Plenary,

Meeting date: Thursday, May 18, 2000

Official Report 637KB pdf

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Community Care

Good morning. Our first item of business is the debate on motion S1M-868, in the name of Iain Gray, on community care, and amendments to that motion.

Today's debate provides a welcome opportunity to restate the importance of community care to the Scottish Executive's agenda of improving the lives of the people of Scotland. I want to report on progress across the community care programme, update the Parliament on some initiatives and indicate some milestones ahead.

Community care services look after some of the most vulnerable people in society. A significantly falling number of vulnerable people, but still too many, live in hospitals. The vast majority of people with care needs live in the community. A relatively small number live in residential and nursing homes. Most live either on their own or with their families. A lot get help from informal carers, be they family, friends or neighbours.

Community care services have to deal with a growing case load. We are all living longer. Family situations are changing and informal care is not always available. People with severe disabilities are surviving at birth and living longer and people with high levels of dependency are now living in the community rather than in hospital. Quite rightly, the expectations of people who use services and their carers are also rising.

The aim of community care is to improve people's lives and opportunities. We aim to do that by: putting people at the centre; enabling them to be included in the community by supporting them, preferably in their own homes; providing services that are flexible, cost-effective and appropriate to people's needs; ensuring quality services by regulating care services and staff; and encouraging joint working towards a joint future for service agencies. Those are the cornerstones. But community care does not stand still. In some areas, we are doing what was unthinkable not that long ago. Community care must constantly progress and improve. That is our aim.

The Executive's programme for government set out our commitments and our priorities. We have launched a strategy for carers. Next year, we will establish a social services council to increase the professionalism of the social care work force; we will also establish the Scottish commission for the regulation of care.

Last week, I launched the Executive's review of services for people with learning disabilities. People have waited for more than 20 years for this review, and many have waited a lifetime for the changes that it heralds. We are gathering responses, to further refine it between now and August, and it is my intention that this Parliament should have the opportunity, as part of that process, to debate the learning disability review in its own right.

The review proposes: a new kind of care organiser, a local area co-ordinator, to organise individualised support for people, to ensure that the services that they receive are those that they need; more access to direct payments, to allow people with learning disabilities to build for themselves the service and care package that serves them best; lifelong service planning, to manage the transitional times in people's lives. Too often, support can fail when someone moves from school to adult life, from the parental home to independent living, or when they are living on their own, when carers die and are no longer there to care for them. The review also proposes the closure of all remaining long-stay hospitals for people with learning disabilities by 2005.

Within a month, I intend to set in motion the creation of a Scottish centre for learning disabilities, to ensure that the momentum behind the review is maintained. However, I do not claim credit for the review or its launch: it was people with learning disabilities and their carers who created and launched it. The review made visits and spoke directly to people in their homes. It held seminars that people were able to attend and set up an interactive website that many people made good use of. People who use services and their carers were also members of the review's national steering group, had their own consultative group and carried out 11 road shows throughout Scotland.

That is exactly how we want to go about making the new Scotland: through genuine and comprehensive consultation, outside the usual suspects and vested interests. We want to involve service users throughout the system, and to put people's experiences at the heart of our thinking. People's experiences will not be just at the heart of the Executive's thinking, but at the heart of the thinking of every agency that is involved.

When I launched the carers strategy, in November last year, we doubled resources that were earmarked for carer services. I undertook to ensure that local authorities consult local carers organisations in developing new and improved services. That dialogue is taking place as we speak, and I have taken part in some of it. It is a tough negotiation, but a real and meaningful one that will shape the services that are available to carers throughout Scotland.

At the same time, the carers legislation working group that was promised in November, which includes carers and their organisations, has met on several occasions to develop proposals for new carers legislation. A few weeks ago, in this city, I launched the biggest-ever Scottish Executive social services media campaign to put hidden carers in touch with services for the first time. Hundreds of people have responded to our adverts in the newspapers and on local radio. They have responded to the national health service helpline, which, since 1 April, has been expanded and extended to include advice for carers. The helpline staff were trained directly by carers and their organisations. The publicity materials for the hidden carers campaign were produced in conjunction with the carers organisations. Every step of the way, we have moved this strategy forward in partnership with carers themselves.

Carers organisations have welcomed their role, but they have pointed out to me, quite rightly, that I have increased their work load. I am pleased, therefore, to announce that I am making available a further £200,000 to help voluntary organisations that represent carers to play their part in supporting the implementation of the carers strategy. That will enable them to work more closely with local authorities and health boards, and with carers themselves, to develop the new and innovative services that carers need and want. I shall write to carers organisations today, to invite them to submit bids for those resources.

Although any new money for voluntary organisations is welcome, will the minister concede that the £200,000 he has just announced does not even make up the shortfall in his budget in the health board allocations to voluntary organisations? The new money does not come close to the cuts that he has introduced.

As is so often the case, Mr Hamilton has missed the point. This is specific funding for a specific task that we have asked the organisations to undertake. It is right that we resource them to do that task.

As the minister knows, the Relatives Association Scotland provides invaluable support and advocacy for relatives of adults in, or about to enter, continuing care. As the association is also playing an important part in the partnership network of carers in Scotland, will he confirm that the Relatives Association Scotland is the type of association that will be eligible for the funding that he has just outlined?

I am happy to acknowledge the work that Sylvia Jackson has done with the Relatives Association Scotland, bringing representatives to meet me to discuss the role they feel that the association can play. I acknowledge that it may fill a place in the continuum of caring that is not covered by other associations. That association is of the kind that could and should bid for the money I have announced. I will ensure that it is included when we write to organisations about the money.

Involving users in service design is the best assurance of quality standards, but we also have a duty to secure standards. Plans are well in hand to legislate next parliamentary year and to establish in 2001 the Scottish commission for the regulation of care and the Scottish social services council.

The commission will regulate services in a systematic, sensible and balanced way. It will cover not just those services regulated at present but also home care and local authorities direct provision. It will ensure a level playing field for providers and quality assurance for users of services. We have set up the national standards committee to prepare the ground for the commission. It is developing standards, in close consultation with all stakeholders, including users and carers.

I am pleased to announce today that I have authorised the publication of the first tranche of standards, covering residential care for older people, children and people with mental health problems. That will be sent out later this week for wide consultation. Further sets of standards will be issued in due course; home care will be included in the next set.

The Scottish social services council will regulate staff. We have two aims in that: we want to protect vulnerable people by ensuring that those providing services are appropriately regulated; but the need to encourage the professionalism, education and training of staff is at the heart of our policy. We have been very pleased by the responses received to the consultation paper. A policy paper will be issued next month containing our proposals for both bodies.

We are also making significant progress on mental health. The mental health framework is now beginning to deliver. I met recently with some of those benefiting from its implementation in Aberdeen. Success there is firmly based on user participation in the planning group—not token but 50 per cent user participation. Earlier this year, Susan Deacon and I hosted a mental health summit to hear at first hand how we should accelerate progress. The outcomes will help shape the way ahead, with the mental health and well-being support group driving progress throughout Scotland.

For the elderly, our work on care standards, on the carers strategy and on the encouragement of more user-focused, integrated services all serve to meet many of the recommendations of the Royal Commission on Long Term Care for the Elderly. We will extend direct payments to people over 65 this year, extending the opportunity to purchase flexible care packages suited to their individual needs—another recommendation of Sir Stewart Sutherland's commission. Funding for care is being actively considered as part of the spending review. People need a system that is sustainable, fair and consistent, and I am determined to deliver that.

If user involvement is common to all those initiatives, so too is joint working, which has moved on enormously since community care as we know it was implemented in 1993. However, there is still a long way to go. The crux of the matter is that we must stop organisational, cultural and other barriers affecting the way in which we deliver services. I do not want to hear that the services that people need are delayed by debates or disagreements about who is responsible for providing them.

People want speedy, reliable and effective services. They want just one assessment wherever possible. They do not know or care who provides the service. They want to avoid duplication, delay and frustration. Those were the key themes of "Modernising community care: an action plan", and we have provided funding of £7.5 million this year to back the changes outlined in that document.

There are signs of positive change, but too often change is project-based or applies only at an operational level. The level at which strategic and financial decisions are made is often where such ideas are not well developed. Agencies need to concentrate on using the knowledge that they have gained on joint working and applying it further upstream. For example, I would like programme budgets to be developed for the whole of a client group or an area, or more substantial change such as that envisaged under the Perth and Kinross Invest to Save project. Everyone now has some experience of joint working. The time for piloting and analysis has passed; it is time to move onwards and upwards.

Driving that movement is exactly the purpose of the joint futures group, which I chair. Our main task is to agree a list of joint measures that local authorities, boards and trusts should have in place, and to set deadlines by which that is to be done. The group has identified a range of subjects that are well known and well recognised. It is considering how to develop better systems and approaches for shared assessments, and how to share information better between social care, health and housing. We know that those things should be in place. They will help to overcome the professional, organisational and cultural boundaries, and they will focus on more integrated services, reducing the bureaucracy and improving outcomes for users and carers. The group is also considering other issues, such as the balance of care between residential and home care, options for charging for personal care at home and how to share best practice among the relevant interests.

There are many examples of good practice. Care services have changed enormously. Between 1994 and 1998, community care services have supported a reduction of more than 7,000 long-stay beds and increased respite admissions to residential care homes by 54 per cent. Staff numbers in home care have increased by 13 per cent, and more and more packages of intensive care of over 10 hours are being delivered.

Those figures illustrate the positive overall trends, but the examples are all around for us to see.

We have successfully closed Gogarburn hospital in Edinburgh and successfully provided alternative care services in the community. Joint working was at the heart of that. The closure plan was sustained through two restructurings in the health service and the reorganisation of local government, but the will was there to make it work, and it has worked.

In Glasgow, Inclusion Glasgow creates packages of care that comprise a mix of funding from health, social care and housing. Of 28 people who used to be in Lennox Castle, all have their own home, seven own them and some have jobs. None has returned to hospital.

In Ayr, two local NHS trusts and the local council formed a rapid response team to prevent hospital admissions and facilitate early discharge, and there is close working with all professions. As a result, between January and March this year, 819 acute bed days were freed up, there were 108 early discharges and 85 admissions were prevented.

Joint working does deliver, but it can deliver much more than better services. I do not doubt that we will hear criticism of service provision this morning. I would be astonished if we did not. Some of that criticism will be justified and some of it will not be. I do not doubt that we will hear much talk of where resources are and how many resources there are. I hope that we will also hear something of the vision and the imagination that we need—the vision that drives the best of community care in Scotland.

That vision should fire our imagination, as anyone who was at the launch of the learning disability review will know. That review started off as an examination of services, but it quickly turned into an examination of people's lives. After all, it is not only the NHS that saves lives, nor is it only surgeons who give back the possibility of participation in the richness of life, but our social workers, care assistants and home helps. It is not only the Prison Service that incarcerates but, too often in the past, the learning disabled hospital, the acute psychiatric ward and even the residential care home.

Too many lives have been lived in the shadows. The common thread in our community care agenda—its purpose—is to bring those lives out of the shadows. That thread runs through the carers strategy, the learning disability review, the new care standards, intensive home care packages and the extension of direct payments.

Will the minister give way?

No. I am winding up.

That approach is not cheaper or easier, but it is better. It is also possible, if we hold to the vision of support for those with disabilities, the elderly and those with mental health problems. We must support them to live their lives to the fullest; to have, or to continue to have, a home, friends, a job, respect and dignity; to be as free as they can be; to have the things that we all want; and to be, as the learning disability review puts it, "the same as you".

I move,

That the Parliament commends the Executive's approach to community care, which aims to put the people using services and their carers at the centre, building on Modernising Community Care: an Action Plan; welcomes progress on the Strategy for Carers in Scotland, published in November; welcomes the work of the National Care Standards Committee to ensure the quality of care provision through national standards; welcomes the consultation on proposals for the independent regulation of care services and staff; welcomes the setting up of the Joint Future Group in December; welcomes the publication of the Learning Disability Review report The same as you? on 11 May 2000, and calls upon the NHS, local authorities and the voluntary and private sectors to make joint working a reality in every aspect of community care, in a Scotland where everyone matters.

We thought that last week's Executive amendment was self-congratulatory and full of touchy-feely soundbites, but—credit where credit is due—the minister has truly excelled at that today. I humbly suggest that his next motion should simply say, "Mirror, mirror on the wall, who is the fairest of them all?", at which the Labour back benchers can shout, "You are, minister, you are".

We have heard many quotations—for example, we heard an interesting Karl Marx quotation yesterday. I simply make the point that Kay Ullrich's quotation comes from a fairy story.

Is that it?

Quite frankly, the motion beggars belief. Either the minister does not know what is happening in community care or, worse, he is choosing to ignore the reality. I suggest that he gets out more and listens to the elderly and the disabled, to their carers and to the hard-pressed social workers and health workers who simply are not being given the tools to do their jobs.

I am surprised that the minister did not mention the problem of delayed discharge, which causes so much distress. The Tory amendment mentions it, but I am disappointed that the Tories chose to use the term "blocked beds", because, unfortunately, that term has become common currency. It seems to imply that around 3,000 elderly people are deliberately refusing to vacate their hospital beds. Nothing could be further from the truth. Those elderly people are being left to languish in totally inappropriate conditions, unable to get the kind of care that they have been assessed as needing. That care is not just residential or nursing care, as they may be waiting for the community care package that would allow them to return to their homes with support. The majority of older people want to be in their own homes. The main reason for the present situation is that Scotland's local authorities are unable to provide the required funding.

On yesterday's evidence, Presiding Officer, I am tempted to ask for an adjournment so that a researcher can find out when the £200,000 that has been announced today was announced previously. When it comes to money from the Executive, no one knows where it comes from, no one knows where it has been and it is anybody's guess where it will go next.

The minister can spin like a peerie as far as I am concerned, but local authorities are not receiving sufficient funding to fulfil their duty to provide client-centred care in the community. I am not talking only about residential and nursing care, but about—

We are going down another critical path. Will Kay Ullrich tell members how much the SNP proposes to spend on care and from where it proposes to get the money? If the SNP is going to be critical of policy, Kay Ullrich must say what the SNP would do instead.

It is a Labour party motion—stick with it.

Community care is about enabling the elderly, the disabled and the mentally ill to remain in their own homes with support services that are provided not only by local authorities, but by voluntary organisations and the private sector.

What we find, however, is that the services on which the most vulnerable people depend are being slashed by almost every local authority in the country. Every member in the chamber must be aware that home help hours are being cut. The Government's latest figures to March 1999 indicate that they are being cut by no less than 30,000 hours a year. There is no doubt that that figure will have risen substantially in the past year.

Home help charges have been increased and much-needed day centres have had to close their doors. Sheltered housing wardens have been removed.

How much will the SNP put into community care and where will they get the money?

It is a Labour motion. If anybody should know about the crisis in community care, Trish Godman should, with her background.

Members must have had letters about the removal of sheltered housing wardens and their replacement by alarm systems. Residents of sheltered housing are being charged about £2 a week for that. That more than takes care of the 75p increase in their pensions.

To the Executive's eternal shame, 10,000 fewer elderly and disabled people in Scotland receive home help since Labour came to power. Who would have thought it? New Labour is delivering less than the old Tories. That is the truth. Do not take my word for it; take the word of the Association of Directors of Social Work, among others. That association stated:

"There has been a real-terms reduction in community care funding of £260 million compared with spending in 1994."

I can assure the minister from personal experience that ADSW is not a hotbed of SNP activists.

Let us examine spending. The mental illness specific grant has remained constant since 1996. So much for the Government's priority pledge about mental health. Grants to voluntary organisations are not merely at a standstill, but have decreased year on year. That is the way in which the Government treats the organisations that provide so much of domiciliary care that is so badly needed by those who depend on care in the community services.

Iain Gray is fond of trumpeting what he has done, especially, as we have heard today, in terms of the Sutherland report. In substantive terms, however, he has done very little. However, I will give credit where credit is due—I am nothing if not bountiful. I welcome the decision to extend direct payments to people over 65, because their exclusion from the original direct payments legislation was, as we all know, simply discrimination against older people.

I also welcome the proposed introduction of a Scottish commission for the regulation of care, which will set and monitor national standards. I hope that it will also address the inconsistencies in the amounts that different local authorities charge for services and in the levels and quality of care that they provide. Where someone lives in Scotland should not affect the quality or the cost of care with which they are provided.

Will the member give way?

No, I have given way often enough.

I welcome the initiative for people with learning difficulties. However, I am somewhat underwhelmed by the carers strategy. The announcement in November last year of the diversion of £5 million to Scotland's carers—which was to be added to the £5 million that was already earmarked from local authority funding—fell well short of Sutherland's proposals for carers. The reality on the ground is very clear. Cash-strapped local authorities are cutting services to carers, rather than matching the £5 million announced by the Executive. Even if the whole £10 million were to reach Scotland's carers, who save the health service and local authorities £3.4 billion each and every year, it would amount to nothing more than 38p per week, per carer. If we consider that meals on wheels cost more than £1 a day, a home help £8 an hour and a week's respite care, which carers need so much, £350, we can see that the carers strategy falls well short of Sutherland's aspirations.

Of course, until the Government at Westminster tackles the tax and benefit system as it applies to carers, carers will continue to be penalised financially. For example, a carer who earns in excess of the grand sum of £50 a week—even if they spend every waking hour outside their working day caring for their relative—is denied invalid care allowance. If a carer gives up their job to look after somebody on a 24-hour basis—and many people do that—they will be the princely sum of £13.95 a week better off than they would be if they were on income support. If the minister agrees, as I sure he does, that that is not fair, will he tell us how many representations he has made on behalf of Scotland's carers to his Labour colleague, the Minister of State for Social Security?

Will the member give way?

No, I have said that I am not taking any more interventions.

The £5 million announced by the minister in November last year ought to be compared with the SNP's commitment in our Scottish Parliament manifesto to a £30 million initiative that would create 60,000 more respite care weeks and an extra 3,000 respite care packages of five hours per day each week.

However, the crux of this matter is the Sutherland report. Quite frankly, getting this Executive and Westminster to address the royal commission report is akin to drawing very strong teeth. Will the Executive agree to the abolition of charges for personal care? That is the one thing that Scotland's elderly most want implemented. It could be implemented today, by this Parliament. We could, by that one measure, go a very long way towards ending the misery that is faced by Scotland's elderly. It is a matter of priorities.

If the Minister for Health and Community Care claims that she cannot afford it, how about challenging her Chancellor of the Exchequer, who has a war chest of £60 billion, £20 billion of which comes from Scotland's oil revenues? What are the minister's priorities? Are they the nation's elderly and disabled, or the Tory voters in middle England for whom the chancellor is saving the money so that he can bribe them with further tax cuts?

I am proud to say that this issue has been a priority of my party since our manifesto for the Westminster election in 1997. That was two years before Sutherland. Our manifesto stated:

"We will abolish means-testing for the residential care of the elderly."

We envisaged that nursing care would be free and that the only charges would be for what we then called hotel charges and what Sutherland refers to as living costs and housing costs. It simply cannot be accepted that elderly people should have to pay for care, or indeed for aids or equipment, that should be provided free of charge. To use Sir Stewart Sutherland's phrase,

"to means-test and charge older people for such care is to place on a charge on frailty."

Make no mistake. A person usually needs personal care as a result of a physical disability, a mental illness such as Alzheimer's disease, or another chronic illness. As such, personal care should be provided free, as it is under the national health service.

It is obvious that the Executive will not act on the main recommendations of the Sutherland report—it has to wait for the permission of its political masters at Westminster—but how about easing the situation? The introduction of a three-month disregard on the value of the family home would allow elderly people a period of convalescence in a residential setting, and allow a proper needs assessment to be done. The Executive could take that measure today, if it had the political will.

I feel anger not only as a politician but as a former social worker who has seen what is happening on the front line and, most of all, as someone with experience as a carer. The fact is that we, as a society, are stripping away the whole concept of care. We are stripping away fairness and the dignity of our elderly population. Remember, minister, that we are talking about the generation who, after the war, entered into a contract with the then Labour Government. Those people were told that if they worked hard and put their bit into the public kitty, they would be looked after when their working lives were over. New Labour and the Executive stand accused of a breach of faith with an entire generation.

I move amendment S1M-868.1, to leave out from "commends" to end and insert:

"supports the concept of care in the community; recognises the excellent work done in the Sutherland Report on long term care With Respect to Old Age; condemns the continued failure of the Executive to implement fully the recommendations of that Royal Commission; demands adequate funding for those providing services within local government and the voluntary sector; urges the Executive to accept responsibility for community care, and invites it to provide real leadership, and the necessary funding, to enable successful joint working in this field."

I greatly welcome the debate on community care, which is one of the many serious health issues that face Scotland today. First, I want to address the Executive's motion. The word that really sticks in my throat—I think the same is true throughout Scotland—is "commends". We are invited to commend

"the Executive's approach to community care".

What is the Executive asking us to commend? The 2,500 patients who languish in Scotland's hospitals because councils have no money to place them? Is the Executive commending itself for slashing the home help service throughout Scotland? Is it commending itself for the cuts to councils and the voluntary sector? Those cuts led to a group in Highland Council having to decide how to save £220,000 and which services—Victim Support, Crossroads, or drugs and alcohol counselling—gave value for money.

How is it possible to put a value on the care and counselling that is given by Victim Support and compare that with the value that is given by a respite carer? That is what the Executive is forcing people throughout Scotland to do. Fortunately, Highland Council found savings elsewhere in its budget, so the cuts were put on the back burner for a year, but the same problems will arise again next year.

Perhaps the Executive is commending itself for the bankrupt and semi-bankrupt residential and nursing homes. Or is it for the council fees freeze for social work funded places? Or perhaps for the many letters—I receive them, and I know that the minister and her deputy receive them, because I receive copies—about patients whose conditions have deteriorated so much as a result of their delayed discharge from hospital that they are now unfit to return home?

The Executive knows the price of everything, but the value of nothing.

Will the member give way?

Not now, Hugh—later.

People in Scotland might have some respect for the Executive if, just for once, its policies honestly addressed problems and positively provided solutions.

Let us consider the solutions that have been outlined. Once again, I have to hand it to the Executive—10 out of 10 and another gold star for "Modernising community care: an action plan", which is a wonderful-looking glossy brochure. The Executive really knows how to do them. Of course I welcome all of these packages, announcements, strategies and documents. I especially welcome the modernising of community care and the progress in the strategy for carers. The problem is, when I tried to find out yesterday about the progress on the strategy for carers, no one knew anything about it, including the Scottish Parliament information centre. I need, and Scotland needs, there to be a recognition of the needs of carers. When will the Executive's words and spin become real? When will carers really be helped and supported, and how will that be done?

Of course I welcome—my party welcomes—the joint futures group that was set up in 1999. Again, I sought information yesterday on the progress of that group; again, from SPICe and elsewhere, no information is available.

I tried to make clear to Parliament that the exact purpose of this debate is to report on progress on those initiatives. If Mrs Scanlon is looking for progress on the carers strategy, she should not ask SPICe; she should ask carers and the carers organisations who are making progress with the strategy as we speak.

When the Executive is asking people to vote on its progress, it is only fair that a report of that progress is given to Parliament so that even Labour members know what they are voting for.

I welcome the fact that the group has been set up, but we want action—not simply words and lots of meetings. I also welcome the point the minister made about it being time to move onwards and upwards, but does it really take a politician to tell social workers in the national health service to share their information? It is tragic that we have to tell them that.

Will the member give way?

Just a second.

I strongly welcome the learning disability review, especially the changes that have been recommended. Recommendation 4 is on the change fund. Of course my party welcomes that. I would like to think that the money will go to help people who are most in need. That has not been the record of councils in the past. I also welcome chapter 2, paragraphs 46 to 51, on autism and Asperger's syndrome. I have raised points on those issues in parliamentary questions and during education debates. I am looking for action, not simply recommendations.

We also welcome the lifelong plan. As they get older, many elderly carers worry greatly about how the people they care for will be looked after in their old age. However, the 29 recommendations all include the word "should". I hope that "should" will become "will" or "must". People know what they should do, what they ought to do and what they can do; we in Scotland have to get into mature, grown-up politics and we have to address needs. I sincerely hope that this is not just another glossy brochure that will gather dust; its recommendations are excellent and I hope that they will be implemented.

It is rich for Mary Scanlon to say that she welcomes the documents that have been issued. She should recognise that they represent a significant change from the days when her party was in power.

Really, Margaret. I do not have to take any lessons from you. The Conservatives decided to spend more on services, more on patients and more on helping, to have fewer cuts and to spend less on glossy brochures. I welcome the wise words in the documents; I think Margaret Jamieson should accept that. What is said is excellent, but I hope it will be put into practice. I endorse the strategy and the practical measures.

We are, however, left with this cultural incompatibility and an attitude of professional preciousness between social work and the NHS. One radical solution is to be found in our amendment and is supported by many of the—

Will Mary Scanlon give way?

I will finish the point I am making. Actually, as you have interrupted me, go on.

I am sorry for putting Mary Scanlon off her stride.

As a former social worker, I take ill some of the criticisms that have been levelled at social work because I am well aware of the difficulties in the real world in relation to health and social care. I also take exception to the wording of Mary Scanlon's amendment, which talks of

"NHS resources wasted on blocked beds".

I am not suggesting that there are not difficulties, but I resent that sort of language. We are talking about people's lives. This amendment should be thrown out.

The beds are certainly blocked. My information is based on submissions to the Health and Community Care Committee. One solution is to have one unified budget to deliver seamless, effective and appropriate health care. That would overcome the current two-tier system of community care, in which those who are self-funding are placed instantly and those who depend on social work wait for months or years. Neither can it be right that a social worker can override a consultant geriatrician's decision about where an individual should go for care. That point also was made to the committee.

We must also address another matter that was raised with the Health and Community Care Committee. Both the Accounts Commission and the Scottish Affairs Select Committee identified £166 million being spent on resource transfer, yet it is not clear how or where that money is spent. If we are to move forward, there must be transparency and accountability.

The Scottish Association for Mental Health stated:

"It is beyond dispute that mental health spending is not keeping up with general health service spending, despite the fact that mental health has been declared a priority."

Funding for mental health associations has gone down from £40,000 to £10,000 in the past three years. I was pleased to hear the minister say this morning that the framework for mental health, which is now two and a half years old, is beginning to make some progress, because a month ago SAMH was at the Health and Community Care Committee and said that no progress had been made on it. It said that too much time was being spent in long meetings between health and social work, that there were lots of strategy documents and that nothing much was appearing in front-line services.

Can it be right that, in 2000, mental health has a bed requirement of more than 100 per cent, with the result that, at the weekend, we have people with acute mental states taking over the beds of patients who are going out with weekend passes? That is the information we received from SAMH at the Health and Community Care Committee.

I have received other correspondence on community care. The Western Isles community care forum hardly commends the Executive's approach to community care. In an e-mail yesterday it stated:

"There are elderly, very elderly and infirm people living in their isolated houses, with no relatives or neighbours to help them, who receive half an hour's help in the morning for fire-lighting, half an hour in the evening and no attendance during the weekend. "

It would hardly support the Executive's community care strategy in Ballachulish, where a community councillor returned home one day to find two elderly people sitting in his living room. They thought it was their home. That hardly gives us confidence in the assessments for community care.

The motion's commendation of the Executive's approach will ring hollow throughout Scotland. A letter I received yesterday from a care home in Nairn stated:

"Unless this deplorable situation is addressed as a matter of urgency, care in this community will have reached an even greater state of crisis come the heavy demand on services during the winter months."

People all over Scotland feel that they are letting down their old folks and their own people. They write to me that they feel guilty that they are letting down their mothers, fathers and grandmothers. Those people's guilt should be ministers' guilt.

I ask ministers to bridge the chasm between their spin and reality; not to assume that a glossy brochure equals success; and, for once in their lives, to accept the responsibility of their position and put patients, carers, and their families at the heart of the health service.

I move amendment S1M-868.2, to leave out from "commends" to end and insert:

"notes that the Scottish Executive's approach to community care has resulted in a 40% increase in blocked beds in acute hospitals since 1997, to a total of 2,400 in the latest delayed discharge census, and that this costs the NHS in Scotland up to £96 million per year compared with the cost of nursing home places; further notes that many local authorities across Scotland have been forced to reduce services and increase costs for community care clients as a direct result of the Executive's latest local government financial settlement; further notes that many nursing and residential homes are facing severe financial pressure, due to decisions by councils to freeze fees for social work funded places despite cost increases; calls upon the Scottish Executive to unify health and social work budgets within Community Health Trusts involving NHS community services, social work services, the voluntary sector and the private sector; and believes that NHS resources wasted on blocked beds should be transferred to Health Trusts in order to provide more community care places and to deliver seamless and more effective community care services for clients."

This debate covers so many initiatives and areas that it is possible in the time available to address only some of the issues. The fundamental point is that we start with the needs of the individual and plan to meet them, rather than create packages and force people to fit them. Such an approach will be possible only in a culture of joint working and shared information.

Having a minister with the joint portfolio of health and community care, which we advocated in our manifesto, is one step towards creating such a culture. There is good practice. Some of it, I am glad to say, is in my area. Ten years ago, Grampian Health Board and the old Grampian Regional Council produced a joint community care plan that laid good foundations on which to build. However, we should recognise that good communication takes time, effort, motivation and will.

The motion mentions the national care standards committee. Its work is in preparation for a Scottish commission for the regulation of care, which was also proposed in our manifesto and which will be widely welcomed. I want to address one aspect of the commission: the proposed involvement of service users. I stress the importance of not taking the easy option of involving only the articulate and accessible service user. All service users should be given the opportunity to contribute, including people with mental health problems, people with learning difficulties, and offenders. To enable the less articulate and those who are usually passed over because communication can be difficult or slow—and we are all so busy—provision will have to be made for support, training and advocacy.

On registration, it will be good to get the right balance between setting standards and achieving consistency, and not creating a structure that is too rigid or prescriptive to allow innovation and choice. We must focus on the choice of the user rather than that of the provider.

In future, it will become the norm that people who wish to be registered will have formal qualifications. However, if we are not to lose good people who have valuable practical experience and skills that have been learned on the job, there has to be some way of accrediting that experience and those skills as an equivalent to a formal qualification. It would also be good practice for the system to have an appeals mechanism for anyone who is refused registration.

It will be a huge job to introduce registration in such a wide range of professional activity, so it is understandable that that is being done in tranches. A decision has been made to start with residential care, but in many ways people who are cared for in their own home, or in a foster home, are more isolated and vulnerable. I am glad that there will be no hold-ups in dealing with that area. Finally on registration, any establishment that cares for children who are away from their homes for any length of time should be registered. That should include, by definition, boarding schools and hostels.

Carers are a huge part of the equation. For a long time they were pretty well invisible, but it is now recognised that they, too, have needs. Unfortunately, although legislation is in place, only a tiny percentage of carers have benefited, largely because there are not enough human and monetary resources to offer them the needs assessment to which they are legally entitled. That must be improved.

Employers are being urged to adopt family-friendly work practices. We need to make them aware that that encompasses all caring responsibilities, not just child care. More women care for an elderly relative than care for a pre-school child and 10 per cent of men in employment have caring responsibilities. Recognising that and making allowances for it could save employers money.

Flexibility and willingness to allow emergency time off could mean that an employee faced with a hiccup in caring arrangements would arrive for work an hour late, instead of phoning in sick and taking the whole day off. At the other extreme, the stress of trying to combine caring responsibilities with inflexible work responsibilities often results in a person giving up their job. I am told that the recruitment and retraining costs of replacing an experienced member of staff can equate to a year's pay. A caring-aware policy would clearly be cost-effective for employers.

One of the most invisible, vulnerable and needy group of carers are young carers—children shouldering burdens that even an adult would find heavy; often those that an adult has walked away from—who do not have an adult's knowledge of where and how to get help. There is an urgent need to raise awareness, particularly in schools and local communities, to identify such children and put them in touch with the help they need. More resources are needed to provide that support. All carers need respite, but young carers need it more than most. They need time to play and to be children; we are robbing them of their childhood. They also need support that is tailored to their needs, even something as simple as leaflets that are written in language appropriate for their age.

Services should be available on the basis of need, irrespective of whether the recipient has a carer. If someone who is entitled to a concessionary fare or reduced entry fee needs assistance, the necessary escort should be give a concession too.

The voluntary sector includes everything from the large, professional service provider to the small organisation meeting particular local needs. I would make a special plea for small voluntary organisations, which are finding money harder to come by and that many sources of funding are drying up. An interesting pair of statistics illustrate what we owe the voluntary sector. It is estimated that the voluntary sector generates about £1.8 billion in income but delivers about £41 billion of services. That is the measure of what we owe volunteers.

I want to highlight briefly the importance of being aware of the special needs of people who live in rural or remote areas and of people from ethnic minorities. It is important to recognise that there are particular difficulties in delivering services to those people, who must be catered for.

I would like to finish with a short quotation:

"The willingness and capacity of carers to continue to care should never be assumed."

That should be carved on the desk of every service manager and funding provider—and probably framed and hung on the wall as well.

The debate is now open. Speeches should last four minutes.

Debates such as this often become rather polarised. We have come a very long way, but there is still a long way to go. To find out how far we have come, I looked back at all the debates on health and community care in the House of Commons the year before the 1997 general election. It was not very hard, because there was only one. It was very ably summed up by Lord James Douglas-Hamilton and the Labour health spokesperson, Malcolm Chisholm. [Laughter.]

On reading the debate, I was struck by several things, including the fact that the Scottish Parliament has had many debates on care, whereas we had one a year in Westminster. Furthermore, the Scottish Parliament has a minister for community care, whereas Lord James was the minister for most things under the sun. There has been significant progress on many of the issues that we raised in that debate, although I cannot list them all. Regulation was the main topic of the debate, and here we are, about to set up the Scottish commission for the regulation of care.

There was also some interesting information. Since it is rather bad taste to quote myself, I shall quote Willie McKelvey, who was chair of the Scottish Affairs Select Committee at that time. Quoting evidence received by the committee about my part of Scotland—Edinburgh—he said:

"‘Edinburgh city social work department has stopped assessing people for care services'—

all people, not just the elderly—

‘and has a waiting list of 1,372 people . . . admissions to residential homes have been frozen.'"—[Official Report, House of Commons, 26 February 1997; Vol 291, c 290.]

We should have a sense of perspective in the debate. The Conservatives should remember the situation that we inherited. They quote figures about blocked beds; the reality is that such figures were not collected in those days. The Executive is collecting those figures, which invalidates the Conservative motion.

I should declare an interest, as it was my son who did the research—[Laughter.] He carried out the research around the time of the election in 1997. The number of blocked beds at that time was—guess what—2,400. It was as bad as that under the Conservatives.

There is, quite clearly, action on bedblocking, on the carers strategy and on direct payments. I do not wish to repeat all Iain Gray's points, except to say that while I welcome the extension in direct payments, I hope that they will be extended to the carers of all people with learning difficulties.

The Parliament's other difference is not just the many debates that we are having, but that we have a Health and Community Care Committee that is carrying out a detailed study on community care. The cross-party group on older people that Sandra White and I convene has done quite a lot of work on that issue.

That, together, we are considering ways forward on this issue is a good example of how the Parliament is working and what it was set up for. It is clear that resources are one aspect of the matter, but it is not just about the totality of the budget; it is also whether they are being used effectively. That, in a sense, should be the key point of the debate.

There are charging issues, but the joint futures group is considering that closely. I hope that it will consider some of the evidence the Health and Community Care Committee has received. The Scottish Consumer Council, for example, recommends national guidelines and Age Concern Scotland recommends national maximum charges.

The most important thing is to consider new ways of working. The committee is focusing on best practice, such as in the pilot project at Perth and Kinross Council, funded by the Scottish Executive. Pooled budgets, augmented home care and the possibilities of the new local health care co-operatives point the way forward.

I take the member back to what he said about the joint futures group. As he rightly says, the group is addressing the issues surrounding personal care and who should pay. Is it right that although Iain Gray chairs that group, he will not tell the Parliament exactly what his position is, what the Government thinks and what he will do? Is that really effective leadership?

It is part of the Scottish Parliament's new way of working, involving a wide range of people.

Will the member wind up, please.

I wanted the main part of my speech to be on mental health, but I have been told to wind up, so I shall have to be brief.

I was honoured to be invited to be the honorary president of the Edinburgh mental health users forum, which has taught me a great deal about mental health. To the credit of mental health services and the Executive, the framework has user involvement at its heart.

We were told by SAMH that user and carer involvement in service planning is tokenistic. That point has been made by the Accounts Commission in "A shared approach: Developing adult mental health services", by the clinical resources and audit group on mental illness and by a recent progress report on the framework for mental health. More needs to be done genuinely to involve users. An important part of that is advocacy. Again, the users forum, in it submission to the Health and Community Care Committee, points out that collective and individual advocacy is essential for mental health users to participate actively in making decisions about their lives.

Some of the concrete demands of users are for crisis services. They have acknowledged—and I know from my experience—the importance of community mental health projects such as the admirable stress centre in my constituency.

Sometimes, community care means spending more money. If we had proper crisis services and community mental health projects, we would save money, as many of the people who end up in beds unnecessarily would be more appropriately looked after in the community.

Yesterday, the Minister for Communities talked at length about small solutions for small minds. I would not characterise the Executive's approach to community care in that way; on this issue, it is more a case of talking big and acting mean.

If we consider the Labour proposals in "Modernising community care: an action plan", we can compare the rhetoric with the reality of community care as practised in Scotland. The document sets out the ethos of care in the community—that people should be cared for in their own homes wherever possible. I am sure that all members in the chamber agree with that sentiment. The problem is that the resources necessary to provide community care have never been made available since the National Health Service and Community Care Act 1990 came into force. More people being cared for in their own homes means more demand on local authority social work services, which in turn means that more funding needs to be released.

Furthermore, let us consider what has been made available to social work budgets under a Labour Government. In the Government's first year in power, funding for social work services fell by 2.3 per cent. In its second year, the figure fell by 1.1 per cent. It fell again by 0.6 per cent last year. In this new financial year, social work budgets will be cut yet again by 2.4 per cent. Those are not SNP figures; they have been provided by the Labour-dominated Convention of Scottish Local Authorities.

Jack McConnell never passes up an opportunity to boast about the strict financial regime he has introduced to manage the resources made available to this Parliament by our masters in London. He echoes the iron chancellor—Gordon Brown's mantra, "prudence with a purpose"—but we are entitled to ask just what purpose is served by this continual squeezing and cutting of social work and community care services. The policy of helping people who can help themselves to become more productive while throwing mere scraps to the weak and vulnerable has some sort of warped Calvinistic streak.

As I am aware of Adam Ingram's particular concern for carers and mental health issues, I am a wee bit disappointed that he has chosen to reduce this debate to arithmetic. Does he agree that there has been a substantial change in culture to allow service users and others to be involved in the planning and delivery of services and that we are starting to target resources on the people who need them most?

I welcome a change in culture, but we cannot get away from the fact that resources are fundamental to this problem. We need sufficient resources to target. My point is that we do not have those resources.

On council funding of social work departments, what purpose is served by forcing councils throughout the country to cope with what Councillor Andy Hill of South Ayrshire Council publicly denounced as

"the worst financial settlement in history"?

We should bear in mind the fact that he is a member of a Labour Administration, working under a Labour-dominated Executive in Scotland and a Labour Government in Westminster, being forced to implement service-destroying cuts.

The human cost of this financial prudence is devastating. I am sure every member can relate examples from their constituency. In the area I represent, warden services to sheltered housing and hostels have been cut. In East Ayrshire, there has been the shameful episode of old people dying in their hostel bedsit and lying there for three weeks before being discovered. In South Ayrshire, lack of resources for those assessed to be in need of home care has resulted in the closure of non-statutory provision for the elderly such as lunch clubs and the transfer of resources. If ever a measure could be described as desperate, that would surely qualify.

Ultimately, the closure of such facilities as the famous Carrick Street halls will prove a false economy. That facility was used by hundreds of pensioners in Ayr. It enabled them to maintain their independence, to keep their minds active through meeting and socialising with each other and, not least, to partake of a good meal every day.

Left to their own devices, and with only memories for company, many elderly citizens lose their purpose in life and can go downhill very rapidly. The call on our home care services can only increase as a result.

What is happening in community care provision shames this Parliament. If we aspire to be a nation in which social justice reigns and our weak and vulnerable people are cared for and protected, the rhetoric of Executive documents has to be matched with real resources—a challenge the Executive has failed to rise to and shows no intention of meeting.

I regret the fact that, so far in the debate, there has been, in a sense, a wasted opportunity. We have heard so much about what the Scottish Parliament might enable us to do, and quite rightly. There has been progress in the work of committees, with thorough, genuine and vigorous debate. It is extremely disappointing that, when we return to meetings of the Parliament, that spirit of thoroughness and vigour is lost in pettiness, mean-mindedness and negativity.

Will Hugh Henry give way?

Some people start to howl even before I identify the culprits. They are obviously resting uneasy in their seats.

It was unfortunate that Kay Ullrich, in her extremely disappointing speech, failed to take the opportunity to tell us how much she would spend and where the money would come from. The same Kay Ullrich said that the debate was a matter of priorities. Matters of priority mean making difficult decisions sometimes. If money is to be found for one area, it has to come from somewhere else—she cannot have it both ways and needs to come up front at some point.

Mary Scanlon demonstrated some of the difficulties that the Conservatives continue to face. On the one hand, she was completely detached from reality in conveniently forgetting the Conservatives' history and experience. At the same time, she made some useful points, some of which were lost in the negativity. She said that we need to consider unified budgets and more efficient resources. The debate should be about building on practical experience and trying to take the Parliament and society forward. Whether we like it or not, there are financial difficulties, but Cathy Jamieson and others have been quite right to say that the culture and climate have changed, and that carers and people who depend on community care services want to go forward in a positive spirit and to see real, lasting improvements.

From my experience in Renfrewshire, I know about some of the changes and about the new moneys that have been allocated, including £161,000 to deliver the action plan there. When I hear the stories about cuts, cuts, cuts, I have to say that, over the past two to three years, Renfrewshire Council's social work budget has consistently been increased, increased and increased. Every penny received from the Government to that department is spent on social work, not directed to other services.

I am sorry, but I shall not give way.

I do not recognise—

Will Hugh Henry give way?

No, thank you. I will extend Tricia Marwick the same courtesy that I was given earlier—so perhaps she could just sit down.

There are opportunities in the learning disability strategy. We should welcome improved joint working and partnership in practice. We should welcome the work of the local area co-ordinators. We should welcome the fact that we are closing hospital beds and moving care back to the community. That is not to say that there are not problems that need to be addressed. I welcome the carers strategy and I would always say that more money could and should be spent. Equally, I welcome the positive response that we get from carers who see real improvements in what is happening in local communities. For example, Carers Action Renfrew District runs the CARD centre, which is performing a magnificent job in the local community in improving the quality of life for carers.

We would like community care implementation to be incorporated into one reporting process. The minister needs to think about that, because there are inefficiencies in the service. We have seen huge improvements in work done by social work services, health boards and housing providers, but it is still not enough: we need to shake out the structure and ensure that money is being used properly.

I welcome, as do the social work providers in my area, the principle of a change fund. We think that it would help to implement the national learning disability strategy. We need new money in real terms, subject to a fair distribution rather than an annual bidding process. Welcome as the funding for the initiatives is, I ask the minister to ensure that we do not fund the initiatives through a bidding process, which involves a huge amount of work and often sets unrealistic deadlines. Resources spent on the bidding process would be better spent on care in the community.

I welcome the opportunity to debate community care again. It is worth recording what community care involves. It is the range of social care, health care and housing services provided in the community to enable citizens to maintain or improve their quality of life in the face of difficulties caused by poor health and disability from the effects of aging. It is intended to support carers, frail older people and citizens with dementia, physical disabilities, learning disabilities, mental health problems, substance use problems, HIV and AIDS. Those responsibilities were detailed in the National Health Service and Community Care Act 1990, which was introduced by the Conservative Government and which continues under the present Administration.

The responsibilities fall on local authorities and health boards, and the services are delivered through joint community care and housing plans. That joint working continues to bear fruit and make progress; the bodies concerned are to be congratulated. The plans are intended to ensure that health, housing, social services, the private sector and the voluntary sector, working with the community, make full use of scarce resources.

Regrettably, because of the recent local government settlements, councils are finding it increasingly difficult to maintain services in that important field of policy and are unable to pursue new initiatives. I acknowledge that the overall settlement grew, but so much was top-sliced or ring-fenced to meet the Executive's priorities that substantial cuts or reductions in other service areas had to be made throughout Scotland to ensure that councils met the Executive's spending guidelines. Those cuts, together with council tax increases—substantially above inflation—affect many services delivered under community care. In recent weeks, there have been either reductions or no inflationary increases in grants to the voluntary sector. Many voluntary organisations are involved in care in the community and are finding it more and more difficult to maintain services. That has an impact on people in need.

There have been substantial reductions in social services budgets, which have resulted in increased charges for home helps and meals on wheels, charges for residential homes rising well above inflation, closure of children's centres and day centres, reductions in grants to alcohol projects and to AIDS and HIV initiatives, reductions in learning disability funding and so on—the list seems endless. From other budgets, grass-cutting services for the elderly have been reduced, adaptations and aids in housing have been cut, and libraries and public toilets have been closed—the Executive is hardly meeting the objective of maintaining or improving the quality of life of vulnerable people.

I am the first to acknowledge that councils should pursue other ways of making efficiency savings. That would address many of the issues that I raised. However, unless there is a complete change of culture in councils or—better still—a Conservative-controlled council to lead the way, I remain pessimistic about that happening.

Will the member give way?

I will when I finish this point, which might answer the member's question.

Too many Labour-controlled councils still believe that they exist to provide jobs, not services. Alternative methods of delivery must be investigated.

There must be much more joint working among councils, the voluntary organisations, the public sector and the private sector. Perhaps councils should consider shared buildings, joint payrolls, joint council tax and rates collections, and shared legal, personnel and other administrative services. Until and unless that happens, and until the Scottish Executive allows councils to determine more of their spending within guidelines, community care will remain an unfulfilled and idealistic dream.

Does not Mr Harding think that the Conservatives have a brass neck to talk about cuts in local government after 18 years of decimation of local government by the Tories? The unnecessary, unwanted and expensive local government reorganisation that the Tories implemented seemed to be designed only to break up the Labour-controlled Strathclyde Regional Council because they thought that it was too powerful.

You have one minute, Mr Harding.

I did not hear a word that Elaine Smith said. I had already finished my speech.

You said that you would take an intervention, which is why I allowed her to speak.

I am sorry. I apologise for not listening to what she said.

In that case, we will move on.

I am sorry that Iain Gray has left the chamber, as I intend to make him an offer that he cannot refuse. Perhaps he will read about it later.

First, I welcome the comments about an application by Relatives Association Scotland being considered. I adhere to what Sylvia Jackson said: they were smashing people, who deserve funds. Secondly, I also welcome—this is becoming a habit—the Scottish commission for the regulation of care. I hope that Iain Gray will take on board my concerns regarding mandatory police checks for those who care for the elderly, and will set about implementing that by establishing an official, regulated and approved carers register. Thirdly, I fully endorse everything that Nora Radcliffe said about the young carers, although that issue is not within my remit. They are lovely people who deserve all the assistance that the Parliament can give them.

I now move on to my main comments. Iain Gray—poor lad, he is not here to hear this—has his heart in the right place, but we should be using our heads. I cannot agree with the last part of his motion, which reads:

"in a Scotland where everyone matters."

That simply is not the case for the 61,000 sufferers of dementia and, more important, the carers who look after them. He knows where I am coming from: I am again pressing for the Executive to take on board changes in the regulations and rules for the payment of personal care for the elderly.

On the anniversary of the Sutherland report, Alzheimer Scotland said:

"The current system is viewed as fundamentally unfair because dementia is not treated on a par with other chronic illnesses such as cancer and heart disease under the NHS. People with dementia are means-tested for many essential services to meet their needs and many have to forfeit their house to meet care costs."

That is a shame on all of us.

Further on that specific aspect of the Sutherland report, I refer to Carers National Association Scotland, which represents 500,000 carers. It says that implementation of the proposal—that is, the payment of personal care from the NHS budget—would reduce the confusion over charging for care, reduce the poverty caused by charging for care, increase carers' security in old age, and improve joint working between health and social work departments by removing disagreements over who should pay for services. We know that that is the reality.

Finally, I come to my offer that Iain Gray cannot refuse—my proposed bill, entitled the "Dementia and Related Illnesses of Old Age (Care) (Scotland) Bill". Section 2(2) covers the apportioning of costs for the recipients of long-term care. Subsection (4) states:

"The costs attributable to personal care costs shall be paid from the Scottish Consolidated Fund."

Subsection (5) states:

"This section shall apply notwithstanding the location of delivery of personal care."

How would we pay for that care? I have a wee idea. The Government will receive £22 billion from the sale of mobile phone licences, Scotland's share of which will be £2.2 billion. The cost of providing care, under the bill, would be £100 million, which is cheap at the price. Iain Gray was looking for a vision—here is that vision. If the Scottish Parliament delivers that, he can take the credit—I do not care, as long as the job gets done.

I want to concentrate on the situation for carers in rural areas, particularly the needs of carers in the Highlands and Islands. The Executive's strategy for carers in Scotland is excellent and I welcome the £200,000 announced today. The strategy identifies those most in need of help; there is a commitment that, through promotion in the media, they will be made aware of the help that is available to them. The extension of the NHS helpline to include information on social care, particularly information about local services, is valuable in rural areas. However, in rural areas, local services can be a hundred miles away and ways must be found for people in very remote places to access services.

I am pleased that the Executive has recognised the need for a single gateway for help and advice for carers. One of the things that I have found is that, although there is help, the number of groups offering help can be confusing. It is sometimes difficult to find what one is looking for, and it can be daunting for those who are seeking help to know where they should start.

Recently, I have had personal experience of the problem. My elderly aunt has developed dementia and I was faced with the difficulty of knowing whom to approach. As my aunt lives in Oban, I had to do it from a hundred miles away. I am tremendously impressed by the social work department in Oban, which responded immediately and has arranged an attendance allowance and an excellent home help. From having had my stomach in a twist worrying about her, I now feel relaxed and that she is in good hands.

Highland Council's carers strategy has pinpointed another issue that we need to remember, that carers often find it difficult to ask for help because their task seems private and personal. Highland Council's strategy quotes a young carer—the sort of carer Nora Radcliffe spoke about—a 15-year old girl called Jane, from Sutherland, who looks after her mother. She says:

"We can't really have our friends in because it upsets the routine, and a routine is the only thing that gets us through what has to be done."

She is 15—no longer a child, perhaps, but a young adult who has had to grow up exceptionally fast because of the responsibility that she has. One of the most important things that she needs is support and the possibility of meeting young people in a similar situation. In Sutherland and in all remote communities, it is difficult to form support groups.

Perhaps the biggest issue raised by the various groups that I have spoken to in the Highlands and Islands is the lack of choice that is a consequence of remoteness. A young disabled man who visited the Parliament said that if he wants respite care, he has to leave Fort William where he lives and go to Dingwall—could not there be residential care that is nearer, so he can still see his family and friends? The rural issues are difficult to tackle, but I hope that in time we will do so.

Lack of transport is another major problem that affects carers. The community transport initiatives have done a great deal to help carers and disabled people in the Highlands. More support from the private sector would be useful. People in Lochaber said that they would like the supermarkets to run a customer care transport scheme; I do not think the situation there is untypical. Both public and private sectors must do all that they can to take account of the needs of the elderly, the infirm, the disabled and those who care for them, so that they can get to and from the shops—shops that might be 40 or 50 miles away—go to libraries and generally do what most of us take for granted.

Information technology holds the prospect of enabling better communication with carers and those for whom they care. The geography of the Highlands and Islands means that people, as I said, are often remote from services. The Highland community care forum is already accessing such technology, but I would like many more community centres, church halls, school libraries and local post offices to provide access to computers and direct people to the websites of relevant organisations, so that they can receive the information that they need. Many voluntary groups already use IT to keep in contact with members and with those who use their services. That is essential in overcoming the problems of remoteness in the Highlands and Islands.

This debate is further evidence of the fact that the Parliament and the Executive consider community care a priority. There are problems that must be tackled, particularly in rural areas, but I believe that the Executive has identified the right strategy for giving those who care the support that they need and those who need to be cared for the information and choice that they need.

We have heard many suggestions during this morning's lengthy debate on aspects of care in the community. Care in the community is a wonderful concept, an inspiring and ambitious ideal that was promoted to sustain and support the physical and medical needs of those who were in most need in our communities. Those who have medical and mental problems are found not only among the elderly; they are a cross-section from all age groups, from the very young to our senior citizens. In fact, the concept was of care from the cradle to the grave.

Care in the community was a brilliant and laudable concept, which I am sorry to say did not achieve the practical success that I am sure we all hoped for. Nor did it meet the demands and aspirations of communities and individuals who needed care and whom the scheme was designed to help. Although I accept that much excellent work has been undertaken by the administrators and carers in the scheme, it is only by their hard work, diligence and dedication that we can claim any degree of credibility for our community care project.

The problem has been a lack of adequate resources from the outset. When the project was introduced, there were no clear guidelines or identifiable costs that could be accepted as accurate. As a consequence, hurried calculations and assumptions were made and a suggested budget for the service was drawn up. From the start, that budget was grossly underestimated and its legacy unfortunately continues to restrict and undermine that very necessary service.

We are constantly reminded that the budgets for community care services are overspent. We hear that all local authorities are being got at for overspending on their budgets—by considerable margins, it is suggested. However, I suggest that their budgets have never been appropriate for their needs and have regularly and consistently been underfunded. Only this morning, I was listening to the chair of social work in the western isles on Radio nan Gaidheal, who highlighted that very problem. She described the problems associated with providing services in rural areas of Scotland and particularly in the island communities.

I ask any member who would like to calculate the expenditure required by care services over the next week or the next month whether they have any idea of what the demand on the services will be. Of course they do not, and neither do the project administrators. Let us therefore endeavour to ensure that sufficient financial recognition is given to the needs of carers and those who need care in our communities.

Taking into account the points made by John Farquhar, who is the former convener of Highland Council's roads and transport committee, does he share my concern that from October 1999 to March 2000 people were unable to take up residential nursing care places, despite urgently requiring them, because of lack of funding? Does he share my further concern that, six weeks into the financial year, Highland Council's social work department's budget is

"already overspent by five persons"?

I ask John Munro to finish his speech now.

I thank Mary Scanlon for her intervention. I support her view, because the whole community care project has been underfunded from the outset. I hear the same pleas from Raigmore hospital, where, as of this week, some of the money that was allocated last year for service provision at the hospital has still not arrived.

I suggest that, were it not for the sterling work undertaken by the many voluntary organisations and the hundreds of home carers of all age groups, who willingly and on a daily basis give of their time and effort, our community care services would be in a much more difficult and discredited situation than is the case at present.

The minister suggested that the service requires vision and imagination. I can tell him that the vision in our communities is not a happy one. That image is not a figment of our imagination and the problem is evident to all—it requires resources, resources and more resources.

In conclusion—

Quickly, please.

I quote my dear friend, Kathleen Murray, of the Highland community care forum:

"I am hearing all the right things. I am reading all the right things. Now I would like to see the right things happen. I am putting my trust in you, as service planners and providers. It is time to make change happen."

I will start with a familiar quotation from the document, "Modernising community care: an action plan":

"Most people want home-based care. We need to shift the balance of current funding and target new resources to increase home-based care"

Home-based care is an essential thread of the strategy that takes people out of institutions and allows them to be part of their community or helps elderly people to remain in their homes.

We still have too little sheltered housing, too little furnished accommodation and too little accommodation for people who need support. Millions are being siphoned off from private sector grants to home owners, which would allow people to live in their own homes.

"Modernising community care" was described as "an action plan". Therefore, it is reasonable to expect that, having identified weaknesses, the Executive would be tackling those weaknesses and making improvements, rather than lodging self-congratulatory motions. The things-can-only-get-better Government is now the Government where things could hardly be worse.

Between 1998 and 1999, the number of hours of home care services provided dropped by around 7 per cent. Since this year's local government settlement, things are getting worse rather than better. In my own area of Fife, where Labour runs the council, home care services have been cut to the point where there is simply not enough to go round. I am sure that Hugh Henry should be talking to his colleagues about how Renfrewshire Council is able to save its services while Fife Council has had to make cuts. Someone, somewhere is simply not telling the truth.

The cash constraints placed by the Executive on Fife Council's budget mean that 1,600 hours of home care services will be lost to vulnerable communities in Fife—that is a cut of 5 per cent on an already overstretched service.

In the past, I have spoken at length about housing waiting lists. Now there are waiting lists for home helps. Iain Gray said that the Executive is doing things that were unthinkable; waiting lists for home helps are unthinkable. How old, infirm or vulnerable does one have to be before one can get one's name on the list? How much older, more infirm or more vulnerable does one have to become before one reaches the top of that waiting list?

What is the motivation behind the change in Fife Council's policy? I will quote from a press release from that council:

"An increased demand for the service, limited resources plus more complex needs have led us to the introduction of waiting lists."

The council has done that to patch a huge hole in its budget—a hole such as has been made by Jack McConnell and the Executive in social work budgets throughout the country. The Labour party—which makes all those recycled announcements—is the same party that tries to spin a reduction in services into a good thing. Fife Council's press release says that home care services should focus on those who need it most, but it makes little mention of the fact that such services are being cut.

Has the Executive ever considered the burden that is placed on carers—the relatives and friends who are left to look after older and vulnerable people when the state has given up on them? The Executive has again produced a glossy document that talks a good game, but I will quote from Fife Council's press release again. Councillor Irene Connolly said, when commenting on the changes:

"This is the first time we have had to introduce a waiting list for this service."

I will repeat that to the Labour party:

"This is the first time we have had to introduce a waiting list for this service."

That did not happen through the long years of Tory government—throughout those years, Fife Council did not have to introduce waiting lists for home help services. In the first year of the Labour Executive, there are waiting lists for home care services in Fife.

Elaine Smith said that the Tories have a brass neck. They have, but the Labour party should be black affrontit that the day has come when waiting lists that affect the most vulnerable people in our society have been introduced in Fife.

The sooner we have a debate about what social work departments do, what their practices are and the size of their case loads, the better. I hope that when we have that debate the Tories will listen and the SNP will stop moaning and groaning.

The ethos of the National Health Service and Community Care Act 1990 was that it should enable people to have some means to allow them to live independently.

Will the member give way?

I have just started. There is no way that I am giving way.

That act expected that we would not end up in hospitals, but in our own homes or choice of residential home. That act did not prepare agencies for the partnerships that are essential for the act to work. Good practice is very clear—social work, health boards and those who provide housing should meet to discuss and plan together.

The Scottish Executive document "Direction on Choice" says that it is fundamental that we allow people to make their own choice in relation to what nursing home they go to or what home care package they use. Local authorities have no powers to impose residence in a specific establishment against the wishes of a client. There is, therefore, a significant correlation between the exercise of choice in relation to residential homes, bedblocking and home care packages. In the short term—although alternatives might be offered—there is no means by which social work services' wills can be imposed. The dilemma is how to resolve the conflict between individuals' right to choose and the requirement to make the most effective use of public resources

I want to talk about Glasgow and Renfrewshire. I was born in Glasgow; I live here, I have worked here and I did my community care assessments here. In Glasgow and Renfrewshire considerable efforts are being made to ensure effective and integrated joint working between social work services and health services at local and strategic levels. There are many, sometimes complex, reasons why there is bedblocking and why there are delays in provision of home care packages. Those reasons include the number of national health continuing care beds, changes in clinical practice, levels of funding, levels of resource transfer between social work and health services following bed closures and the exercise of choice.

What can be done? Joint protocols that govern the time scales for assessment to placement can be very helpful. We can use protocols that involve consultant geriatricians in the assessment of frail and elderly people in the community who might require nursing home care. We can also use joint service plans. I give the example of the respite facility for children with special needs in Kilbarchan, which was created by a number of groups working together. As both Malcolm Chisholm and Richard Simpson have pointed out—and I hope that the SNP will listen to this—that has resulted in a reduction in bedblocking in Glasgow of 75 per cent since 1997, from well over 1,000 cases to under 100.

Community care still offers real opportunities to redesign social and health services in this new century. As Iain Gray said, services at Lennox Castle were inappropriate for people with learning difficulties—wrong type, wrong place. The move to good social services in the community for those people and their carers was correct.

Support for carers locally should be part of our wider regeneration strategy. Local public services are part of local economies. They create jobs and training opportunities for local people that need to be maximised as part of the shift in service provision. Community care needs strong and active communities. Partnerships between public services locally and strategically will make that work.

It has often been said that the measure of any society is the way in which it treats and looks after its vulnerable: the very old and frail, the very young, and those who are physically and mentally disadvantaged. I do not think that anyone who has spoken in this debate would disagree with that statement.

However, we need to stress the desirability of independent living. That is what we are attempting to do in the amendment that we are putting forward today. Earlier, a Labour member criticised us for including in our amendment a reference to bedblocking. Our aim is not so much to point out the financial cost of bedblocking, which is considerable, but the human cost. We are seeking to achieve a situation in which, where possible, people can be cared for by loved ones in suitable circumstances at home. There is nothing in our amendment that does not seek to achieve that aim, which is shared by many people.

Iain Gray said that this was a report on progress, but it is not good enough for him to wallow in self-congratulation, as a great deal remains to be done. He must appreciate that and direct his mind to it.

Entirely inadvertently, Keith Harding failed to respond to Elaine Smith's point about cuts in local government expenditure. We have heard Labour councillors quoted—I could quote Councillor Baillie of East Dunbartonshire—as complaining bitterly about the recent local government settlement. Things changed—not for the better, in my opinion—in May 1997. However, often in debates of this type the Labour party seems to be living in a political time warp. That party has been in control of the situation for the past three years. When services fail to materialise or performance targets are not met, that is Labour's responsibility, irrespective of what may have happened previously.

I said two minutes ago that in the very city where we are now meeting there had been a 75 per cent reduction in bedblocking since we took over in 1997. Why is the member talking such nonsense?

I am not talking nonsense. Does the member not agree that any bed blocked is someone being deprived of the opportunity to live in the community, and that one bed blocked is one too many? The issue must be addressed comprehensively.

Let us deal with the issue of pensioners, who are becoming an increasingly alienated section of our society. The Labour party has not been tremendously kind to pensioners. Not only was the pension increase derisory, but many pensioners now genuinely believe, with some cause, that there is a two-tier national health service, and that the treatment that they receive is unlikely to be the same as that given to a young person.

Those pensioners see the Administration's spending priorities and the spending that was agreed last week for the rehabilitation of drug offenders. They are entitled to ask whether drug addicts get priority over the elderly in the eyes of the Scottish Executive. If drug addicts do get priority, that is disgraceful.

The Executive is failing manifestly to look at what is really happening. The ticking bomb of the Sutherland report and the delayed-fuse time bomb of the changing demographic situation are not being recognised or dealt with adequately. Progress must be much better than at present because, quite manifestly, the Executive is failing a substantial proportion of the population, who are finding themselves repeatedly excluded and alienated.

I, too, welcome the opportunity to contribute to this important debate. I also welcome the Executive's strategy and vision for community care, as set out in the motion.

Any strategy must put not just people but their carers at its centre. People expect care to be delivered in a people-centred way. To those who are in need of care, who delivers the services is less important than the quality, flexibility and accessibility of the services that are provided.

I will concentrate on the promotion of joint working, which is vital to the success of any strategy, and on the learning disability review, in which I have an interest. I have seen many examples of good practices in joint working. We should talk today about good practice and the innovative work that we have seen.

Since the launch of the Fife carers strategy in 1996, Fife Council has made support to carers a priority and, in partnership with Fife Health Board, has committed resources to developing the Princess Royal Trust for Carers in Kirkcaldy, my constituency. The trust has provided vital support to carers and, equally important, has provided vital information to inform the future planning strategy, which will bring the role of carers out of the shadows and into the forefront of civic life and society.

The role of carers in our society cannot be overstated, and their commitment has been unparalleled. Like Nora Radcliffe, I recognise that young carers in particular are vulnerable and I welcome the Executive's commitment to introduce legislation to enable carers under the age of 16 to have, for the first time, a direct assessment of their needs. Those carers are the unsung heroes of our society. Our help and support is much needed, and they will now get that support to participate fully in education and social life.

We have seen many improvements in joint working and attitudes, but we must—and do—accept that much still has to be done if we are to provide the totally seamless community care programme that we want to provide.

Will the member join me in regretting the fact that Fife Council could not find the resources to support the linking education and disability—or LEAD—project in Glenrothes, which provided services to allow people with disabilities to get back into education?

I am unaware of that issue, but will take it up with the council.

Before I became an MSP, I worked in further education for 16 years and did much work with people with learning disabilities. I welcome the learning disability review, which is the first review of such services for more than 20 years. I accept, and welcome, the fact that the main focus of the review is on social care and health, but I am pleased to note the recognition of the importance of education for people with learning difficulties. I welcome the choice that that will give those people.

The Scottish centre for learning disabilities that was announced on 10 May is a key part of the review. I was pleased to hear about that, because we must raise public awareness of the issue. It is widely acknowledged that better outcomes can be achieved by using better the considerable sums of money that we spend on learning disabilities, and by enabling people with learning disabilities to access mainstream activities and to have choice.

I also welcome the setting up of the new managed network for autism and the appointing of local area co-ordinators to support people innovatively in the community. The way forward is to strengthen people's entitlement to direct payment, to modernise day services and to focus on personal development, employment and educational needs. I welcome the review.

I make a plea on behalf of people in families where there are special learning needs. We are looking for choice: a choice of curriculum, a choice of employment opportunities and a choice of educational opportunities.

I welcome the publication of the learning disability review last week, even though it was slightly late. I understand that it should have been out at the end of last year.

Some important recommendations have been made, and I hope that the minister will make progress on them, especially for people who suffer from autistic conditions. There is considerable concern about the lack of services for such people. I am sure that the minister is aware that the Autism-Europe congress will be in this city tomorrow. More than 1,000 experts and parents from all over the world will come together to discuss the whole issue of autism. I am sure that all members will hope that the congress is successful here in Glasgow.

Having worked in community care for seven years prior to the elections last year, I resent the implication of the comments of Conservative members that, in some ways, it is the staff in the community care services who are letting the system down. Unfortunately, Keith Harding seems to have disappeared. When I worked in the council that his party controlled, £400,000 was cut from three community care budgets. The results of that were extensive waiting lists for assessments and for nursing and residential home places. Two of our local authority residential homes were closed—two of the best that we had.

Such are the results of the Conservatives' spending commitments, the decisions of the council in Stirling and the Labour Government's decision to continue with the previous Conservative Government's spending plans. That is what staff in local authorities have to put up with. Staff are having to deal with the crises in funding brought about by the spending commitments both of the previous Conservative Government and of the present Labour Government.

The member has just heard Adam Ingram from his own party outline the way in which the Labour Administration has cut the budgets that the Conservatives provided. I am not going to take any of that nonsense from the member.

It is all very well to be in denial, but there is treatment for it. The member may want to look into that.

I would like to discuss the needs of disabled people, and especially equipment and adaptations for disabled people. Getting access to the equipment that they require is a minefield for many disabled people because such equipment is supplied by many different agencies—social work departments, the health service and education departments.

The complexity of identifying which department they should go to for equipment creates many difficulties for disabled people. Having worked in the system for seven years, I know that it was confusing for us at times to know whether it was our responsibility in the social work department to provide the equipment, or whether it was the responsibility of the health board. That issue has to be addressed. There is a lack of joined-up thinking in policy making across those agencies.

I would like to give an example of a way in which the system fails. A young girl with cerebral palsy was assessed by her education authority as requiring a special computer to help her with her education. The computer had to be specially adapted for her needs. When she left school, she could not have the computer. It was of no use to anyone else, as it had been adapted for her needs, but the equipment belonged to the education authority so, when she left school, she could not have it. That lack of joined-up thinking in policy making must be addressed so that disabled people receive the equipment that they require, no matter what their age or who is providing it.

The extensive delays in getting the equipment that is required are largely linked to funding. The consequence of many disabled people not receiving the equipment that they require is that they become more dependent upon their carers. The carers then often require greater periods of respite. If we provided disabled people who are being cared for with the right type of equipment, they would be able to lead a much more independent life and their carer would be under less stress. In that sense, it is a false economy not to provide them with the equipment when they require it.

There is an increasing inconsistency across local authorities in the way in which equipment is provided by means of charging for it. I have heard of instances when people have been told to go to Argos because they would get the equipment quicker than they would from the local authority. Some local authorities means-test for every piece of equipment and others do not charge for anything. We must address that inconsistency so that we do not have service delivery for disabled people based on their postcode. I ask the minister, in summing up today, to ensure that there is a clear commitment to joined-up thinking across all the agencies and that there is consistency in the way in which equipment for disabled people is provided across all local authorities in Scotland and it is not based on postcode.

As a member of the Health and Community Care Committee, I welcome the opportunity to speak in this debate and in this city. As in my own constituency, there will be few families in Glasgow that are not touched in some way or another by care in the community. Malcolm Chisholm said earlier that we have come a long way, but we have a long way still to go. Few members would disagree with that sentiment.

I will concentrate on the need for co-ordination of services. Trish Godman said earlier that it is easy to talk about partnership, but it is much harder to deliver it. Anyone who has followed the Health and Community Care Committee's inquiry into community care will know how elusive that matter has been for us. Attention tends to focus on the relationship between health and social services. The problem is that those artificial divisions, as well as being unhelpful, can polarise the debate and leave out in the cold the voluntary agencies that are integral to keeping old people in the community, but provide a service that falls between two stools.

An Age Concern group in my constituency provides meals, advocacy, social activities, advice and information on many matters relating to the elderly. Unfortunately, the health board regards it as a social service and the local authority, while it recognises the important role that the group plays, does not see it as a mainstream service provider. It has therefore been difficult to find mainstream funding; yet, if the project goes under, 35 frail elderly people will find independence in the community very difficult. The ethos of community care is to give elderly people independence and to enable them to live in their own homes, which most of us want.

We must find a way of moving the organisations and structures forward to take a more holistic view. The motion calls on service providers to make joint working a reality. I applaud that sentiment, but know that it will be difficult. There are many stumbling blocks: some are deeply ingrained in the system and some are at odds with the delivery of a patient-centred service. Today, we have heard about some positive examples of joint working. Those should be encouraged and developed. More comprehensive solutions include policy and practice agreements, joint commissioning, pooled budgets and the creation of local community care agencies.

In conclusion, joined-up proactive government has become one of the buzz phrases of the Parliament. There are few areas in which it is needed as badly as it is in community care. I hope that the solutions that agencies across Scotland are exploring will ensure that we can deliver it.

Yesterday, I spoke to an elderly woman who was part of the lobby by Strathclyde elderly forum outside this building. She wanted me to tell the chamber this morning about her experience of community care. For many people, the reality is different from the self-congratulatory smugness and complacency of the Deputy Minister for Community Care and the Minister for Health and Community Care, who was sitting next to him during his speech.

The husband of the woman to whom I spoke was terminally ill with cancer. They required aids and adaptations to be installed, including a shower, as she was no longer able to help him in and out of the bath. They requested an assessment by an occupational therapist. However, due to a lack of resources and, consequently, of occupational therapists, it was more than a year before a letter arrived to say that the assessment would be carried out. Unfortunately, the letter arrived on the same day as her husband's funeral. Can members imagine how that woman felt?

That is not an isolated example. Similar stories are being told the length and breadth of Scotland, as Michael Matheson showed. Frankly, the system is not working and the complacency of the minister in denying that is staggering. Local authority budgets cannot be reduced without affecting community care services. The Convention of Scottish Local Authorities has identified a shortfall of no less than £299 million.

The minister spoke about a 13 per cent increase in home care hours, but the facts do not back up that claim. Figures that were obtained from the health department show that there was a drop of more than 25,000 hours between 1998 and 1999—a 7 per cent reduction. I will let the Deputy Minister for Community Care explain that discrepancy now.

The explanation of the discrepancy is that the nature and configuration of home care is changing. There has been a 13 per cent increase in the number of people working in home care, and an increase in intensive care packages of more than 10 hours. Those are the packages that will produce the effects for which so many members have called today. I suggest that Ms Robison listens more carefully to the figures.

I listened very carefully to the figures. The minister cannot escape the fact that there has been a drop of 25,000 hours. Those hours had been given to elderly people in the communities who required them. The figures confirm what we all know is the case, that many elderly people are having their home care services reduced and that many receive no services at all.

The funding problem is not just in home care. In my constituency, a very good project that is run by SAMH for people with mental health problems is under threat. That project provides a range of services, including training opportunities to allow people to get back into work. It is under threat because the cash-strapped Tayside Primary Care NHS Trust is struggling to find match funding to allow it to continue. It provides the very community-based services to which the minister referred earlier for people who used to live in institutions. The threat to the project is distressing for the users of the services that it provides because they require a stable routine, which is important for people with mental health problems. I would welcome intervention by the Minister for Health and Community Care to save the project, the threat to which I have brought to her attention.

There has been much talk today about a change of culture. That is welcome, but a culture change will only deliver real change if it is backed up by adequate resources. Although I accept that finding additional resources is not necessarily an easy task, the fact that the minister continues to deny that there is a lack of resources does nothing to make the case to the UK Treasury that more resources are required. I urge the minister to change that policy.

I was pleased to hear the minister's announcement of £200,000 specifically for voluntary organisations representing carers. Most members recognise the contribution made by carers in our society and the fact that any one of us could become a carer or require one at some point in our lives. Whether carer or cared for, I am sure that we all hope and expect that help and support will be available and that we will have certain rights.

The debate is wide-ranging and I am interested in all its aspects. However, I would like to focus on the right to respite. Disabled people must have their rights respected and should not have services imposed on them. However, if our society does not recognise that carers have rights too, the outcome of the caring relationship could be that carers exercise their right to walk away and choose not to care. In some cases, carers will not even have the right to make that choice because they will simply become unable to cope.

I vividly recall the story of Angela, which was told at the Shared Care Scotland conference in 1998. Angela was in her mid-40s and cared for her parents—one had Alzheimer's and the other had had a stroke—as well as her son who had Down's syndrome. All the professionals involved saw only part of Angela's difficulties. She felt that it was her duty to care for her parents and her son and felt inadequate because she was not coping. A neighbour occasionally sat for Angela, but then they moved away. When Angela told her GP that she was under stress, she was told that she was doing a good job. Angela had a complete breakdown and four members of that family ended up in residential care.

Research by the Carers National Association has consistently shown that carers and disabled people are not getting enough support. I recognise the changing culture that my colleague Cathy Jamieson mentioned and I commend the Executive for that. However, the services that are available do not always fit people's needs. Common needs exist, but carers and the cared-for also have individual needs. Ask any carer about their needs and most would say that they want to be recognised and respected, to be given the appropriate information and to have a bit of a break. That does not seem to be a huge amount to ask.

We have not yet managed to empower disabled people and their carers and that means that there is still a lack of recognition, information and opportunities for breaks. Carers cannot receive services in their own right. That means that if the cared-for person refuses an assessment or services, the carer could be left unable to access support, yet still be expected to care. Services such as holidays, delivery services, domestic help and counselling should be provided to carers in their own right. Clearly, respite care and short-break care are services provided for the disabled person. However, carers are beneficiaries of such services and, in most cases, a right to respite would benefit and empower both cared-for and carer.

There is no compulsion for the carer to care, but most choose to do so because of the wishes of the disabled person, love for them and a sense of duty towards them. For those reasons, it is extremely difficult for carers to refuse to care, even when they are not receiving the help and support that they need. I hope that the carers legislation working group will come up with proposals to give carers their own right to direct services and will consider the issue of respite care in full. A statutory right to respite is a logical step in empowering the cared-for and their carers.

I have been interested to hear a variety of members extol the virtues of the new schemes outlined in the Labour motion. The one thing all those schemes share is the likelihood that they will be underfunded. A common complaint that I have heard in my constituency and a common theme of today's debate is that there is not enough funding to go around—even Elaine Smith mentioned that.

Another common complaint is that Labour is long on talk but short on delivery. We have new schemes, ideas and initiatives, but for people on the ground that simply means more red tape, bureaucracy, reviews and less money going into the services for which people are crying out. Indeed, it is hard to know where to start. Should we talk about how Labour has failed pensioners—the 73p insult dressed up as a rise? In South Ayrshire, a 5 per cent rise in council tax and a rise in water charges swallowed that up straight away.

Should we talk about bedblocking? Bill Aitken and others already have. The important fact is that the figures keep on rising month by month.

The member talks about the situation in South Ayrshire. Is he aware of the joint work undertaken by South Ayrshire Council, East Ayrshire Council, the Ayrshire and Arran Acute Hospitals NHS Trust and the Ayrshire and Arran Primary Care NHS Trust to ensure that individuals were not admitted to hospital? People were discharged earlier, with appropriate support. Is he prepared to accept that that was an innovation and that it was fully funded and assisted?

I am prepared to accept that a lot of people are trying to do a lot of good work, but the reality is that they are underfunded. I will address that point later.

The funding that was provided last month to address the problem of bedblocking will only tinker round the edges.

Should we talk about how residential care homes are closing down while the demand for places grows daily? Throughout Scotland, it is mostly private sector nursing homes that are closing down because, for ideological reasons, Labour-controlled social work departments will not put patients into them. South Ayrshire Council has the worst of both worlds, because the local authority is closing residential homes as well, Content House being the most recent example. That is a double whammy for people who are most in need.

South Ayrshire Council has removed overnight warden cover—Adam Ingram has already referred to this—in sheltered housing complexes. These are realities. Perhaps we should talk about the closure of Glenburn hostel, which offers residential respite care for the mentally handicapped, in Prestwick. I heard the minister describe—he almost boasted about it—how closures are to be regarded as successes. That is not how people see it.

Will the member take an intervention?

I already have, madam.

Will the member give way?

Okay.

That is an outrageous convolution of what I said. I said that we are proud of the closures of long-stay hospitals for the learning disabled and of acute psychiatric hospitals. I am happy to boast of those closures because they are freeing people to live their lives more fully in the community.

I still say that we cannot get away from the fact that the minister boasts of closures. However well-intentioned Labour is, its approach is not working—that boils down to a lack of funding, which has been a common theme throughout the day. The Executive says that the funding is not available.

To go off tangentially—that will surprise no one—many members will recall that, in 1997, Labour pledged to clamp down on welfare spending, and on fraud in particular. Members may have noticed last week that a Department of Social Security report revealed that welfare fraud is costing £7 billion a year. If Scotland's share—as it often is in such UK matters—of that is one tenth, £700 million is being fraudulently claimed in Scotland. The same report notes that 81 million people in Britain have national insurance numbers—20 million more than the population.

Come to a close, please.

I will.

If the Westminster Government could sort out the fraud, it could fund these areas. However, the Executive will probably not solve the fraud or provide the funding—that is the bottom line. The message to pensioners is to start looking out for themselves, because the Government will not do it. That is a stark message, but it is the reality.

I call Cathie Craigie, to be followed by Dorothy-Grace Elder. I ask both members to keep their speeches as tight as possible.

Thank you, Presiding Officer—I will try to do that.

Like the minister, I want to boast about the closure of hospitals that have institutionalised people for years and to welcome those people back into the community.

The Tories and the SNP think that they have given us the answers to the problem of community care. The Tories are going to solve everything by dealing with welfare fraud and the SNP are going to use the windfall from mobile phones. I live in the real world, and welcome the coalition Executive's approach to community care. Thanks to the change of Government and the Scottish Executive, the importance of community care has been recognised and the issue has been placed high on the political agenda.

We have heard a lot about the many groups of people who require care. Like Elaine Smith, I want to talk about the people who provide the main care in the community—the half a million carers who see to the needs of their family and friends. Many of us will have experience of caring for a partner or elderly relative; many more of us will know what it is like to care for fit and able-bodied children. We have all experienced feelings of gratitude and relief when a friend or relative asks if they can take the kids out for the day, or when granny says that the kids can stay over at her house so that we can have a night out.

It is easy enough to organise care for someone who is able-bodied; it is not so easy to arrange for someone to look after a young adult or a 30-year-old with special care needs. That is why respite care is a lifeline for many carers. Caring for another person takes a lot, and many carers suffer from stress and isolation. It is very important that the carer and the person being cared for can get a break. As we all know, many carers can be reluctant to ask for help, as they have a strong sense of responsibility and duty to the person for whom they care.

The importance of respite has been emphasised in the "Carers Agenda for the Scottish Parliament", which was produced by Crossroads and other voluntary organisations. The third point of that document demands a regular break for carers through the provision of flexible and appropriate respite care. We must emphasise that respite care is for the benefit of the person who is being cared for and the carer. We need a more appropriate balance that takes the needs of the carer more into account. All carers should have an assessment of their needs, which is available on request. Such an assessment is common practice in many local authorities and should be established across the board.

I have many things to say, Presiding Officer, but I can see that you are anxious for me to wind up. Expectations are high; carer groups have been campaigning for recognition for years and a great start has been made. Carers' expectations of the Scottish carers strategy must be met and I welcome the minister's commitment to do that. I hope that the minister will continue to work with everyone involved so that the work and dedication of carers is recognised. Furthermore, I hope that we can ensure that carers have the required support and back-up and that their needs are assessed.

I am the only Glasgow member of the Health and Community Care Committee and I have been shoved down towards the very bottom of the list, with the poorest chances—rather like Glasgow itself. That is not the Presiding Officer's fault. I will have to race through some of Glasgow's community care problems in a couple of minutes, which is an absolutely impossible task. Glasgow, more than any other area, deserves a strong representation.

It is only fair to acknowledge that the minister has put a lot of hard work into his plans. Whether we like somebody's projects or not, and whether we attack them or not, we must acknowledge that hard work has been done—I just do not happen to agree with what the minister has done.

Like Mr John Scott, I take exception to the minister's remarkable comment about "successfully closing" a hospital. It seems that the minister—[Interruption.] Yes, "successfully closing" hospitals, minister. I mean, come on! What a bizarre expression.

Will Dorothy-Grace Elder give way?

Does he wish to explain it? Please do, minister. Enlighten me.

We spent 18 months with people with learning disabilities on a review. Here is the one thing they asked above all: "Close those hospitals."

I know the sort of hospitals the minister means, but I also know relatives who are very concerned about the closure of Gogarburn, for example. The minister's exact words were, "We have successfully closed Gogarburn." Only the long term will prove whether such decisions were entirely correct.

The minister is also closing day centres. It seems that every time he opens his mouth he closes a hospital or day centre. The minister should—please—visit the east end of Glasgow. Easterhill day centre in Baillieston is to close. It has been a marvellous centre for people with all kinds of disabilities, and for elderly parents who are the carers of children aged 40 or 50. Those people have been distributed against their will to other centres. I ask the minister please to visit the growing concern project at Daldowie in the east end. It is a magnificent project that involves youngsters with learning difficulties. It has been under threat for 18 months. It is a horticultural project, which the young people much enjoy. They want to remain on the land. I ask the minister please to end the uncertainty over such specific projects.

We all know that the phrase "care in the community" was first degraded by the Conservatives. It became a dirty expression and a euphemism for "going on the cheap". I am afraid that what we heard from the Tories this morning demonstrated their mass bout of amnesia: they cannot remember anyone called Margaret Thatcher, who started chucking people out of sheltered facilities, including hospitals, to no care in the community. That is where we must be extremely careful.

I will give a typical Glasgow case, involving an elderly couple. The wife is looking after the bedridden husband. She cannot get any proper home help service. Her health collapses and she has to be removed to hospital. Her husband is then also taken into hospital. For lack of help—£30 or £40 a week with the home help service—the state will pay £1,000 to £2,000 a week because they have been forced to stay in hospital. Bean counting does not work. It is inhumane and it does not even make sense.

That ends the open part of the debate. We now move to the winding-up speeches. I call Margaret Smith to close for the Liberal Democrats.

I welcome today's debate. Many speeches have offered the minister nuggets of good information, truth and guidance. However, I have been quite shocked by some others, particularly from Conservative members, which have been very unfortunate and done the Conservatives and social services staff a great disservice. I would like to think that some of it was down to a basic lack of understanding. I hope we can leave it at that and that they will go off and learn a bit more before they return to the chamber and attack people of high integrity in the social services.

Community care is about dignity and quality of life. It is about giving our fellow citizens real choices about where they live, how they live and the type of care they receive. Trish Godman is right: some of the time, that gives us problems. Choices about where people go after leaving acute service are sometimes difficult but, as the minister said, one of the choices open to people is to live their lives as we choose to live ours. It is our job to give them the chance to do just that.

As many members of the Health and Community Care Committee have mentioned already, we are considering this important issue. All members felt that we ought to consider it. There is frustration at the lack of activity on the Sutherland report. I have a great deal of sympathy with much of the SNP amendment—although I lost much of it when I heard Kay Ullrich's comments—and I agree that the Sutherland report should be implemented in full and quickly. I call on the Executive to bring pressure to bear on Westminster to do that as part of the comprehensive spending review.

Will the member give way?

No. I have a lot to get through in very little time. I know Duncan wants to lead me astray, but I will have to say no on this occasion.

Sutherland's proposals would have a beneficial impact on the issue of delayed discharge that Mary Scanlon's amendment raises. For that reason, the proposals are worth considering.

The Health and Community Care Committee has been taking evidence on this issue in recent weeks. Many good speeches today have mentioned the 500,000 carers in Scotland. Everybody welcomes the Executive's carers strategy. As the minister said, we have to ensure that we involve service users and carers at every stage of the process to deliver good-quality services. We have to get better at that level of consultation. Nora Radcliffe made a number of good points about young carers and the benefits to employers who encourage carers whom they employ. That support can have a beneficial impact on their work.

The Executive is committed to modernising and redesigning health services. The newly established primary care trusts and the local health care co-operatives have a big part to play in joint working and bringing together all the relevant professionals from social work, health boards, the housing sector and the voluntary sector. Many people are working to deliver good-quality community care.

As John Munro said, community care has always been underfunded. No one denies that more can always be done. Michael Matheson was absolutely on the button when he gave us a classic example of the kind of thing that we all know goes on. We all know that a little bit of common sense applied to such a problem would have a major impact on people's lives. Money is important but the issue is not entirely about money.

While putting together its report, the Health and Community Care Committee has come across a number of funding issues. There is concern about the lack of transparency in resource transfers, which has led to difficulties with the delivery of seamless service. There is also a problem with mistrust between health boards and councils—people wonder what is going on with the money, who is making best use of the money and where the money is being spent. Evidence that we have heard suggests that social work departments do not always spend their indicative amounts on community care in certain areas.

Will the member give way?

Yes. Dr Simpson will not lead me astray.

On resource transfer, does Margaret Smith agree that, rather like a joint investment fund, the health board and social work department should agree on the total amount of funding that is involved and on its application? That would ensure transparency about what is happening with the funds. Whether the funding for mental health is spent by the health board or the social work department, there should be a joint agreement.

Dr Simpson's intervention shows why I gave way to such a mature and responsible member. I agree with his point entirely.

Almost 50 per cent of the voluntary sector is involved in the provision of community and social care. We all know of the struggle such organisations have to keep their head above water and ensure that services are delivered. Susan Deacon was told by the Health and Community Care Committee that we had concerns about the apparent drop in voluntary sector funding and the standstill in the mental illness specific grant. Both would have a damaging impact on community care provision. I was glad that the minister gave us assurances that she will examine mental health in the voluntary sector as part of the £173 million budget surplus.

I welcome much of what Iain Gray talked about today. The joint futures group will be absolutely essential in trying to put together good practice in joint working. The minister is right: pilot schemes have been undertaken before and they go only so far. It is now time to take the pilots forward and put them into action. We all know that a lot of work is going on throughout Scotland, which is very good. We know that there is a need to improve the standard, and some of the work that is being done by the Executive, such as the proposed national commission for the regulation of care and the Scottish social services council, will play a big part in that.

As I said at the beginning—Malcolm Chisholm summed up the situation well in his remarks—there is still a long way to go, but the Executive is on track and is taking on board the comments that I made earlier about the Sutherland report. We are on the way to delivering better care in the community than we have delivered in the past.

In October, I received a letter from Mrs Low, of Dundee, in which she expressed her gratitude for the care and help she had received over many years from her Crossroads assistant. My constituent hoped to participate in the UK's caring about carers award. She said:

"Now, I thought, I can put in words all that I think about my carer and perhaps give her the recognition and reward".

She went on to describe her disappointment when she found out that the Scottish Executive had withdrawn Scotland from that awards scheme—a scheme that aims to go some way to recognising the real contribution that is made by the thousands of carers.

As I investigated Mrs Low's concerns, I found that the many national carers organisations were also bewildered by the Executive's decision. Rather shockingly, when I contacted the Minister for Health and Community Care's department and asked for the reasons for the withdrawal, I was told by an official that the department was too busy to participate. No doubt it was too busy because of the continued pressure to produce glossy documents. That seems to have been the story all along. The Executive has been too busy to read, let alone implement, the Sutherland report on old age. I do not understand why; it commissioned the report. Although the Conservatives do not agree with all aspects of that report, at least we had the courtesy to respond to it.

The Executive seems to be too busy to free up the hundreds of hospital beds that use up more than £50 million of precious NHS money, by placing the patients in appropriate care. It also seems to be too busy to ensure that £116 million of resource transfer from health boards to local authorities is being spent in the right areas of social services. Now it seems that the Executive is just too busy to recognise the value of hard-working carers throughout the country.

The minister's motion reflects the Executive's attitude and mentions many strategies and glossy documents, one of which was delivered only last week. The fact of the matter is that for all its glossy documents, the Executive is failing in its task. People who deliver community care are confused by local authority assessments and are being penalised as a result. Although the Carers (Recognition and Services) Act 1995 gives a carer the right to an assessment of their ability to care, that assessment is not being undertaken. Glasgow City Council stated that carers assessments and reviews are not routinely part of social work practice in Glasgow. I would have thought that the Executive should be busy monitoring local authorities' practices to ensure that the act is being observed—or is it too busy?

Mary Scanlon observed the pressures that are being put on care homes because local authorities are refusing to acknowledge the rising costs when they set their fees. I hope that the Executive will take note of those pressures. There is no point in shifting people from blocked beds if there are no homes to go to.

The Conservative record is clear: it was the Conservative party that introduced the legislation to recognise fully the role of carers. The Carers (Recognition and Services) Act 1995 underlines two main elements: the right of carers to receive an assessment of their ability to care, and the local authority's duty to take into account the assessment of results when considering what support to provide for the person who is cared for.

I acknowledge that the Conservative party introduced that act very recently. One of the things that, unfortunately, has kept us very busy is setting up the carers legislation working group to work on replacing that act with the kind of legislation that carers need and want.

The deputy minister should pay attention to the submission from the National Carers Association. It said that the minister should concentrate on implementing fully the Carers (Recognition and Services) Act 1995 before he starts producing new legislation.

Under the Conservative party, the person being cared for was better off. In 1996 we doubled the capital disregard for continuing care costs from £8,000 to £16,000. The chancellor has still not reviewed that. Between 1993 and 1997, Scottish local authorities received £339 million towards community care. Between 1979 and 1997 the number of sheltered houses provided by public agencies increased from 7,500 to 34,000. Specific housing for the disabled increased fivefold. That is what happened under the Margaret Thatcher and John Major Governments and it is a record I am proud of.

The Conservative party wants to improve on that, with proper, seamless care between health and social care, joint management and unified budgets. Above all, we want the barriers between health workers and social workers to be broken down. Only through innovation can health care work alongside social care. I recently visited Dr Beattie in Inverurie. He wants to build a new surgery co-located with social work, voluntary groups and community activities, with health promotion, medical care and community care all in one place. That must be the way forward.

The SNP's contribution today has been the usual criticism plus funding commitments from fairytale land. When Kay Ullrich looks in her magic mirror all she will see is Pinocchio.

No, I must finish.

I agree with what Nora Radcliffe said about the needs of young carers and the effect for them of full-time commitments. We should all agree with Hugh Henry's very positive contribution on the way forward for social care, but while, according to him, Renfrewshire Council may be passing on Government money, he should also think about authorities such as Lanarkshire Council, which has frozen fees to care homes for the past five years without recognising any of the increased costs such homes now face.

Christine Grahame is an exception to the SNP more generally. I agree with her that dementia should be recognised. I hope that we will make it possible to do as she hopes. Trish Godman said that Glasgow has had a 75 per cent drop in blocked beds. If that is the case it is very welcome, but across Scotland bedblocking is rising again and there are hundreds of people still in inappropriate beds in Labour local authority areas outside Glasgow.

The Conservative party welcomes the steps towards independent regulation of homes and the Executive's pilot scheme for seamless social work and health care, as in Perth, but we are well aware that all gloss and no action will give the impression that the Government is more concerned with image than with the people working every day on the front line. A Government that is too busy to keep in touch and to participate in awards schemes will soon not be a Government at all.

I want to say this to Margaret Smith, on the question of being led astray. She did not take an intervention from me on the ground that I might lead her astray but then took an intervention from Richard Simpson on the ground that he is older—has it occurred to her that perhaps he is too old to lead her astray properly?

It is always a pleasure to discuss an issue of such importance, but I cannot be the only MSP suffering from a sense of déjà vu—or perhaps déjà écouté—because it was only two weeks ago that we had a debate in Parliament about community care, and nothing substantially new has happened in the intervening period. That makes me wonder about an Executive that has nothing new to say. It is an odd choice of topic for the second day in Glasgow, because in the previous debate, the Executive took a bit of a pounding on the ground that its record did not stand up to scrutiny. To bring that record back before the public in a different part of the country is generous in the view of the Opposition parties, but it might be an act of political suicide.

Will Mr Hamilton give way?

No, I will not. Trish Godman might be attempting to lead me astray—perhaps we can come back to that later.

I have been trying to fathom why we are having this debate again. We were all primed for some huge, groundbreaking announcement that would set the scene for a whole new era of community care. I thought that we might have heard something about the carers strategy, or the usual Government reannouncement of the £10 million from November—which was, in fact, only an extra £5 million, but we will not squabble about Government double counting today.

However, we heard none of those things. When it was pointed out, to the dismay of Labour back benchers, that that £10 million—or £5 million—equates to 38p a week for every carer in Scotland, all of a sudden the silence was deafening. It became clear then that, on that front, the Government had nothing to brag or boast about.

The minister moved on, in a seamless transition, to the voluntary sector. He managed to announce £200,000 this morning, but after I intervened to ask him about the real-terms drop in the transfer of funds from health boards to the voluntary sector, we heard not a squeak about that £200,000. Not one other member dared to mention it, because it seems to have disappeared into the ether.

I mentioned it.

I beg Maureen Macmillan's pardon. It was mentioned by one solitary back-bench member who is looking for promotion.

Let us be clear about what is proposed for the voluntary sector. There is that £200,000 windfall—extra money—but the Government's own figures, which the Health and Community Care Committee is currently analysing, show a real-terms drop from 1999-2000 to 2000-01 of about £333,000.

If the Government wants to receive congratulations, it should not cite those figures as a shining example of the Executive's commitment to joined-up working and recognising the contribution of the voluntary sector. If we exclude the elderly—and we tend to forget that community care is not just about the elderly—80 per cent of residential care is provided by the voluntary sector. I would have thought that everybody in the chamber, cognisant of the fact that throughout the election there was no bigger issue than community care, would have been aware that the voluntary sector is the one area that needs more money from the Government's spending priorities rather than less. When it comes to future spending announcements, I suggest that the minister looks at his own figures before he comes to the Parliament expecting congratulations on money that actually represents a real-terms cut.

If today's debate was not about the voluntary sector or about carers, was it about the Sutherland report? Perhaps today was going to be the day when the Sutherland report finally got a fair wind from the Executive. I was pleased to hear that the Liberal Democrats were minded to support the SNP amendment. If anything that has been said subsequently has dissuaded them from doing so, they should ignore it.

Will Mr Hamilton give way?

No, I will not.

During this period of coalition government, the question for the Liberal Democrats is this. If they favour full implementation of the Sutherland report's recommendations, what pressure are they bringing to bear on their coalition colleagues? What will be the tangible proof that the coalition is a partnership and not a takeover? What is the key point that they will drive home? We have not heard about that and I do not think that we will.

The Sutherland report was published in March 1999. Since then, all we have had is inactivity and prevarication. I know that the minister will say that various committees are studying the report in great depth and that he sits on many of them. However, he must understand that the role of Government is to provide clear leadership. That is why the SNP amendment emphasises the need for clear, strong leadership.

Way back in the mists of time at the beginning of the debate, Kay Ullrich asked about the abolition of charges for personal care and about a three-month disregard. What is the minister's view on those questions? He responded by saying that he was considering them. I suggest that that is not enough; we need to know his view. I asked Malcolm Chisholm, in an intervention, why the Executive had no policy and whether he thought that it should have one. He said, "Well, that's just the way we do it now." Well, that is not the way it should be done.

By all means, let us consult and invite the broadest possible spectrum of opinion to ensure that we make the right decision, but the minister should at least tell us—for 70 grand a year and a company car—what his view is. Does he not even have an opinion? Does he not even have the faintest clue as to whether he is broadly in favour or broadly against? Or is he just going to tease the Parliament on every occasion?

The SNP has been accused of not being constructive in the debate, but Christine Grahame brought perhaps the most constructive thing that anyone could ever bring to a debate—her own bill. It does not get much more constructive than that. What is it, if not constructive, to be able to say that the SNP's personal care policy of two years ago was precisely where the Sutherland report finally ended up? Is not that constructive politics? Malcolm Chisholm says that there is much more work to be done and gets a rousing round of applause, while when the SNP suggests that there is more work to be done, we are carping, moaning and whining. I suggest that those are double standards.

On the issue of leadership, I look forward to hearing in the summation by the Minister for Health and Community Care an indication of the views of the Deputy Minister for Community Care. I know that he has not come to a conclusion, but how is he minded? He is paid to decide, so he should make those decisions.

Let us consider what people have said about the Sutherland report. Age Concern and Help the Aged have been four-square behind the attempt to implement the report's recommendations as quickly as possible. The report's author, Sir Stewart Sutherland, said that there had been

"no substantive response from the Government on the crucial issue of funding".

The SNP's apparent obsession with resources is shared by the author of the report that the Government commissioned. I suggest that the area of resources is important.

When I spoke to Sir Stewart Sutherland only last Friday, he said, "I have to admit that there has been substantial progress on all the other recommendations of the report."

I would welcome with open arms Sir Stewart Sutherland being the driving force behind the minister, because he would want to implement all his report's recommendations. If Sir Stewart is now the minister's source, he should give us a commitment to implement fully the report's recommendations, in which everyone in the chamber—bar the Executive—believes.

I dare say that Sir Stewart told the minister that it was important for the Executive to go back to Westminster to fight the corner for people in Scotland. He meant that the Executive should ensure that the Treasury opened its coffers to give people a fair, just and dignified lifestyle. I hope Sir Stewart told the minister that, and that the minister was listening to him.

Joint working was the final area emphasised by the Government today. Margaret Smith made a good point about the need for transparency in resource transfer, which certainly comes up time and again in the Health and Community Care Committee. However, is the minister listening to members of the joint futures group? I presume that Oonagh Aitken of the Convention of Scottish Local Authorities, who is an advisory member of the group, has taken the opportunity to tell the minister that the shortfall in local government funding is £299 million—that is COSLA's figure.

The minister wants to get into the idea of joint working, but has the reason why joint working has not come to fruition crossed his mind? It is not that anyone is against it. Who could be against the idea of coherent government? Rather, the reason is the lack of resources, which makes people defensive about their budgets. They do not want to share. If the Government's response is not to increase resources, I want the Executive to tell me how, in the absence of those resources and in the light of the scarcity of money in the system, it expects to break down the cultural barriers that have been outlined.

Mr Hamilton, you are into your last minute.

We have not heard a great deal that is new during the debate, but it has been a useful opportunity to flag up some of the challenges facing the Executive. The motion congratulates the Executive and welcomes this report and that committee, but I suggest that John Munro's point about the need for action is the way to go.

Rather than setting up a committee, what will the Executive do to make joint working a reality? What will it do about resources for local government, to break down the cultural barriers that the Executive admits exist? What will it do about carers, to ensure that they are adequately provided for? What will it do to make good the shortfall in home helps and home-based care? Most important, what will it do to implement the recommendations outlined in the Sutherland report? That will be the acid test of the Executive's commitment to community care. If it fails that test, it will fail Scotland and then, I hope, it will be turfed out.

It has been an interesting morning. I am pleased and proud to have the opportunity of closing this debate and, in doing so, I am bound to reflect on the debate that has taken place over the past three hours.

I was reminded of a leading trade unionist's contribution to a Labour party conference a number of years ago. He made one of those great soapbox faux pas when he referred to the motion in front of him as being a bit like the parson's nose—good in parts. Today's parson's nose has been good in parts, but, sadly, not quite so good in others.

I will start by focusing on the positive, because there was much that was positive in today's debate. I found that one of the most encouraging aspects of the debate. I hope that people listening will also have been encouraged by the number and range of MSPs from all political persuasions who truly care about community care. They brought to the debate an insight into and feeling for community care, based on their professional and personal experience. That is important and encouraging.

I will also say, in the spirit of the new politics—as my colleague the Minister for Enterprise and Lifelong Learning might say—that it is important to identify some of the things that we all agree about. We agree about the importance of community care, despite the fact that it might not have the high profile of other aspects of care and the health service. We have also acknowledged and agreed that it is, in many circumstances, better that people are cared for in their own homes and communities, when that is possible.

We have agreed that people must be at the heart of our community care agenda. We must build services around the needs of individuals and—crucially—their carers. The carers' concerns must be at the heart of our policy agenda on service design. We have agreed—not only today, but on other occasions—on the importance of giving a voice to those who have not had one for so long. That includes the mentally ill, many frail and elderly people, people with physical and learning disabilities and carers. I am proud and glad that Parliament has, early in its development, placed so much emphasis on the needs of those groups. I hope that that will continue.

I will tell members something else on which we have agreed—that community care needs additional investment and that money must be invested in the right places. We have also agreed that for that to happen, people have to work together. They must work jointly and work effectively in partnership. Those are the things that have been missing in the past, and that has stood in the way of community care delivering for people in the ways in which they need and want it to be delivered.

The minister talks about joint working and working together and says that we all acknowledge the need for resources. Will she make representations to the Chancellor of the Exchequer, Gordon Brown—her colleague at Westminster—to open his war chest and provide the resources that we need for community care?

It is unfortunate that, after a year, the line of questioning in interventions is becoming no more original.

A joint ministerial committee has been established—which the SNP questioned—involving the four health ministers in the UK. The Prime Minister chairs the committee and our respective First Ministers have been present. The first meeting of the committee was about six weeks ago and the next will take place presently. The committee discusses how we are co-operating effectively throughout the UK, in the best interests of people in all parts of the UK, on all aspects of health and community care. We will continue to do that because effective co-operation is the way forward.

We acknowledge that things need to get better. I resent the suggestion that the Executive is being complacent or self-congratulatory. Let me tell members—and I am sure that I speak also for Iain Gray—that there is not a day when we do not get impatient about the need for change and the need to achieve more. A day does not go by when we do not see at close quarters how much still needs to be done. A day does not go by when we are not prepared to push, to try and to try harder yet to ensure that we make a difference.

We have moved forward—community care is at the heart of the Executive's agenda. There is a minister whose remit is dedicated to work in community care. The fruits of that work have been shown this morning. We are investing more money and more energy.

It is easier in the community care agenda—perhaps more so than in many others—to identify problems, but it is so much harder to identify and deliver solutions. It is sad that we have heard so much empty rhetoric rather than contributions that suggest how results can be delivered. Open debate about where problems lie is important, and it is important that criticisms are heard.

I welcome Michael Matheson's speech. I welcome his identification of problems—identification that is based on his practical and professional experience. We might not agree about all the answers—that is fine. We must, however, have an honest debate about the problems and their complexities. Let us work together to come up with results. Rhetoric is not enough.

I want to comment on three issues that have been raised by the Opposition. The first is joint working. We would all like to think that joint working happens naturally and has happened naturally in the past. Sadly, that is simply not true. When last November Iain Gray and I brought together the leaders of the NHS and local government here in Glasgow, it was the first time that they had been brought together, with Government, to examine the whole community care agenda. Day in, day out, week in, week out, we speak to senior managers and figures in the NHS and local authorities, who tell us that only over the past couple of years have they started to plan and work together effectively. We are determined to build on that, not just through meetings and warm words, but by putting in place the levers, mechanisms and incentives to ensure that it happens.

I want to drag the minister back to what was said about the complexity of solutions. Presumably, that complexity was the reason why the royal commission was set up. If it reached its conclusions only after a long time and after hearing much wide-ranging evidence, are not those conclusions ready-made solutions that the minister could simply adopt, instead of trying to reinvent the wheel?

That is precisely why we have moved forward on so many of the recommendations that were made by the royal commission. That is why we have said time and again in Parliament that the remainder of the royal commission recommendations will form part of our considerations in the forthcoming spending review, when we will look to the future—when we will look to how we will spend the resources that are available to us.

On that note, I would like to refer to resources. Today, once again, we have heard calls for more, more, more. [Members: "Yes, yes, yes."] "Yes, yes, yes" is easy to say, but half the equation is always missing from speeches by the nationalists—how and from where they will fund spending. Kay Ullrich said that this is a matter of priorities, and that is absolutely right. The Executive has set out clearly and firmly where its priorities lie. In our spending review, we will continue to address them to the best of our ability, within the resources that are available to us. That is what any Government has to do. We owe it to the people of Scotland to be open and transparent about our decisions.

I do not have time to take any further interventions, but I am keen to address some of the points that have been made in the debate. We have heard a blizzard of figures cited, but let us examine the level of resources in social work and the NHS, two of the key areas that are relevant to what we are discussing today. An extra £51.3 million was invested in social work in 1999-2000—that is a fact. An extra £43.3 million is being invested in 2000-01, and an extra £35.7 million has been committed for 2001-02. Cumulatively, that is an extra £300 million over three years. Local decisions still need to be taken and local authorities still need to decide on their priorities. We respect the right of democratically elected local authorities to do just that. However, we want to sit down around the table with the leaders of local government in Scotland and senior figures in the NHS, to agree shared priorities, for the benefit of the people of Scotland.

Alongside the additional resources in social work are the additional resources in the NHS. In the current year, an extra £0.5 billion is going into the NHS in Scotland. In the past two weeks, £60 million has been allocated to health boards across Scotland. One of the four key priority areas on which that money will be targeted is tackling delayed discharge. If we are to resolve deep-rooted problems that have blighted us for years, additional investment and input from the NHS and local government are required. We are moving forward in those areas.

I want to make a point about the future. Some disturbing things have been said, particularly by Tory members, about forms of care and the needs of individuals. Like Iain Gray, I was present at the closure of Gogarburn hospital. Like him, I was proud to meet the many people who, over a number of years, had been involved in reprovisioning the services from Gogarburn hospital, and in working with parents and carers to reassure them and give them the support that they needed for reprovisioning to take place effectively. It did.

I have been proud to meet people in Scotland who are now, for the first time—after being institutionalised for, in many cases, 30 or 40 years of their lives—enjoying fulfilling lives in communities. For the first time, they are attending such things as evening classes; for the first time, very often, they are taking up jobs. I am proud of that, and the Executive will continue to be proud of its work in that area.

Today, in the main, has been positive. There is much that we have been able to agree upon. I hope that, in the spirit of the new politics, we can concentrate more of our time and energies on the things on which we can agree, rather than the things on which we cannot agree. Community care matters; it matters to the people who depend on the services, and to the people who deliver those services. We owe it to them to take forward our agenda with commitment, determination and energy. The Executive is doing that, and will continue to do that. I hope that members from all parts of the chamber will join us.