefore continue to ensure that the care inspectorate has an approach to regulation and inspection that can genuinely ensure quality.
Just to return to Richard Simpson’s question, I am told that the details of the two Southern Cross homes that I mentioned in my speech are not yet on the COSLA website. However, the homes are Belhaven in Troon and Forth View in Leven. That information will be on the COSLA website in due course.
I welcome the cabinet secretary’s statement and her eventual consideration of the Health and Sport Committee’s inquiry into the regulation of care for older people. Will she consider giving a greater role to general practitioners, pharmacists, physiotherapists and allied health professionals in informing SCSWIS—or the care inspectorate, as it shall now forever be known—so that they have more formal input when there are inspections, and other methods of input when there are not inspections, should they have concerns about care home performance?
When I referred in my statement to the minimum frequency of inspections, I pointed to the very important additional risk-based inspections that the care inspectorate will undertake. One of the important triggers for additional inspections would be complaints, which is why it is important to raise the profile of the complaints system. However, the health professionals to whom Bob Doris referred—GPs, pharmacists and others—can also raise concerns. They have an important role to play in ensuring that they draw any concerns that they have—for example, through visiting a patient in a care home—to the attention of the care inspectorate. Bob Doris has made an important point, and I assure him that it is taken very seriously.
I am afraid that I now need short questions and answers.
Liberal Democrats, too, welcome the changes that the cabinet secretary has announced this afternoon. Does she agree that it is not a matter of merely maintaining standards in care homes and that there should be a relentless focus on improvement, and that the care that is offered to our vulnerable older people should encompass the highest quality of dignity and respect as well as good physical care? Will the cabinet secretary confirm that the care inspectorate will not be deflected from driving up standards?
The very short answer is yes. However, to expand on that briefly, I said in my statement that although the change of name to the care inspectorate is important, it does not deflect from the organisation’s improvement function. I know that my colleague Angela Constance will be particularly keen to stress that in relation to early years and childcare facilities. Improvement is a critical and central function of the organisation and that will not change.
In a conference call, Southern Cross senior management assured me that all care home staff will be transferred to the new operators under the Transfer of Undertakings (Protection of Employment) Regulations. Indeed, I understand that negotiations with staff and trade unions are under way. If those talks are unsuccessful, will the cabinet secretary intervene, and what support will she make available to the care home staff?
I understand why Margaret McCulloch has asked that question. After all, we talk about the anxiety and concern caused to users of the services, but I am also very aware of the great anxiety and concern that is being felt by those who work in Southern Cross homes. That said, the member will appreciate that the relationship between employer and employee is just that. That is as it has to be. Southern Cross has given assurances about TUPE transfer and I see nothing to suggest that it will not honour them. However, as with the care aspects of this matter, we will continue to discuss with Southern Cross and other interested parties the interests of the staff who work there.
Will the cabinet secretary confirm that the minimum qualification for care workers and residential staff will be Scottish vocational qualification level 2 and consider whether those in supervisory roles should have SVQ level 3 and those in management positions an appropriate management qualification?
We should always consider whether we have an appropriately trained and skilled workforce. With regard to the differences that Dennis Robertson has drawn between the different categories of worker—and to go back to Mary Scanlon’s question—I point out that that is all reflected in the timescales for registration. In fact, the management staff of care homes are already registered. Nevertheless, although we must ensure that we make progress towards completing registration, we should always be examining how we ensure that staff in care homes and other care services have appropriate skills and we will always look at how we can improve.