Community Care
The first item of business is a Scottish National Party debate on motion S1M-1356, in the name of Nicola Sturgeon, on community care, and two amendments to the motion.
I note that the Minister for Health and Community Care and most Labour, Liberal and Conservative members have not ventured into the chamber this morning. They should not believe everything that they read in the newspapers about the Scottish National Party's new health team.
The subject of the debate will strike a chord with thousands of families across Scotland. It has already provoked much discussion—some of it allegedly heated—among members of the Parliament. Sadly, that discussion has not been about the issues that will be raised today, which I am sure all members deal with daily in our constituencies. Rather strangely, the discussion has focused instead on whether the debate should take place at all.
The Executive amendment asks members to await the publication of the Health and Community Care Committee's report. It is worth while noting that Susan Deacon was not prepared to do that before making her ministerial statement on community care on 5 October. Like my colleagues on the committee, I am not at liberty to comment on the contents of the report prior to its publication. I agree whole-heartedly with the ruling that the Presiding Officer just gave.
As a new member of the Health and Community Care Committee, I am happy to pay tribute to the work that has been done over a long period by past and present members on an issue that is of enormous importance to all of us in Scotland. I make particular mention of my predecessor, Kay Ullrich. On the committee, and more generally, she has done a fantastic amount to highlight the many community care issues that require to be addressed. Kay is no longer a member of the committee, but the report that is published will be in no small part a tribute to her efforts.
I have no doubt that the committee's report will make a substantial contribution to the debate about community care arrangements and I look forward to debating its conclusions in the Parliament in due course. However, the issues that the SNP will raise today are immediate and pressing. They concern real people—some of the most vulnerable in our society—who need care now and cannot access it, and whose inability to access the care that they need and to which they are entitled will have a knock-on effect for other parts of the national health service, at a time when the pressures on the service are already intolerable. Those issues cannot wait. I do not think that those people, their families or their friends will even begin to understand why so many members of the Parliament have chosen to absent themselves from such an important debate.
Nicola Sturgeon says that the issues cannot wait. I am puzzled why they could not wait two weeks for a more comprehensive debate that would allow members to reflect on the recommendations of the Health and Community Care Committee. Where were SNP members when the Minister for Health and Community Care gave committee members a briefing? The Tory, Liberal Democrat and Labour members turned up, but no SNP member came to debate the future of health and social care with the minister and her team of advisers.
If Hugh Henry cares to wait a few moments, he will find out why this debate is so pressing. He should also acquaint himself with parliamentary procedure, because when the report of the Health and Community Care Committee is published in two weeks' time, it requires to lie for eight weeks to allow an Executive response, thereby ruling out the possibility of a debate in the chamber before Christmas and the winter period.
Not again, Mr Henry.
Will the member give way?
I am not prepared to take an intervention from Mr Henry at this stage.
Last month, Christine Grahame lodged a parliamentary question asking how many elderly people in hospital or at home had been assessed as needing a place in a nursing or residential home but whose placements had been deferred by local authorities due to lack of funding. Members may think that that was a simple question, but the reply from the Scottish Executive was that such information was not held centrally—a response that members will recognise as one of a few standard lines that ministers use when they want to avoid answering difficult questions.
Not one to give up, however, Christine Grahame wrote to all local authorities in Scotland, asking them to provide the information that the Scottish Executive was unable or unwilling to provide to the Parliament. The details that she received from councils around the country are deeply disturbing and—I suspect—give us the real reason why so many Labour and Liberal MSPs are reluctant to debate this issue here today.
From the 16 local authorities that have responded so far to Christine Grahame's inquiry, we have discovered that almost 900 people in Scotland have been assessed as needing residential or nursing care but have not yet been allocated a place; more than two thirds of those people are in hospital beds. If that pattern is repeated in the remaining 16 local authorities, 2,000 elderly people in Scotland will be denied the care that they need at the most vulnerable and fragile time of their lives and their families will be denied the peace of mind that comes from knowing that elderly relatives are being cared for properly. Those figures do not include the thousands more who are waiting for assessments in local authorities around Scotland.
Last week, the Mental Welfare Commission published its annual report, which, although it is about people with mental illness, sums up the situation for everyone who is caught in this position. The report says:
"The commission is aware of many people about whom there is unequivocal agreement that they need residential or nursing home places or other community care but who remain in hospital—either because there is no local authority funding for their placement or because there is disagreement about responsibility for funding. The outcomes of these delays are inappropriate care for patients . . . insecurity and anxiety for them and their relatives"
and
"frustration of the government's community care policy."
The effect on individuals is not the only issue. I have never been keen on the pejorative nature of the term "bedblocking", which tends to stigmatise the patient. Nevertheless, delayed discharge from hospital is a real problem. Every hospital bed that is occupied by someone who needs to be in nursing or residential care instead is a bed that is not available for those who genuinely need hospital care.
Already, we hear reports that 10 per cent of acute beds are blocked. The statistics appear to give credence to those reports, which is hardly the mark of an NHS that is ready for winter and all the pressures that that will bring and is evidence that action must be taken now if the health service is to cope over the next few months of winter.
As Nicola Sturgeon is three quarters of the way through her allotted time, will she come up with some proposals to support her motion? Unless she does so, she is simply detailing the current situation.
I remind Mr Wallace that patience is a virtue.
I dare say that the minister will point to the £10 million that was released to local authorities last month in order to help them to deal with delayed discharge. There is no doubt that that money was welcome, but it is not enough. For example, in East Ayrshire, of the 64 people who are in hospital waiting for a place in a residential or nursing home, only 25 will be discharged as a result of the extra money provided by the Executive. In North Ayrshire, out of 71 people who are waiting for a place, only 20 will be discharged. Those figures show that many beds will be blocked during the winter. The Government must act now, not in a couple of months when we will have the chance to debate the Health and Community Care Committee's report.
There are also people who remain at home, notwithstanding an assessment that they need residential care. I agree with the thrust of the Executive's policy—where possible, elderly people should be enabled to stay in their own homes for as long as possible. That is what most people want, but there will always be some cases where it is not possible or desirable. People in that situation must also be catered for but, from the evidence that the SNP is presenting to the Parliament today, that is not happening for many of them.
It is not surprising that many local authorities cited lack of available places as the reason why elderly people who have been assessed as requiring care are not being placed. Perhaps the minister should listen to what I am saying, given that there has been a reduction in the number of places in residential care homes since Labour came to power in 1997.
Many people who have been assessed as needing residential or nursing care would be capable of staying at home if the right support existed. The minister has articulated that point on several occasions. Many people are at risk right now, because that support is not provided for those who live in their own homes. Since 1997, the number of hours of home care provided by local authorities has fallen by 7 per cent and 11 per cent fewer people receive home help assistance. The drop in Glasgow over that period is 20 per cent and there are fewer health visitors than there were when John Major was Prime Minister. [Interruption.] If Richard Simpson is proud of those figures, he should be ashamed of himself.
The rhetoric of the Government's community care policy simply does not match the action on the ground. Of course, Malcolm Chisholm will talk about the £30 million released for home care, but he should listen to what I am about to say. That money will not be released until next April. Here is an idea for the Government: release that money now to provide adequate home care for people who need it right now, this winter, in their own homes.
I have to tell Mary Scanlon and her party colleagues that, taken on its own, the SNP would absolutely and unequivocally support the amendment lodged by the Conservative party. Unfortunately, the effect of the amendment is to delete the SNP's entire motion. I assume that that is a mistake but, if it is not, it betrays a deep misunderstanding of the issues that Parliament is dealing with this morning. The SNP motion and the Tory amendment are not mutually exclusive. In fact, they are mutually supportive.
Implementation of the Sutherland report's recommendation on free personal care would have a positive impact on many of the problems that we are raising in today's debate. Only this morning, before coming to Parliament, I took a call from a member of the public asking me to point out yet again how wrong it is to make elderly people sell their family homes or use their life savings. To make them pay for the basic personal care that many of them require because of old age, frailty or illnesses such as dementia is, in effect, to punish them for having been responsible throughout their lives.
It is about time that the Parliament righted that wrong and it is about time that members were given some clarity about where the Executive stands on implementation of the Sutherland report. Is it the Executive's policy to back the Minister for Health and Community Care when she says that it would not be right to make personal care free at this time? Alternatively, does the Executive support the position of the First Minister, Henry McLeish, when he says that it would not be right to continue with Labour's opposition to free personal care?
That is a basic question, to which everyone in Scotland, especially vulnerable people who require care, deserves to have an answer from the Executive now. I certainly hope that Malcolm Chisholm uses his time this morning wisely and is allowed, at long last, to give the Parliament and the people of Scotland an answer to that question. The question will not go away until the Executive gives us all an answer to it.
The SNP has raised a series of issues that are immediate and pressing for thousands of elderly people and their families throughout Scotland. Those issues must be addressed not in a month's time and not in two months' time, but here and now. It is the duty of any Opposition party in any Parliament to raise such issues. It is a disgrace and an act of contempt, not only for Parliament but for the people of Scotland, that Labour members have absented themselves from today's debate.
The people of Scotland will see that the SNP is raising issues that are important to them. We have put into the domain of Parliament this morning evidence that there is something very wrong with the Executive's policy on community care. What I want to hear, what the Parliament wants to hear and what the people of Scotland want to hear are some answers from the Executive and a commitment that it is prepared to act now to improve the lives of elderly people across Scotland.
I move,
That the Parliament is concerned about the current waiting lists held by local authorities of people in hospital and at home who have been assessed as needing residential and nursing home care but for whom no funding is available; recognises that home care services are inadequate to enable them to safely stay within their own home; notes that most of the additional funding announced by the Minister for Health and Community Care on 5 October 2000 will not be introduced until April 2001 and therefore calls upon the Scottish Executive to bring forward proposals as a matter of urgency to address these issues before the onset of winter.
The SNP motion is right in pointing out that there are still problems with delayed discharges and in recognising that there is a need for more home care services. Where it is wrong is in totally ignoring all the proposals that have been brought forward specifically for this winter, quite apart from the major resources and improvements for future years that were announced on 5 October.
It is nothing short of astonishing that the SNP front benchers—and presumably its back benchers as well—have no knowledge at all of the many measures that have been put in place for the coming winter. We have already put in place a range of specifically targeted measures backed by significant amounts of new money to strike at the heart of some of the problems that have bedevilled the national health service and community care during previous winters. Those measures will establish a firmer base for future service development.
Malcolm Chisholm refers to the resources that were announced on 5 October. Nicola Sturgeon recognised that resources had been made available, but the evidence from local authorities is that that money will deal with only 25 per cent of waiting lists. What does the minister intend to do about the remaining 75 per cent of people on waiting lists?
As I will make clear in a minute, far more than £10 million has been allocated for this winter.
Before I describe the preparations that have been made, I would like to pay tribute to the Health and Community Care Committee for the work that it has done, which we acknowledge in our amendment. We are all looking forward to seeing the committee's conclusions. I am sure that its report will not only contribute to thinking about policy in this area, but intensify our determination to drive forward change with urgency and focus.
Will the minister take an intervention?
In a minute.
We have made clear our intended direction of travel: to provide maximum benefit to the maximum number of people, especially those in greatest need. We want a person-centred approach that focuses on the needs of individual service users. There will be a drive towards joint, seamless, multi-agency and multidisciplinary working, to ensure the most effective use of the community care pound. In particular, we want joint resourcing and management of all services for older people by 2002 at the latest.
I want to make two more points before I take an intervention from Nicola Sturgeon.
We are determined to improve the quality of care, through our "Aiming for Excellence" proposals and by tying new resources to outcomes. We are also determined to shift the balance of care towards care at home, which all the evidence and research suggest most older people want.
The minister mentioned the work of the Health and Community Care Committee. Will he answer a question that Susan Deacon has so far failed to answer? If—and I stress the word "if"—the Health and Community Care Committee recommends full implementation of the Sutherland report, will the Executive go ahead with that?
On a point of order, Presiding Officer. The member is straying into conjecture and debate about the committee's conclusions. I do not think that that is acceptable, unless all members are allowed to debate the committee's conclusions.
The minister can deal with that.
In response to John Swinney last Thursday, the First Minister made it quite clear that the Executive is reviewing its policy on the Sutherland report. There is an important debate to be had about the funding of personal care. However—and this point is also relevant to the Conservative amendment—free personal care would not help us to solve the problems that the SNP is bringing to our attention this morning. Today's debate is not about the Sutherland report. If pressed, I will restate the Executive's position on the report, but that would be a waste of time.
Before I describe the specific measures for this year, I will remind members of the important announcement that was made on 5 October, which embodied the principles that I outlined a moment ago. For the three years starting in April 2001, we will have flexible rapid response teams in every part of the country to support up to 18,000 older people at home. There will be free home care support for those who need it for up to four weeks following discharge from hospital. There will be 1,000 additional long-term home care packages for those in greatest need and 22,000 extra weeks of respite care. There will be a local service in every part of the country for shopping, laundry and minor household repairs. Formal guidance on charging for home care will be issued, to be used if the Convention of Scottish Local Authorities initiative to reduce variation does not achieve the desired result.
Perhaps the thought of all those significant new resources and initiatives has taken the Opposition's eye off the ball in the current year. I assure the Opposition that the Executive's eye is firmly fixed on what needs to be done now for this winter.
Will the minister give way?
If I have time, I will take another intervention, but I want to devote the second half of my speech to what we are doing now for this winter.
Back in the spring, the Executive recognised the need to learn from the experiences of the NHS and local authorities last winter and to make full and adequate preparations for the coming winter. It should come as no surprise to anyone that additional capacity in health and social care will be needed over the winter months. We know that winter puts real pressure on the NHS and on social services. We are talking about day-to-day events. Hospital admissions always rise in the winter. Flu can strike unpredictably. Icy weather leads to accidents and broken bones, and staff get sick more often. The Executive's aim is to ensure that these events do not cause health and social services to break down. To ensure that the NHS manages its way through the inevitable pressures, in July about £10 million was allocated to the service so that it could take forward winter planning work and put appropriate arrangements in place. That was new money within the wider allocation for modernisation that was allocated to all health boards at that time.
I must press on. I have only four minutes to cover a lot of territory.
A winter performance group was established in the spring and it reported in August. A seminar held in September acted as a springboard for further work by health boards, trusts and local authority social work departments. We now have winter plans from all health board areas—with input from trusts and social work departments—which are being assessed by a service-led panel. A great deal of work has been done by all agencies to make preparations.
Examples of the services are: ensuring that complementary general practitioner and pharmacy services are available out of hours, over weekends and at Christmas and new year; expanding use of rapid response teams; a review of hospital admissions procedures to ensure that potential admissions are dealt with in the community wherever possible; expanding the number of acute beds and associated staffing; increasing the number of critical care beds; and reviewing plans for elective procedures to allow capacity for emergency admissions. A winter panel has also been established to review winter planning arrangements and monitor developments ever more intensely as winter unfolds.
Does Malcolm Chisholm care to answer Dr Anthony Toft, consultant physician at the Edinburgh royal infirmary? Dr Toft said:
"I suspect we won't cope this winter . . . The feeling among doctors is that although plans have been made, these plans will prove inadequate."
I have talked to Dr Toft on more than one occasion and have the highest respect for him. It is generally recognised that he is in a minority on many aspects of health policy. Dr Bill O'Neill, the Scottish secretary of the British Medical Association, said:
"We have never been better prepared for winter than we are this year . . . I think we have had better planning and we are better prepared this year than we have ever been in the past."
I was going to say more about flu immunisation but, as I have only two minutes left, I will just remind members of the £10 million that has been put into the programme for it. I hope that every member of the Parliament will take seriously the message that is being promoted through our television and newspaper advertisements and encourage all their constituents who fall into the appropriate categories to take the time to go to their GP and have the flu jab.
Nicola Sturgeon made a point about not knowing the numbers for delayed discharges. The Executive has ensured that we will soon know the numbers because the first ever census has been taken. At the end of November, we will have the first figures. Nicola Sturgeon gave the figure of 2,000; the unofficial figure when Labour came into power in 1997 was a lot more than that.
The SNP motion refers to people waiting for admission to nursing or residential care after assessment. We agree that there are unacceptable delays and clearly action has to be—and is being—taken. We have allocated £19 million in the current financial year to local authorities and to the NHS specifically to tackle delayed discharges from hospital. That money went out in response to plans that the NHS and local authorities submitted.
Will Malcolm Chisholm give way?
I have only a minute left, so I must press on.
Those plans have now been improved and are being put into effect. Apart from providing resources and monitoring development, we have also set up a service-led learning network to disseminate good practice and be a catalyst for change.
The final aspect of current expenditure for this year that I will mention is equipment and adaptations. We estimate that around 10,000 people who have been assessed as needing some kind of equipment or adaptation are on a waiting list. Another 10,000 or so are waiting for their assessment. That is unacceptable. Susan Deacon has already announced that we intend to allocate £5 million specifically for equipment and adaptations in the current year to help to tackle that backlog of people.
Order.
I am out of time.
When the money for this year is added up, it amounts to £44 million specifically to address the problems that the SNP motion refers to. That means that the SNP's suggestion that nothing has been done and that we need to produce proposals is nonsense. We have the winter money of £44 million and we have the extra money that was announced on 5 October, which will be £100 million in year 3.
Other community care announcements will be made that involve additional money. A great deal of action is being taken. We are not complacent. We recognise that the problem will take some time to deal with; it has existed for three decades. As Susan Deacon said at the Health and Community Care Committee two or three weeks ago, it may take more than a year to deal with it. Significant action is being taken this year and significant progress will be made. I reject the SNP motion.
I move amendment S1M-1356.1, to leave out from "is concerned" to end and insert:
"notes that the Health and Community Care Committee is conducting an inquiry into Community Care and believes it is appropriate that the Parliament awaits the outcome of the Committee's conclusions."
I remind members that they should not ask other members to take interventions when they have gone beyond their time limit. The minister was in injury time for interventions that he had already taken when Mr Gibson tried to intervene.
I find it quite insulting that Nicola Sturgeon stands up to declare the issues as though she had suddenly discovered them. When the Health and Community Care Committee first met in June 1999, we drew up a list of priorities that we thought should be addressed in the new Parliament. Many concerns were expressed, but the overriding priority was care in the community for the elderly, the disabled and the mentally ill. That priority was agreed unanimously by committee members.
Over the 10 months of our wide-ranging inquiry, we heard evidence from people throughout Scotland—from carers to royal colleges, from the decision makers and from those who depend on the services. We not only heard evidence, but got out there to see how the service worked. We witnessed the attitudes and cultures that exist and we heard stories that we will probably never forget. That allowed us to compile a cross-party report that is a tribute to the committee and a document of which the Parliament can justly be proud.
In that vein, I was keen to visit the Western Isles to engage with the different structure of services, the smaller population and the traditional culture. I must admit that, if I had had to choose a companion for that week, from this chamber, Margaret Jamieson would probably have been near the bottom of my list; the dark islands became less appealing by the minute when Margaret suggested that she would come along. However, as we pursued similar lines of questioning it quickly became apparent that the dignified care of the elderly, the disabled and the mentally ill was—in our book—well above party politics. Across the political divide, our views may differ on the means of achieving the objectives, but identifying the problems and applying the principles to them was never a problem.
It was quite a shock to those whom we met that Duncan Hamilton, Margaret Jamieson and I could work as a team and put the health of the people of the Western Isles well above party politics. Duncan Hamilton has received various jibes in the chamber about his age, but in my opinion Duncan has wisdom and compassion beyond his years. [Applause.] That is quite true. The people of Scotland have the right to expect the Parliament to put their health care needs above party politics, and I am proud that the Health and Community Care Committee achieved that.
It is therefore with sadness rather than anger that I turn to the SNP motion. As our confidential committee report makes several recommendations on tackling the problems that have been raised, and other recommendations that impact indirectly on the subject of the motion, I cannot speak of those recommendations. I can only move the amendment that is consistent with our approach in previous debates on the funding of personal care and the monitoring of council spending. I look forward to the frank and full debate that will take place in January following publication of the Health and Community Care Committee's community care report and the Executive's response to that report's extensive list of recommendations.
I do not want the Executive to come back within 24 or 36 hours with a quick-fix response to a serious problem. The extensive list of recommendations in the committee's report requires a measured, considered, detailed and financially focused response, which will take time. I find it insulting to all members of the Health and Community Care Committee that this subject has been chosen for debate only days before the publication of a report that has been 10 months in the making.
Nicola Sturgeon is right, however, to say that something is very wrong, and I acknowledge that local authorities have a serious problem with the difficulty that they face over home care. Given the SNP's choice of subject today, we might assume that that party's urgent concerns would be a major priority in Angus Council. Such is the commitment of that SNP council to care in the community that, this week, it proposed a novel approach. The Courier and Advertiser reported on Tuesday:
"One of the main proposals . . . was a plan to phase out local authority home care services and replace them with a voluntary organisation.
Social work director Bill Robertson admitted yesterday that such an option could not be achieved . . . He said that under a move away from council-run home helps, nearly 900 people would no longer receive care . . . this would mean an unacceptable risk was being transferred to a voluntary organisation."
That is SNP policy. Thank goodness that the good folk of Angus have a caring social work director to look after their interests, because they certainly cannot depend on their SNP councillors. I suggest that before SNP members preach to others, they get their own house in order.
I move amendment S1M-1356.2, to leave out from "notes" to end and insert:
"agrees that the best way forward is the eventual implementation of the Sutherland Commission's recommendation of free personal care, and urges the Scottish Executive to monitor the use of new monies allocated to local authorities for community care in light of winter pressure to ensure that the elderly receive the appropriate care and support."
Anyone who has examined the complex issue of community care will agree that many of the problems that are mentioned in the SNP motion can be tackled through joint working and multidisciplinary team working. Over the past year and a half, it has been my privilege to lead a multidisciplinary team of members whom I respect such as Kay Ullrich and our very wise Duncan Hamilton—although I think that Mary Scanlon's comment spells the end of Duncan's career. Some of the tales of that team will probably not emerge in next week's committee report on community care; they will probably have to wait for the memoirs of Mary Scanlon, Margaret Jamieson and Duncan Hamilton.
The serious point is that Mary Scanlon is right. When committee members first got together, we decided to make community care our No 1 priority. We found that the issue kept cropping up in our individual surgeries; indeed, the point that kept cropping up was that the problems that are identified in the SNP motion definitely exist and must be tackled.
Margaret Smith mentioned Mary Scanlon, who said that there would be a debate on this issue in January. Does she accept that, as we fast approach winter, issues must be debated and dealt with here and now, and that action must be taken to help the frail elderly?
Speaking personally, and not for my party, I would have preferred today's debate to have been delayed for two weeks. That would have allowed us to see—[Interruption.] Well, if the SNP had asked for such a delay, I am sure that the business managers of the other parties and the Presiding Officer would have looked on the suggestion favourably. Such a delay would have allowed us to consider the contents of not only the Health and Community Care Committee's report, but the joint futures group report; as Kay Ullrich knows, that group is part of the way in which the Executive has been investigating the problem of integrating services and making people work together. Both reports are due to be published in the next fortnight. Furthermore, through Mr McLeish's teasing press releases, we know that a policy review is under way. In the light of those facts, I would have preferred to delay the debate for two weeks.
As for committee reports, it is right that we have to wait eight weeks for a full response from the Executive. However, it would have been possible for the Executive to make a partial response, perhaps in the same way that the minister, Malcolm Chisholm, has contributed to today's debate. The problem with today's debate is not the Executive's response, but the fact that I cannot stand here and say what I feel, what I want, and what I think is right based on my experiences over 10 months of my life.
Will Margaret Smith give way?
No, I want to finish this point.
It is absolutely impossible for every member of my committee—including the new members—to discuss this issue in the round. Today, Nicola Sturgeon has simply highlighted the problems. Part of the reason for that is that the SNP cannot suggest any of the solutions that are contained in the committee report, because the report cannot be talked about. That makes the debate difficult. Every member of the committee who has talked to me feels constrained by their inability to talk about what we have been talking about for 10 months, namely, conclusions, answers and solutions, not problems—we all know what the problems are.
Will Margaret Smith confirm that what she is saying to the approximately 2,000 elderly people in Scotland who are in inappropriate care settings and need the Parliament's help is that she is sorry, but there is nothing that the Scottish Parliament can do to alleviate their problems because we have to wait two months to be able to debate a community care report?
Absolutely not. Nobody in the chamber is in any doubt about my views on community care or my passionate concern. I am saying that the debate would have benefited from being delayed by no more than two weeks; it could then have benefited from 10 months of work by colleagues of all parties, who have worked together, showing respect, in the way that Mary Scanlon outlined. That would have added not only to the debate, but to the pressure on the Executive. My aim is not to let the Executive off the hook. If I were about letting the Executive off the hook, I would have voted with my party and with the Executive in the debate a few weeks ago. I am not in the business of letting anybody off the hook on community care and, at the end of the day, our work will reflect that.
Will the member give way?
No.
Once again, we have heard nothing new from the SNP today. A few weeks ago, the Minister for Health and Community Care came before the committee and answered questions from us all about the plans to deal with winter pressures. We know that there are all sorts of complex reasons for winter pressures. If we are honest, we also know that the Executive is at least attempting to tackle them. It may not get its response right but, as the minister said, it took 25 years to develop some of the problems so it will take more than a couple of years to get the answer right. The Executive is moving towards getting it right.
Feelings ran strongly in the debate on community care in September. The minister acknowledged some of the problems on 5 October, and I remember what she announced: £25 million to make nursing care free wherever it was obtained; £5 million for household adaptations; £3 million for needs assessments and £126 million over three years to improve home care provision. That is not to mention the two tranches of funding—£70 million—to deal with delayed discharge, which the minister announced earlier in the year.
Will the member give way on that point?
No.
The winter pressure measures on which we questioned the minister two weeks ago are in place. We will monitor them, the Executive will monitor them, we will see whether they work and the Executive will learn from experience, as it learned from last year's sad experience of flu and winter pressures. Compare that approach with the SNP's commitment under its penny for Scotland proposals of £30 million over three years in new resources for community care. Compare the Executive's action with that of Angus Council, as outlined by Mary Scanlon.
Today's debate is not about community care. The reason why the SNP did not delay the debate by a week or two was that it could not delay the Anniesland by-election. The problems have been highlighted time and again. I believe that the reports from the Health and Community Care Committee and the joint futures group will examine many of the issues that concern MSPs across the chamber, and that we will learn a lot from those reports. All of us who care passionately about community care and who have given 10 months to the issue—not one and a half weeks—will keep up pressure on the Executive to ensure that the problems are tackled.
I have had no alternative today but to decline to comment on some aspects of community care that I would have wanted to comment on and will comment on in future. We shall meet again on this subject—the issues will be debated again and we will find solutions. However, today, out of respect for my colleagues and for a committee system in which I believe and which I take seriously, I have not been allowed to talk about the recommendations in what I believe will be a good report.
Before I deal with the home help service, I want to respond to Mary Scanlon. The Health and Community Care Committee might have been conducting an inquiry for the past 10 months, but I recall that, on 28 September, we debated a Conservative motion that called for the implementation of free personal care, in line with the Conservative party's policy. I do not think that Mary Scanlon is in a position to castigate the SNP for its choice of debate.
I see that Margaret Smith has such concern for the debate that she has left the chamber. She, and all other members, should bear in mind the fact that the SNP and the other non-Executive parties have certain days when we can debate subjects of our choice. Our choice of subject and the timing of the debate on that subject is a matter for us alone. We will not be dictated to by any other party in the chamber.
On a point of order. Is not it a matter for the Parliament, rather than for a political party, to decide what is debated?
I believe that the SNP had the right to call this debate.
Thank you, Presiding Officer. I wish that Mr Henry would acquaint himself with the facts before making a point of order. The fact is that the SNP and other parties in the chamber have the right to call debates on subjects of their choice. That has nothing to do with other parties.
The home help service is vital in allowing people to remain in their homes. The Labour MSPs turn their back not on the debate and not on the SNP, but on some of the most vulnerable people in Scotland. I am hardly surprised that they do not have the guts to come here and say that.
Sometimes, I think that the Executive ministers live in—
On a point of order.
We have a point of order from Margaret Jamieson.
I apologise, Presiding Officer. I meant to ask whether Tricia Marwick would take an intervention.
Let us clarify that. Will Tricia Marwick take an intervention?
I will.
When the Health and Community Care Committee had a discussion with the Minister for Health and Community Care, no members of the SNP were there. Will Tricia Marwick explain how that fits with what she has been saying?
I am speaking in the debate not as a member of the Health and Community Care Committee, but as a member of the Scottish Parliament. Other members care as much as members of the Health and Community Care Committee about home care services, home helps and all the rest of it. The SNP is having this debate to give MSPs who are not members of the Health and Community Care Committee the opportunity to debate issues that are of concern to us all.
Will the member give way?
I would like to, but I have not even started my speech yet.
Sometimes, I think that the Executive ministers live in a parallel universe. We heard Malcolm Chisholm say that extra money has been put into council services and home care, but those services have experienced cuts in every year that the new Labour Government has been in power. That is what I am being told every day of the week—I suspect that Labour back benchers are being told the same thing—by senior citizens, their families, doctors, nurses and home carers. Is it just possible that all of those who provide the services, all of those who need the services and all of those who use the services are wrong and that ministers are right? I do not think so.
I will quote from a letter that was written last year by a Fife Council official:
"We fully appreciate the importance of providing a service to the perceived low need category and there is much researched evidence to support this view. However, in the current financial climate, I am unable to respond to these situations as we have done in the past."
That is a direct reference to the fact that Fife Council now prioritises home help services to different groups. The only people who can get home help services now in Fife are those who are terminally ill and have been discharged from hospital. All the rest are on a waiting list. For the first time, Fife Council has a waiting list for home health care services. That is a disgrace—even under the Conservative Government we never had a waiting list for home helps.
Fife Council is a Labour council, and we have a Labour Executive working to a Labour Westminster Government. When I visited a group of general practitioners in Fife, I was told that the situation was totally unacceptable and that patients were already suffering because of a lack of social care.
Malcolm Chisholm and other ministers have to address such issues now, not at some time in the future. They have to address the real health care needs of people in Fife and elsewhere in Scotland.
As a member of the Health and Community Care Committee, I have great difficulty in contributing to the debate because, like other members of that committee, I am constrained in what I can say.
It is right to acknowledge the cross-party work that the committee has done since we were told on 6 October last year that we would embark on an inquiry into community care throughout Scotland. Kay Ullrich will remember that our Christmas reading was contained in two huge white folders. We were expected to use the recess—that is a wonderful term—to ensure that our knowledge was fully up to date and that we could make a good start to the inquiry at the beginning of the year.
Since then, the committee has heard oral evidence from 18 organisations and received written evidence from 80 organisations, and members have undertaken visits to 10 areas. I will not go into the details of our visit to the Western Isles, as Duncan Hamilton will agree that our credibility has gone down as a result of it. We did not go to those areas with answers, as we wanted the people whom we visited to provide us with those. I believe firmly that the committee report will give answers, and that not all of them will be political; they will be practical solutions.
Will the member give way?
No.
The people who need and use the service can tell us how it should be delivered and how it should be client centred. We need to recognise that community care is not all in the gift of local government or the health service. During the inquiry, I learned that there is a desire for joint working and that the barriers that prevent joint working must be removed by statute or some other means to ensure that we deliver for the people of Scotland.
There is no quick fix—financial or otherwise—that will deliver quality care in the community. We need to consider the preventive measures that can be taken to ensure that people are not placed inappropriately in acute hospitals. We have discussed such questions before, and I make no apology for mentioning again Newmilns and Darvel in my constituency, where GPs, nursing staff and others got together to ensure that such inappropriate placement did not happen. We also have rapid response teams, which are being recognised throughout Scotland as a way forward; we must allow them to develop.
Will the member give way?
No.
This is not all about money. Some projects have not cost one extra penny, but have made professionals examine whether the way that they deliver services is the best way and, if it is not, change it.
We also have the nursing care stakeholders group, of which the chief nursing officer is a member. That group is examining ways of defining nursing care. Only when that definition has been set will we be able to consider measures to ensure that there is appropriate personal care.
It is unfortunate that Nicola Sturgeon and her SNP colleagues do not wish to be involved in the joint work that is so evident throughout Scotland. I ask Nicola Sturgeon in particular—I am sorry that she is not here to hear me—to take a leaf out of Kay Ullrich's book and to work together for the benefit of all.
I remember last Christmas ploughing through the files of statistics that Margaret Jamieson mentioned. For me, it was one up on the previous Christmas when I had to plough through Scottish sewerage statistics. I have gone up in the world from studying toxic dumping.
The Health and Community Care Committee has put a lot of hard work into its forthcoming report and I am constrained—a condition to which I am utterly unaccustomed—and cannot be outspoken. However, the false facade on so-called care in the community that we all know exists in all parties is being torn down. "Care in the community" is a term that Mrs Thatcher invented. It is not working; people of good will and good sense in all parties know that.
In the Health and Community Care Committee, we have worked together harmoniously, although I was not on the fabled visit to the Western Isles. Some of us got to only a few away days, so we are envious. A genuine desire to right wrongs has been common to all members of the committee. Committee members have repeatedly pressed on the Executive the need for a sense of urgency, both in public and behind the scenes.
Eighteen months after the Parliament was created, what is happening at grass-roots level? In common with most MSPs, I hear the most desperate pleas at surgeries from social work clients and their relatives. MSPs should compile a dossier on threatened projects around Scotland. Let us get together to do that and submit the dossier to the Health and Community Care Committee.
I work mainly in the east end of Glasgow, which has three of the poorest constituencies in Britain, yet the cuts in community care have been most savage there. Just a few months ago, I was called out because of the closure of Easterhill Day Centre in Baillieston, which was a centre for adults who are multiply disabled and cared for by increasingly aging parents. Social work chiefs told those people that the centre was closing because they had to save money. There was no consultation whatsoever.
Just a week or so ago, I was next door to that closed centre because Baillieston community care project is now in imminent danger of closure. The project runs a day care home service to look after people in their own homes as well as a day care centre. The project cannot pay its wages bill of £11,000 this month. I have drawn that to the attention of the First Minister and he is, I think, sympathetic. I believe that the council may restore some money that the project is owed, but that will save the situation only until December and will mean living hand to mouth.
The centre sends people out to help incredibly vulnerable people in their own homes. One case is of an 87-year-old woman caring for her 100-year-old sister, who suffers from dementia. Imagine the effect on those people of being told that their only source of help may close within a couple of weeks because of insecurity of funding. That is the funding crisis we hear of all over Scotland. Think of that 100-year-old woman, born at the beginning of the previous century. She would have started work at age 14, as the first world war broke out. She has contributed to society for between 70 and 80 years, experienced two world wars and raised a family. What are we saying to her now? That the one thing that she has left in this world, the loving care of her sister, will have to go.
If the daily helper goes, the sisters will be split up after 87 years together. I do not think that our Parliament was created to oversee such inhumanity. I urge the Executive to set up emergency bridging funding for threatened projects, and not to wait until spring comes, when it will be too late. Emergency bridging funding would be a sensible alternative. The Executive should also consider the money that has been gained through selling off hospital real estate. That money was supposed to be ploughed back into community care; I do not think that it has been. Please ensure that it is.
Like others, I would like to condemn the opportunistic nature of the SNP motion and its attempt to reinvent the wheel. I suspect that people such as Kay Ullrich and Christine Grahame must find it rather patronising.
I would like to make some points about balance. In the care in the community programme, almost excessive efforts are being made to keep people in their own homes in South Ayrshire. Visiting Mathieson House in Ayr last Saturday, I was struck by how content the ladies are to live there. They enjoy the sense of security, they enjoy each other's company and they enjoy the food that is prepared for them by caring staff. They are more comfortable than they would be in their own homes. Houses such as that one are under threat, because social work departments are making such huge efforts to keep elderly people at home when perhaps—I repeat, perhaps—it is not always in the best interests of the people concerned. We are in real danger of losing those publicly and privately funded residential homes—which would be throwing the baby out with the bath water—because of a doctrinaire approach to looking after the elderly.
Furthermore, the withdrawal of warden services from sheltered housing in my constituency is part and parcel of encouraging the elderly to stay at home and not move into sheltered housing. Sheltered housing is no longer what it was; it is no longer as sheltered as it was. I have been asked whether those houses can now be bought from the council because they no longer meet the criteria of sheltered housing—they are council houses or flats. I would be interested to hear the minister's opinion.
Every day we hear about money flowing into the health service, yet for many people it seems to be getting harder to access the most basic services. In my constituency, podiatry care that was previously available to the elderly is no longer available. Lunch clubs for the elderly that were previously funded by the council are now being delivered by volunteers and the churches. The sense of community that those clubs engendered is under threat. It appears that the Government is setting out to destroy it and I cannot understand why. Imagine the outcry that there would have been if, during these three short years, the Conservatives had achieved such cuts.
I understand the current idea of caring for every individual in their own home, but the law of unintended consequences is at work here. What is being delivered is a reduction in choice in care for the elderly—the closure of good public and private residential care homes and the reduction in value to the individual of sheltered housing. The loss of venues such as the Carrick Street halls affects communities—virtual communities, to use the word in its old-fashioned sense.
Given the real concerns that the member has outlined, does he agree that the SNP was right to give him the opportunity to raise such concerns?
These matters will be discussed in a fortnight's time when the Health and Community Care Committee's report comes out. I am more than happy with that. It is the correct procedure.
The loss of venues produces a less contented group of elderly people and a more vociferous group demanding that its basic human needs be met. Once again, as with so much new Labour policy, this policy suggests that all the generations that went before were either naive or stupid, when demonstrably they were not. That is why I applaud the diligent and measured approach of the Health and Community Care Committee over the past year. I urge the Executive to produce a balanced report in a fortnight's time. I urge members to support the Conservative amendment.
I do not want to get involved in the debate about motions; I want to discuss respite care. I welcome the packages that were announced in Susan Deacon's recent statement, particularly the 22,000 extra weeks of respite care.
Recently, a constituent drew to my attention the fact that even when respite care is needed and funding is available, there is a great shortage of places for respite care. Nursing homes are closing and institutions are unwilling to make places available for respite care on a weekly basis. They prefer to wait for long-term patients. I am delighted that the funding has come through, because that has been a stumbling block. However, we must consider the issue structurally and ensure that there are places available for respite care.
I would like to emphasise the importance of day care, which was not prominent in the Sutherland report or in Susan Deacon's announcement. I have a paper that I sent to Malcolm Chisholm and Margaret Smith, which was sent to me by the organiser of the Broomhill day centre in Penicuik, a redoubtable lady called Tilly Suttle. She has harangued Iain Gray and is making a strong case for day care to be considered as a statutory responsibility. Currently, the funding for her centre comes from Midlothian Council, but it is not statutory. Many people are referred to the centre through health professionals. Joint futures and funding will be very important, but it must provide some stability. Day care does much good, but is currently undervalued and underfunded. It is a vital link. It reduces hospital and social work costs. Tilly Suttle provides day care at about one sixth of the cost of the same service provided by Midlothian home care services.
I received the same paper as Ian Jenkins and I support everything that he says. However, he should know that I asked the minister to make day care centres a statutory requirement of local authorities and that the minister said no. Does Ian Jenkins support me in pursuing the point that day care centres should be a statutory responsibility of local authorities because they are essential in allowing people to stay in their own homes, but ensuring that those people are in the community and not just stuck in their homes?
I support Tilly Suttle in her drive to increase the value that we give to day care. There is a debate to be had on the matter.
Iain Gray has told me that there are moves to raise the profile of day care and I hope that something comes of that. People need to be secure in the knowledge that such provision is available.
I commend the paper to Malcolm Chisholm and I recommend that other members read it. I have no doubt that day care provision is valuable or that it has so far been undervalued.
I am disappointed, but hardly surprised, by the opportunism of the SNP. What we have seen today is posturing in anticipation of the Anniesland by-election. Several SNP members commented on attendance being equal to concern, but we still have to get an answer from the SNP on why no SNP members turned up to discuss health and community care with the Minister for Health and Community Care and her team. I suspect that the answer is that there was no press there, so there were no opportunities for them to make political capital. That is the reality. It was hard work. It was a detailed and sensible discussion, which does not sit easily with the SNP.
Can Hugh Henry confirm that at the time of the briefing that he referred to, neither I nor Shona Robison were members of the Health and Community Care Committee—yes or no?
If that is the case, there were other members of the Health and Community Care Committee who are members of the SNP and they failed to turn up, so Nicola Sturgeon should address that issue within her party.
This issue fits with other attempts by the SNP to undermine cross-party work. I think back to the debate on Mike Tyson coming to Scotland, when—
On a point of order. The Presiding Officer gave us clear instructions on where we should not stray today. Hugh Henry is in serious danger of straying from the motion. He is getting into other issues that are not part of this debate. Given that time is short, could you ask him to concentrate his remarks on the debate that we are having?
The Presiding Officer's judgment was specific to what was said in committee. Hugh Henry is illustrating a point. I ask him to do so briefly.
What has happened is a blow to the committee system and to the independent scrutiny that committees perform. This debate puts those of us who are members of the Health and Community Care Committee at a severe disadvantage in trying to have a sensible debate. I appeal to you, Presiding Officer, on behalf of Parliament and the committees, to intercede with the Parliamentary Bureau so that when business is being planned for the future, the valuable work of committees is never again undermined in this way.
There is a good-news story to tell about community care but, equally, there are concerns to be expressed. Malcolm Chisholm was right to speak about the extra £44 million that is being put into the NHS this year to move matters forward. That contrasts, as Margaret Smith said, to the £30 million over three years that was promised by the SNP. [Members: "An extra £30 million."] We can clearly see the difference in priorities as far as community care is concerned.
On that point, does Hugh Henry agree that the SNP completely missed the fact that there are two streams of money? There is a stream through health boards. In my area, Forth Valley Health Board has allocated £800,000 to care of the elderly this year. Separate from that, there is a stream through local authorities amounting to £10 million. Those resources have been used to release beds and provide a rapid response to prevent those beds from becoming blocked again.
I note Richard Simpson's point. Money is going in, but this is not just about money. There are structural and organisational issues that need to be addressed. Over the past week, I have struggled to help my mother to come out of hospital, return to her home and look for services. The problems that my family and I have faced are not specifically about money; they are about the response of the local authority, communications between the different agencies that are involved, and getting an appropriate response within a time that is suitable for my mother, my father and the rest of the family. We have to resolve those organisational issues.
Will the member give way?
No, I am over time as it is, and I have taken three interventions.
We have to resolve those problems in order to get a satisfactory service in the community. I look forward to the publication of the Health and Community Care Committee's report. It will make a contribution to taking us forward as a Parliament, but I regret that we have not had the opportunity to have a debate on community care where that report was the central focus of the Parliament. I hope that the report will help to move the Executive in the direction that the committee has been pressing for for some time.
The point is that the debate on the report of the Health and Community Care Committee cannot take place for eight to 10 weeks. I know nothing about that report—I am not on the Health and Community Care Committee—but I have carried out my own inquiry, which I was compelled to do because the Scottish Executive could not tell me how many elderly people had been assessed for care in residential and nursing homes. As at 17 October the Executive had no idea. I managed to find out. Those people need something to be done now.
I read bits of the Health and Community Care Committee's reports, I attended the committee when Sir Stewart Sutherland gave evidence, and I have visited him myself. I do not think that I am not entitled to speak in the debate, when about 2,000 people have been assessed for residential homes and cannot be placed. I say to Hugh Henry that that figure is mainly due to lack of funding, although part of it can be attributed to a lack of places.
I have the answers from authorities and they are available to any member who wants to see information on their constituency. I have a whole folder of information that the Executive should have known. Page 6 of the Executive's "Response to the Royal Commission on Long Term Care" says:
"Sadly, as many as 1 in 5 . . . already in residential or nursing home care might have been looked after at home had the necessary support and services been available."
We all agree with that. We want people to stay in their homes, but the reality is that the services are not available.
Home helps are being cut and, in the Borders, the number is down by 21 per cent. Health visitors and district nurses have also been cut. A written answer to Donald Gorrie shows that the figure for health visitors and district nurses in the Borders has remained static for the past five years. The number of wardens in sheltered homes has been cut. A headline from South Ayrshire says:
"Two wardens to take care of 612 elderly residents".
That is because of cuts that the local authority made to save £100,000. It made 19 full-time wardens into 19 part-time wardens. That is happening now.
I say to Margaret Smith that we cannot wait 10 weeks to talk about those issues. We must highlight them now, to assist the Health and Community Care Committee. The Parliament can shine a bright light on those dark corners.
I will speak to Christine Grahame straightforwardly. I would like to have had the opportunity that she has had to say exactly how she feels without constraint from a committee report or party. That is all that I ask for. I am not asking for a delay of eight or 10 weeks. A two-week delay would have given us the report and allowed all members, including those who have spent much time considering the issue, the chance to do what Christine Grahame has done. I congratulate her, and I am always delighted to hear her talk about the issue, because she cares so much about it.
I believe that there is some cross-party consensus, but I have doubts about whether the report would have been accelerated to allow it to be debated in two weeks' time.
I will return to an important issue that Ian Jenkins raised. Day care centres are under serious pressure. I have visited some in Glasgow, I have been to Broomhill day centre and I will visit some centres in East Lothian. They are at the heart of services to maintain people in the community. They provide social contact, lunch clubs, somewhere to go and somewhere to get dressed up for.
I was canvassing in Anniesland yesterday and could find nobody to canvass. Why? They were all at their local community centre. I was pleased that they were there, even though it meant that hardly anybody was in that day. That is what it should be about—keeping people stuck in their homes is not the answer. We must progress on the role of day care centres, giving them much more secure funding. Broomhill day centre's funding has remained static for the past six years, yet 30 dementia patients go there to socialise with non-dementia clients. That is essential to the community and gives carers the respite they need.
My final point concerns the £10 million that the Executive has put into delayed discharges. On 1 November, I lodged a question—S1W-10377—on the £10 million. The answer I received was that local authorities could apply any balances that they had to other services. I have a series of questions in today's business bulletin, reflecting my concern that those balances might be artificial and that money that was meant for older people will be deployed elsewhere. I ask Malcolm Chisholm to consider my questions, which I hope are fairly specific, and give me straight answers about how those balances will be monitored.
We move to wind-up speeches. Sorry—point of order, Mr Jenkins?
On a point of order. Forgive me, Presiding Officer, but it suddenly occurred to me that I should put on record the fact that I serve on the management committee of Broomhill day centre, although I was not seeking extra funds for the centre on this occasion.
Thank you, Mr Jenkins. Your comment was helpful.
We now come to wind-up speeches. The Liberal Democrats will have four minutes, the Conservatives will have five minutes, the Executive will have seven minutes and the SNP will have 10 minutes.
There is no question but that we should have this debate. As Nicola Sturgeon said, the issues are immediate and pressing, but they are also long term and are not going to go away—certainly not in the next fortnight.
Significant action has been and will be taken, and further action will be required. Care in the community, as it should be, is the best way and the best place to care for an increasing number of people, not just the elderly. Treatment of mental illness is improving and public treatment of people with mental illness is gradually becoming more enlightened. As the Disability Discrimination Act 1995 kicks in, its provisions will make it physically possible for more people with disability to live in the community. We know that we will need more, and better, community care provision.
Care in the community merits serious and informed debate. Two significant reports will be published soon: after 10 months of work, the Health and Community Care Committee will publish its report and recommendations, and the joint futures group will publish its report. The Liberal Democrat view is that a more significant, productive and informed debate will be possible when those reports at published and that their publication should have been the impetus for this debate, rather than a somewhat childish desire to be able to say, "This was our debate".
I owe SNP members an apology: I thought that they had 10 minutes for their opening speech, but in fact they had 15 minutes. However, given the fact that they used those 15 minutes to make no points at all, the intention of my intervention during Nicola Sturgeon's speech stands.
During the debate, Scottish Conservative members have tried to put across our policy, which is that we believe that the Executive should implement Sir Stewart Sutherland's central recommendation on funding personal care. That has been a consistent Scottish Conservative policy and it does no disservice to the Health and Community Care Committee's report.
We also recognise that the nationalists' motion concerns the here and now. They are concerned that Scotland's winter measures may not be robust enough and that the welcome new funding for local authorities is not reaching the right places fast enough.
I will address the latter point. A few weeks ago, the minister presented to the committee her plans for the winter pressure group. If SNP members of the Health and Community Care Committee had been present for that private briefing with the minister, they could have questioned her further on those plans. Given Christine Grahame's concerns about day centres, perhaps she should be asking why her colleagues did not attend that evening, as they could have questioned the minister robustly.
The Executive's document "Lessons from Winter 1999/2000", which was published in August, makes clear, strong recommendations on how to cope in the here and now. It is important that the Parliament is informed how many of those recommendations have been implemented so far, and I ask the deputy minister for a clear response to that point. I also ask him how much of the £10 million has reached the front line, to the Executive's knowledge, and how many beds have been affected to date. If we are to make a genuine difference, it is important that we monitor the number of beds and places, so that members are not told that the information is not held centrally.
By way of a warning, I hope that Susan Deacon's announcement on pledged commitments to Scotland's elderly does not pre-empt the committee's report. I draw her announcement to the attention of the Presiding Officer, because if it does pre-empt that report, some form of reprimand should be issued to the Executive, given that it has made a strong point of castigating the SNP today.
We would have liked to support the entire SNP motion, but the latter half is not fully accurate. We recognise that the Executive has implemented a number of measures to try to alleviate immediate problems. I am afraid that the Scottish Conservatives do not take the magic wand approach to politics often adopted by the SNP—that if there were an independent Scotland tomorrow morning, everything would be fine and beds would be unblocked in minutes. We live in the real world, while the SNP does not.
Will the member give way on that point?
No, I am afraid not. I am coming to Shona Robison, so she should not worry.
It is a shame that the SNP has chosen such a divisive debate today. Its contribution has done nothing to ensure that members of the Health and Community Care Committee continue in the non-partisan way in which they have worked over the past year. We have worked hard on our report—and I do not include the two new haudit-and-daudit members who are sitting on the SNP benches. The SNP members who were on the committee at the time contributed in a strong and passionate manner and they should be proud of their contribution. I will miss Kay Ullrich, who always fought for fairness and for sensible debate, even in the face of some of her own.
As I depart from the committee, I would like to fire a warning shot across the bows of the new members. If Scotland is to get the better health service that it deserves, it must have a non-partisan, hard-working committee. Scotland does not want a committee of bullies and showboaters and it does not want the sort of behaviour that we have seen from Nicola Sturgeon and Shona Robison. The next time that they feel a strong need to persuade, I suggest that they pick on someone their own size, such as a 14-year-old. They have done a disservice to the community and to their SNP predecessors on the Health and Community Care Committee. Above all, they have done a disservice to their colleague Christine Grahame, who has been fighting since long before I was involved in the debate to improve care for everyone. The credit for many of the issues raised in the debate must always go to Christine Grahame, but the type of cheap politics that we have seen from Nicola Sturgeon and Shona Robison has done nothing at all to improve the future care of people in Scotland.
I was almost overcome by nostalgia during some of this morning's speeches. For example, Margaret Jamieson reminded me of the huge white folders that I spent last Christmas reading, and Margaret Smith waxed lyrical about the multidisciplinary team that she still leads. Perhaps the most touching moment of all came when Mary Scanlon described what must surely have been the high point of the new politics: when she, Duncan Hamilton and Margaret Jamieson went together to the Western Isles. I regret that I was not with them.
All those comments lead me to the main point that the committee members were making: it is regrettable that we could not have their collective wisdom on the subject for a debate such as this. However, the point about the timing of the debate has already been made by many members.
Perhaps Malcolm Chisholm will take this opportunity to say whether the Executive will be in a position to give a full response to the inquiry report in two weeks' time or even before the Christmas recess.
I am also mindful of Mary Scanlon's request for us to make a measured response. Indeed, she asked us to take time over it, and that is precisely what we shall do. Of course, having a debate two weeks from now would not have prevented committee members from using their collective wisdom.
On a slightly less new-politics note, I was pleased and slightly amused to hear Mary Scanlon castigating the SNP in Angus for failing to protect local authority home care. Strange things happen in the Scottish Parliament.
Many other members made interesting and important contributions to the debate. John Scott emphasised the importance of choice and of sheltered housing. I echo those points. Not only do we need more sheltered housing; we need more very sheltered housing. That is the way that we would like to see a lot of community care going. John Scott was right to say that choice is important. Although we want to shift the balance of care towards home care, there will be a continuing need for nursing home and residential care, and people ought to have a choice.
Does Malcolm Chisholm have any comment to make on the fact that warden services are being slashed up and down the country to the detriment of the care of our frail, elderly population?
Kay Ullrich has overstated the point, but I shall certainly give attention to the matter that she mentioned as part of my new work.
I saw Christine Grahame rising to intervene a moment ago, and I shall now deal with some of the points that she made in her speech. She also emphasised the importance of home care. She supports it, Sir Stewart Sutherland supports it, and, of course, the Executive supports it, as I said at length in my opening statement. She also referred to money and mentioned the sum of £10 million. However, as Richard Simpson reminded us, the delayed discharge money is, in fact, £19 million. Perhaps Ben Wallace should remember that point too.
Christine Grahame raised an important point about money being directed towards older people, and there is an historic issue about grant-aided expenditure not always being spent on them. Local authorities need to address that point, but Christine Grahame should also recognise the new basis on which we have allocated that new money. It is given for specific outcomes, which will be closely monitored.
Although local authorities have submitted their bids and the sums have been agreed, the answer that I was given did not make it clear what that money would be used for. I was told merely that it would go "towards other services". Is the minister telling us now that those other services will be services relating to older people, rather than buses, rubbish collection or whatever local authorities feel they need the money for?
Yes. We considered carefully the bids that were made. Some people complained about a delay, but we wanted to ensure that plans were in place and we will continue to monitor them. We will also monitor the money that has been given to health boards for winter and for delayed discharges. That addresses Ben Wallace's point. The further we move into winter, the more closely we will monitor the use of that money.
As Ben Wallace said, the Conservative amendment talks about free personal care being "the best way forward". I repeat that we are reviewing that issue, which is an important matter in its own right. However, free personal care would not help solve the problems that we are discussing this morning. Indeed, it could be argued that if the money that we are putting into home care and the other areas that I have mentioned were used to provide free personal care, the problems would be exacerbated. That is not to say that the funding of personal care is not an important issue; it is simply to say that it is not at the heart of this morning's debate.
It is not too long since Malcolm Chisholm was a member of the Health and Community Care Committee. Does he, as an individual, think that it is right for the Executive to pay for personal care, or does he support the current arrangements?
In September, when I was still a member of the Health and Community Care Committee and a back bencher, I made a speech on that very matter. I cannot repeat that speech in one and a half minutes, but perhaps Nicola Sturgeon could read it at 11.15.
Hugh Henry and Margaret Jamieson made the important point of principle that this is not just about money: it is about the best way forward. As Hugh Henry said, structural and organisational issues are of fundamental importance. One of the key principles that I outlined in my opening speech was that we want joint and seamless working, to ensure the maximum use of the community care pound.
Tricia Marwick made a hard-hitting speech, as is her wont, in which she said, exaggerating somewhat—as is also her wont—that we were turning our backs on some of the most vulnerable people in society. I remind her once again of what the SNP has collectively forgotten this morning: that action is being taken now. That action includes the £10 million that has been made available to health boards for the winter, the £10 million for dealing with flu, the £5 million for aids and adaptation and the £19 million for delayed discharge.
Will the minister give way?
I do not think that I am allowed to give way in the last minute of my speech.
We have two or three minutes in hand. It is your call, Mr Chisholm.
I will give way to Tricia Marwick.
Does Malcolm Chisholm accept that, despite all the money that he claims is going into services, home help services in Fife and throughout Scotland have been slashed since the Labour Government came to power?
With regard to home care, there are regional variations and regional choices to be made. However, from the debate this morning the current direction of travel is clear. It is self-evident that building up home care is at the heart—
Will the minister give way?
The member is stretching the Presiding Officer's patience.
Extending home care is at the heart of the Executive's priorities. The announcement of 5 October was all about that.
Will the minister give way?
I really am in my last minute now.
I confirm that Mr Chisholm is in his last minute.
I remind members, with particular reference to the wording of the motion, that, besides the £25 million that has been allocated, £19 million is available to the NHS and local authorities now, for this winter, to deal with delayed discharges. That money will be available again in the next three financial years.
We have not yet seen the full effect of the money in action. We wanted to be sure that plans were right, so the money was released to health boards in August and to local authorities in October. It will take a little more time to bring about the improvements that we have promised, but we will track the outcomes and ensure that the money is used to good effect.
I do not suggest that the money will solve all the problems. Earlier, I reminded the chamber of Susan Deacon's words about this being a three-decade-old problem that we will need two or more years to deal with. However, we should remember and acknowledge the money that is being invested and the action that is being taken now, for this winter. We have made a good start. We are committed to continuing improvement and we shall press forward with urgency.
Ben Wallace bizarrely suggested that I should be picking on 14-year-olds. I wonder whether he was volunteering to go first.
I look forward to the unveiling of the community care inquiry report. I know that the Health and Community Care Committee has been working hard on it for 10 months. Margaret Smith said that she had given 10 months of her life to that inquiry. I have given 10 years of my life to working in the community care sector, which I care about passionately.
The community care inquiry will be far-reaching and will make many important recommendations on the way in which community care should be delivered. It is widely known that the SNP has pursued the issue of current waiting lists for nursing homes and residential homes for some weeks, as Christine Grahame outlined. I questioned the health minister on two occasions about the matter and failed to get an adequate response. The SNP brought the motion to Parliament this morning to try to get answers to our questions, but unfortunately we have yet again not been given any.
It is plain to any rational person that the debate is about the here and now. Malcolm Chisholm let the cat out of the bag when, in response to my intervention, he failed to confirm that there would be a substantive response to the committee's report from the Executive before the Christmas recess. He is clearly saying, "Watch this space." It will be January at the earliest. That is not good enough for the 2,000 people who are now on waiting lists. They require care to prevent them from being in a vulnerable situation.
In responding to Shona Robison's intervention, I referred to another member of the Health and Community Care Committee—who if I may say so has been on it for a longer time than Shona Robison—who asked for a measured response. I do not know whether Shona Robison is aware of the procedures of the Parliament in relation to responding to reports. We are doing many things in the interim, but the correct response to a report is to take time to respond properly.
That flies in the face of Margaret Smith's contention that the SNP was wrong to bring the debate to the chamber because there will be a similar one in two weeks' time. Who is right and who is wrong? I am confused on that point, if Malcolm Chisholm does not mind my saying so.
The debate is about what happens over the next few weeks as we head into winter. It is disappointing that certain members of Parliament have chosen to squander the opportunity by indulging in tittle-tattle instead of addressing the needs of their constituents.
People outside Parliament will not understand why members who are supposed to be interested in community care have taken their ball away and have not contributed to the debate as they should have done. That is disappointing.
Does Shona Robison accept the point that members are making, that the joint futures group report and the Health and Community Care Committee report would have allowed the debate to be much better informed? Passionate advocates from the Health and Community Care Committee would have supported some of the excellent and passionate points that we all want to make.
I look forward to those passionate points when they are made—probably in January. We are talking about the here and now—the 2,000 people who cannot wait for us to deliberate in January because they need support now.
The SNP began the inquiry because the Executive did not have the information that it should have had. Mr Chisholm should consider why the Executive did not have the information about waiting lists. We have done the work for Malcolm Chisholm. We have built up a picture of the here and now; of the immediate issues that must be addressed before it is the middle of winter. As my colleagues have outlined, the picture is worrying. Waiting lists are long for both hospitals and those at home.
The returns that we received show that almost 900 people are vulnerable and inappropriately placed. At least 2,000 people in Scotland are awaiting a place in a nursing or residential home. Let us be clear: the £10 million that was announced by the Executive for that purpose—albeit welcome—is inadequate to meet those needs. If members do not believe me, they should read the letters from the many local authorities which say that £10 million will not be enough to meet those needs. At least 75 per cent of the people who are on those waiting lists will remain on them—the evidence is there for all to see.
Given the member's concern for those 2,000 people, does she support the SNP-led council in Angus, which is abandoning local authority responsibility for home care and making it possible that 900 people will not receive any care? Is that the SNP policy in action?
I have never before heard of a council being criticised for listening to people and doing the right thing—keeping home care in the local authority. It is strange that a council is being criticised for doing the right thing—only the Tories could make such a criticism.
Let us return to the crux of the matter. Scottish Care, the organisation that represents 60 per cent of private and residential care homes in Scotland, claims that it will be impossible to move the elderly out of beds that they do not need because councils cannot afford the places. Nicola Sturgeon's quote from Anthony Toft showed that people in the health profession are less than convinced that the procedures that are being put in place will protect elderly people this winter.
Members have cited examples from local authorities throughout Scotland. Perhaps Margaret Jamieson should turn her attention to the 62 people in East Ayrshire who have been assessed as needing nursing home or residential care, but for whom no funding is available. If she wants to see the letter that I received from East Ayrshire Council, I shall give it to her after the debate. That is where the problems lie, and it is unfortunate that members have not turned their attention to those important issues this morning. In the constituency of the Deputy Minister for Health and Community Care, 34 people are in the same position through a lack of funding. I would be happy to give him the letter from the City of Edinburgh Council which identifies that fact.
People are being forced to resort to the courts to receive the care that they have been assessed as requiring. Mr Arthur MacGregor, who is 90 years old, was assessed as requiring full-time care, yet South Lanarkshire Council told him that he was 16th on a waiting list of 199 people and so it could not provide him with funding for seven months. We want to know about the plight of Mr MacGregor. We want to know what the minister is going to do for Mr MacGregor. The debate is about the here and now.
The situation appears to be even more serious when one considers that the needs of those who require a nursing home or residential care place will be intensive while they remain at home. The present home care service is insufficient to meet those people's needs. Local authority after local authority has confirmed that services are not in place to meet the needs of people who require intensive home care. We have lost 30,000 home care hours since Labour came to power—a point that Malcolm Chisholm did not try to deny. That means that authorities are even less likely to be able to provide intensive home care support. People will be left in vulnerable situations over the winter months, and that is not good enough.
Although we welcome the additional resources that were announced by the Minister for Health and Community Care last month, they will not come on stream, in the main, until April 2001. We want to know about the here and now: we want to know what the minister will do between now and April. We have had no answer to that question this morning.
There is nothing to dispute in the Conservative amendment: we agree with the full implementation of the Sutherland recommendations and have been calling for it for much longer than the Tories have. Yet again, the minister has chosen not to give the Parliament an answer on when the recommendations of the Sutherland report will be implemented in full. Nevertheless, I am at a loss to explain why the Tories feel it necessary to remove the crux of the matter—the fact that, although we need action now, resources will not be available until 2001. Only the Tories can explain that.
Let me be clear: it is the SNP's duty to be an effective Opposition and to bring these very real concerns to the chamber. We will not shirk from that responsibility, even though others might. We want to discuss the real issues that affect the people of Scotland here and now, not the mince that we have heard in other debates. After today, it will be clear to all that some members in the chamber are not so keen to debate those issues and indeed prefer to hide behind smokescreens to avoid doing so.
Will the member give way?
No, I am just winding up.
The Health and Community Care Committee's report on its inquiry will be published at the end of the month, after which the Executive has eight weeks to respond. That takes us beyond the Christmas recess and the key pressure points of the winter weeks. Today's debate presented an opportunity to question the Executive about people trapped in inappropriate care over those weeks. By taking the stance that they have, members of the Health and Community Care Committee have achieved nothing more than letting the Scottish Executive off the hook.
I urge members to support Nicola Sturgeon's motion.