Care Home Costs
Good morning. The first item of business this morning is a Conservative party debate on motion S3M-7422, in the name of Mary Scanlon, on care home costs.
09:15
There is no denying the changing demographics of Scotland. In the past 10 years, the number of people aged 75 and over has increased by 14 per cent and the number of people aged 60 to 74 has increased by 12 per cent. It is projected that, in the period up to 2031, the number of people aged over 75 will increase by about 80 per cent. The number of those aged 65 to 74 is projected to increase by 40 per cent in the same period. It is estimated that, in the next six years, the number of older people who need care and support will increase by 25 per cent. I hope that today’s debate will help us to plan services, as part of the Government’s reshaping care for older people process, to ensure that value for money is coupled with continuing high standards of care for our older people.
In March this year, there were 943 care homes for the elderly, providing 39,150 places, with more than 5,000 empty places. The independent and voluntary sector provides about 85 per cent of care home provision in Scotland, with the remaining 15 per cent in the council sector. All care homes must achieve equal quality standards, as set and regulated by the Scottish Commission for the Regulation of Care. Undoubtedly, there are excellent, good and not-so-good care standards in all sectors. We look to the care commission to take the necessary action against any home that is not performing to agreed standards of quality care; ultimately, that can lead to closure of a home.
Against that background, and in the current financial climate, questions need to be asked about the amount that councils pay for a placement in their homes, which is £800 a week on average, although the amount that is paid to the independent and voluntary sector for the same placement and standard of residential care is £480. I appreciate that local authorities pay higher wages and have significant pension provision for all employees, but some independent providers pay rates that are similar to those paid by local authorities. As an MSP who represents the Highlands and Islands, I am also acutely aware that in remote and rural areas, councils provide care in smaller homes, which are more costly to operate due to the absence of economies of scale and which would not be viable in the independent sector. However, although the cost of providing care is a matter for each local authority, section 22 of the National Assistance Act 1948 requires local authorities to set fees in their homes at the full cost of providing care. Therefore, if the cost of providing care is around £800 per person, surely that would be the cost for all sectors to provide the same level of care to the same standards.
That takes me to my next point: how do independent care homes stay in business when they are paid almost half the amount per placement that is paid for the same level of care for a person in a council home? The answer for many is that care home providers enter into contractual agreements with self-funding clients. The self-funding person in standard residential care tends to pay a considerably higher rate than the £480 that is paid for a council-funded placement. That means that there is significant variation in payments for the same level and quality of care.
I am not proposing that the fees that the independent sector receives should increase from £480 a week to the council level of £800 a week. However, the Government’s review provides us with an opportunity to look afresh at maintaining high-quality care, appropriate placements and value for money, especially given that £4.5 billion of the Parliament’s budget is spent on care for older people.
As I mentioned in a speech last week, independent and voluntary sector care homes could be used to prevent hospital admissions. That would ensure that patients receive the rehabilitation that they need to retain independence and go home, instead of waiting for six weeks in a hospital bed and becoming a statistic for delayed discharge. It would also help to utilise the 5,000-bed spare capacity to which I referred. The fee to care homes in the independent and voluntary sector is £480 and £550 per week, compared with costs of £800 a week for council residential care, around £1,400 a week for general hospital provision and upwards of £2,800 a week for acute hospital care. In these difficult financial times, that is a significant factor.
Care homes could also provide significant amounts of day care and respite care, as well as home care. That would enable elderly people to become familiar with the care home and its staff and lead to a more joined-up service, enabling people to have temporary stays in care homes before returning to their home.
More support could be given to unpaid carers, and our care home sector could be utilised more for respite care. Greater volunteering and community support could be developed by better integration. Telecare and telehealth developments have real potential to enhance quality of life and to create even more efficiencies, as well as better-quality care. The situation could be improved by extending telehealth links to care homes and using technology to provide direct connections to clinics and hospitals, which would help to prevent unnecessary out-patient and in-patient visits. I understand that West Lothian is working on a project of that type.
The independent care sector employs more than 100,000 staff, with an annual turnover of more than £1 billion. It is only right that we utilise that capacity and knowledge to enhance care for the elderly. Although the coalition Government at Westminster is considering a range of ideas through its Commission on the Funding of Care and Support, including a voluntary insurance scheme, it is up to the Parliament to ensure that older people get the care that they need and deserve, at the time when they need it, and in the place of their choice.
The motion in my name asks the Government to review
“existing models of funding and provision”
as part of the reshaping care for older people process,
“to ensure that value for money is coupled with continuing high standards of care.”
I hope that all members will support it.
I move,
That the Parliament recognises the changing demographics of Scotland and the increasing financial pressures on services providing care for older people; notes that independent and local authority-run care homes in Scotland are regulated in accordance with standards set by the Care Commission; further notes the wide disparities that exist between different service providers with regard to fees and costs and the disparities in the amounts paid by or on behalf of service users for the same service, and accordingly calls on the Scottish Government to ensure that its public engagement process, Reshaping Care for Older People, reviews existing models of funding and provision to ensure that value for money is coupled with continuing high standards of care.
09:23
I welcome the opportunity to debate care services for older people and the important programme of change on which we have embarked.
The current systems for delivering social care will not support increasing numbers of frail older people. That is why, as outlined in the spending plans and draft Scottish budget for 2011-12 that we announced yesterday, we are making available £70 million to be used in partnership across health and social care to focus on delivering improvements in older people’s services.
Residential care is just one of a complicated labyrinth of interrelated tough problems that we must tackle. We will tackle it, but we cannot do so in a disjointed, short-term way.
To help us to understand the complex issues that we are discussing today, l will touch on a few of the facts about care home provision for older people in Scotland. At the end of March this year, there were 943 care homes, providing 39,150 places. Almost 14 per cent of residents were in local authority homes, 75 per cent were in private homes and 11 per cent were in voluntary sector homes. However, the picture is changing. The number of residents in local authority homes has fallen by almost 15 per cent in the past 10 years, to just over 4,000. At the same time, more than 30 per cent of care home residents are self-funders, because they have capital in excess of £22,750. That number is increasing year on year.
Self-funders pay their own fees, over and above any entitlement to free personal and nursing care. Publicly funded residents have capital of less than £14,000, and the local authority pays for their care over and above the contribution that the individual makes from their pension, benefits and other income. It is clear from the statistics that local authorities depend to a very large extent on the independent sector for the provision of residential care to the older people in their areas—and I refer back to what I said about 14 per cent of residents being in local authority homes.
In response to long-running concerns about the stability of the care home sector and the quality of the care that is provided, the Convention of Scottish Local Authorities developed the national care home contract, in negotiation with Scottish Care, the body that represents the independent care home sector. The national contract was introduced in 2007-08, and the rationale for developing it was to standardise the terms, conditions and fees for publicly funded clients and to incentivise improvements in quality, through the grading system.
All the published research on care home costs shows that there is a wide variation in the weekly costs of residential care, regardless of who owns and manages the home. That is true for all sectors, drawing on comparisons within and across sectors. In spite of those wide variations, COSLA and the independent care home sector have successfully negotiated a standard national contract rate for publicly funded residents over the past few years, which has removed the need for costly and time-consuming negotiations between each of the 32 local authorities and the care home providers in their areas. Importantly, that has been linked to driving up quality.
I know at first hand from the recent Scottish Care conference, which Mary Scanlon attended, just how strongly the independent sector feels about the apparent inequity in the charges for local authority care home provision, compared with the amount that local authorities pay for a publicly funded care home place under the national care home contract. As with most things, the situation is not quite as black and white as it first appears. Given the clear interdependence of local authorities and independent providers, an adversarial approach to the single issue of the cost of a care home place is not helpful.
Faced with the dual pressures of diminishing public sector funding and increasing numbers of frail older people, we need to work together to develop new models of providing and paying for care. That has to mean much better joint commissioning, because only when partners in health sit down with their counterparts in councils and bring in expertise from the independent sector will we start to see real innovation, both in business models and in service development.
The £70 million change fund, which I have referred to already, is a significant milestone on the road to securing high-quality, person-centred care for the future. Our long-term proposals will be set out in our reshaping delivery plan, which is to be published at the end of this year.
We will not miss the opportunity to review current arrangements on funding and charging for care to ensure the development of long-term, fair and sustainable new models of care. In doing that, it would be wrong headed to focus on only one care sector and one care setting. Reshaping care requires us to take a far more fundamental look at the way in which care services are delivered across the board. That is what we have set out to do with the reshaping care process. A number of public sessions have been held across Scotland, and they have been very positive in bringing forward suggestions.
I am totally committed to keeping up the momentum on this important change agenda, and I hope that that finds support from across the Parliament.
I move amendment S3M-7422.1, to leave out from first “notes” to end and insert:
“recognises the need to shift the balance of care; notes that independent and local authority-run care homes in Scotland are regulated by the Care Commission in accordance with standards set by ministers, and further recognises the opportunity through the Reshaping Care programme public engagement process to examine existing models of provision and funding across all care sectors and care settings to ensure that value for money is coupled with continuing high standards of care.”
09:28
I, too, welcome the opportunity to debate the provision of care. Mary Scanlon has focused her motion on care home costs, and I will deal with that issue first. I share her view, however, that the debate should be wider and should consider the rich and diverse continuum of care that is provided in communities throughout Scotland.
Mary Scanlon’s central point—and indeed that of the minister—is that the cost of public sector care homes can be much higher than the cost of provision by the private sector. All else being equal in terms of quality, why is there a disparity? I know from experience that Argyll and Bute Council, which covers part of my constituency, can charge up to three times as much for its care home provision than the private sector does, so the question is a valid one.
The situation is not quite as simple as many people would have us believe, however. As Mary Scanlon rightly suggested, there will be variations in staff terms and conditions, in whether pensions are provided for staff and in how much an employer will contribute to those pensions. Providing for older people in remote and rural areas can be less attractive for the private sector. Whatever is the case, I have no doubt that local authorities will be considering how they secure best value for their limited resources. I welcome the development of the national contract to ensure that a partnership approach to the care of the elderly is taken between local authorities and the private sector.
I am disappointed that the motion does not mention the voluntary sector, with its rich history of providing social care, including in care homes. I accept, however, that Mary Scanlon covered that in her speech.
That brings me to the point about the diversity of care provision. There are a variety of care providers, including local authorities, voluntary organisations and the private sector, and they are engaged in delivering a variety of different levels of care. Increasingly, providers are developing models of care that sustain people in their own communities and in their own homes. That is what older people say they want, and that is borne out by the trend that is emerging across local authorities of an increasing emphasis on home care.
We face the challenge of changing demographics and I understand that, 20 years from now, there will be about 75 per cent more 75-year-olds. As I look around the chamber, I see that to be true.
Members: Oh!
On the Tory benches, anyway.
It is indeed the case on the Tory benches, Karen Gillon says.
We need to rethink how we do things. Doing more of the same in the face of those statistics will just not do. We should not view older people as a burden, who require to be cared for. The overwhelming majority of people—more than 80 per cent—do not come into contact with the care system at all.
We should be encouraging a healthy and active old age. Let us value the lunch club or the older persons’ club that is delivered in the local village hall. Let us value the yoga class taken by an 87-year-old pensioner—and in case members think I mean a participant, I am referring to my constituent Lily Kennedy, who leads a yoga class of people half her age.
Care at home is one possibility—it is a matter of ensuring that the right level of support is provided by home helps and specialist staff. There is also sheltered housing and very sheltered housing, much of which is provided by specialist housing associations such as Bield. Sheltered housing enables older people to maintain their independence, balanced with the appropriate support.
We must value and support our carers—the army of relatives and friends who provide care for loved ones every day. They need access to respite care, not just in emergency situations—although some councils are restricting eligibility to that. We should encourage diversity in provision and we must not lose sight of the value of prevention. That means funding the lunch club, the yoga class and the befriending project, because we know that they sustain people in their communities.
To meet the challenge of the future we need the creation of a national care service, bringing together primary health and social care in one organisation, with one budget and one focus—on the person being cared for. In too many areas of Scotland, agencies are not working together. They are guarding their own budgets or, worse, cutting budgets in the expectation that somebody else will pick up the work, and it is the person who needs the care who suffers.
It is often said that a society is judged by how well it treats its older and vulnerable people. Let us ensure that our society is well judged.
09:33
The sight of Jackie Baillie holding a mirror in front of her while she tried to gauge the average age of the members in the chamber is not an experiment that I shall repeat.
The debate is timely, and I am glad that it has been secured. In reality, it is difficult to disagree with much that has been said so far in relation to both Mary Scanlon’s motion and the Scottish National Party amendment. The Parliament has placed an enormous emphasis on how we care for the elderly, and our policy in Scotland of free personal care for the elderly has not just been welcomed; it has had a radical effect on how care provision has been sustained. It has called on us all to examine critically exactly what goes on in the care sector. However, having put a spotlight on the sector in that way, we are finding out that, even 10 years on, there continues to be a huge disparity in costs. Mary Scanlon rightly pointed that out and, as Jackie Baillie said, there are not just differences in costs between local authorities and other providers; there are disparities within each group.
Each and every establishment is regulated by the Scottish Commission for the Regulation of Care, but there is quite a wide disparity in the range of services and standards of care in them, which is slightly worrying. That is not to say that they fall below the required standards—I am not accusing the care commission of being negligent—but a wide disparity exists. Of course, we are dealing with individual elderly people who require, demand and, rightly, should receive the highest quality of care.
I have some sympathy with the point that Jackie Baillie made at the conclusion of her speech. She spoke about integration of the model. We do not yet know what the outcome of the reshaping care for older people process will be, but there is a debate and we will not necessarily agree with the solution that is proposed. However, we understand that we must put the microscope on how care services are provided for all our elderly people.
There is a difficult interface. The intended purpose of free personal care was to ensure that more people would be able to stay in their home, but a burgeoning number are seeking places in care homes. There is also the unusual interface with the statistics, which show that the number of hospital admissions is still slightly increasing. We have to understand better the relationship between those three areas before we can be clear that our policy of providing adequately for the care of our older people is being properly directed.
That points to the issue that Jackie Baillie raised. There are concerns about care for the elderly in homes, there is care for the elderly in their own homes and people are still seeking hospital admission. Therefore, an holistic approach is needed to the question of how to shape care in communities. The Liberal Democrats are absolutely clear that, notwithstanding issues relating to the appropriate level and standard of care and the appropriate cost measurement, the structural issue of how we shape care in our communities is behind dealing with individuals’ needs. That means that we should try not to take a silo approach to care for elderly people; rather, we should look at the whole picture of care in the community. I am not sure whether that requires a new, separate organisation, which the Labour Party appears to posit—I look forward with interest to hearing more detail on its policy; instinctively, I feel that the creation of a separate institution is not necessarily attractive—but we must readdress how our elderly people and everyone else in our community are to be properly and financially dealt with. The efficacy of the approach that has been taken is quite worrying. Some statistics that Mary Scanlon has brought to our attention are not easily explicable. We are all aware of the different rates and costs, at different times, for no apparent difference in provision. Such an approach is not good value for the public purse.
We have no difficulty in supporting the general principle that we must consider reshaping care for older people and we hope that the Government will publish the results of the reshaping care for older people process fairly shortly so that we can have an intelligent debate about future provision and can consider the structure. The Government can be assured of Liberal Democrat support if that leads to far greater integration of services and far greater understanding of and openness and transparency about how we evaluate standards of care and how that relates to a more uniform level of costs. That would be much appreciated.
09:39
As Mary Scanlon said in her opening speech, there are 943 care homes for older people in Scotland. Some 174 of them are run by local authorities, 637 are private and 132 are run by the voluntary sector.
Issues relating to care homes, their standards and costs have been raised with me as convener of the cross-party group on older people, age and ageing on numerous occasions. I attended the care conference that the minister mentioned with Mary Scanlon and Richard Simpson. Many issues pertaining to the care of older people were raised at it, and it was very good. I think that 450 providers attended it and they were very aware of the changing demographics, the need to consider different care models and the need to work in partnership with all providers, such as local authorities and health boards. I was impressed by the range of ideas that came forward. Some, such as on telecare, which Mary Scanlon mentioned, were innovative, and some were based on plain common sense. People knew exactly what they were talking about and wanted to provide good care for older people.
The issue of the disparity of costs rumbled about the hall while we sat in it. I am sure that Richard Simpson and Mary Scanlon will remember that the issue came alive during the question-and-answer session. At the time, I said that it was the elephant in the room that people did not particularly want to address. Mary Scanlon’s motion concentrates on the issue, and she spoke about it in her speech. I want to pick up on it.
We were asked questions at the conference and I offered to consider the comparisons between local authority and private provider costs. I have looked at some of the figures, and will refer to them. There is not so much disparity in the average gross weekly charges in care homes for older people figures as some people might think. The Aberdeen City Council charge has been £440 on average per week, whereas the independent figure in the area was £477. The Glasgow City Council charge has been £453 on average per week, whereas the independent figure in the area was £448. The City of Edinburgh Council charge has been £523, whereas the private provider figure in the area was £567. I have more figures and could go on, but I simply want to give members a taster. Things are not as clear-cut as they seem to be. We need to consider the figures. When I said that I would consider the comparisons, I was told that the Local Government and Communities Committee had taken evidence on the subject. Therefore, there is evidence. I hope that we can look at that evidence and that it can provide a basis for seeking further evidence.
It has been said that there is a lot more to the matter than simply providing care homes for older people. Homes can be used for things such as respite. As our population gets older and in need of care, it is our duty to provide it. I emphasise that we must work together to do that. Health boards, local authorities and others need to work in partnership. I am sorry that things have broken down in Glasgow City Council, but I hope that we can get back to working together. People cannot be admitted to hospital simply because there is no suitable accommodation for them with their family, in the community or in a care home. That is an example; I will not give a name. Admitting such people to hospital is not good for the person or the family, and it is certainly not good for the health service. Older people cannot be left to languish in a hospital because a local authority has quotas, as Glasgow City Council has, and they cannot get into a care home or even a house. I know that Jackie Baillie had such a situation in her area. We cannot have such situations, which is why we must ensure that we work together. Doing so is good for the older person, the community and, obviously, the health board. It is obvious that, if someone is languishing in a hospital, they could pick up an infectious disease; indeed, things could be worse for them.
I think that Jackie Baillie mentioned that this is not just about care homes; it is about other things that they can do. We must consider different models. Care homes can be used for respite and other things.
The debate has been consensual and very good. We have explored various avenues. If we explore such avenues and get together with providers, we can look for better care for older people and better care in care homes in future.
09:43
Ensuring that there is good-quality provision of care for all of us in the future unites all members because we have a vested interest in it. We need to ensure that there is such provision for our constituents who require it at the moment, in particular.
Many of us had a variety of experiences in previous incarnations before we became MSPs. I was a full-time trade union organiser and negotiator for the GMB. I worked with care workers, private schools and many trade unionists in local authorities and the independent sector.
One the great things that we had at that time but do not have any more was the fair wages resolution. We also had the Employment Protection Act 1975, which established the Central Arbitration Committee. Schedule 11 of the act was also important. That all meant that a private sector worker could go to the Central Arbitration Committee—as I did on my members’ behalf—which could award pay and terms and set conditions that matched those in the local authority sector. For whatever reason—I do not know the reason—that system has gone. It also provided for equitable holiday pay, sick pay and pensions. It is a huge miss that that is no longer part of employment law. In one instance, when I used the Central Arbitration Committee and went up against Queen’s counsel, we won the case and our ladies from a private school were awarded a rate of pay similar to that of local authority cleaners. The Central Arbitration Committee could also be used in the care sector. However, I have to accept that we are where we are.
I have made great play of visiting the care homes in Fife. I was interested to hear what Sandra White said about the information that the Local Government and Communities Committee has gathered. I will have a look at that, because I am interested in it. In Fife, we have a bigger disparity than there is in the figures that she quoted. Figures have been quoted to me of the private sector cost per week being £585, as opposed to £785 in the local authority. I do not know whether Sandra White has information on Fife, but that is what I was told during my visits to the care homes.
Incidentally, I was hugely impressed by the care homes that I visited in Fife. Some of them are brand new homes and are places that I would not mind having to stay in. They struck me as providing quality care. That is equally the case for the local authority homes, which are very good.
There are cost issues that we need to address, but I am much more bothered by another issue: I know that the debate is not about delayed discharges, but Fife still has the highest number of delayed discharges in Scotland. That has happened before and it is happening again. That is not acceptable, because we now have to count every penny. Care must be top quality, but how can it be right to consider charging £300 per night—that is £2,100 a week—for a national health service hospital bed when the people in those beds want a care package and to be put into a home? That money should be taken from the local authorities, which are the bottlenecks that are holding up the system. It is the taxpayer’s money irrespective of which budget it comes from. The difference between £2,100 a week and £585 or £700 a week is huge. We all need to get our heads round that issue at a time of such financial constraint.
I welcome what the minister said about the £70 million change fund and I echo the points that other members have made about telehealth. My father-in-law is over 90 and I am pleased that he is still at home. God willing, he will stay at home. He may be one of the people who needs a care home, but I hope not—I hope that his family will always be able to care for him.
09:49
I praise Mary Scanlon for lodging such an important motion.
I also put on record my praise for all the staff and managers of care homes in my region, who work hard day in, day out to provide excellent care for our elderly people. In my native Argyll and Bute, there are 24 care homes with more than 600 places for older people. Those homes fulfil a very important role.
I also welcome Scottish Care’s recently published manifesto “Making the case for care: A Manifesto for the future of care and support services for older people in Scotland”. It sets out clearly the extent and gravity of the challenges that face us as we try to reconcile increasing levels of demand and complexity of need, the rising costs of care and support delivery, and the continuing shift of the balance in care away from the acute health sector. Those challenges are set against a backdrop of very challenging public expenditure levels.
Because of all those factors and the need to ensure that available public resources achieve the most efficient results, the Scottish Conservatives will continue to speak out about the disparity that exists between the costs of local authority and independent sector care homes. Scottish Care indicates, as Mary Scanlon pointed out, that the average local authority cost per place per week for non-nursing care is around £800, while the equivalent cost for a place under the national care home contract is around £480. That is a massive difference. The cost per hour of care at home and housing support is estimated at £21 to £25 in the local authority, compared with £16 to £18 in the voluntary sector and £12 to £15 in the private sector.
Having spoken to the excellent Eventide care home in Oban, which is independent, I find that Argyll and Bute Council has done away with the enhanced rate, which added about £40 per week for clients who need extra care. However, the patients in that category still come to the home, which is paid the basic rate of £475, while a self-funding resident next door at the council’s Eadar Glinn care home pays £903. That is an enormous discrepancy and is unfair on those who provide a vital care service on which many of us depend. I do not know whether other councils have also abandoned that category, but it is obviously a cost-cutting exercise rather than a care improver.
Although I recognise the current mixed economy of care home supply in Scotland, we should still scrutinise the 15 per cent or so of care home places—and, indeed, the 50 per cent of care at home and housing support—that local authorities provide and ask why it is so much more expensive than the provision that is offered by the independent and voluntary sectors.
Will the member give way on that point?
As Scottish Care’s manifesto suggests,
“it seems clear that”,
where the private and voluntary sector can provide a stable system of care homes,
“pursuing a phased process of outsourcing has to be the most sensible option, potentially delivering higher volumes of care and support for the same or possibly reduced levels of expenditure.”
Scottish Care also goes on to point out—rightly—that there is no evidence that, in general, local authority-delivered services are of higher quality, despite the higher cost. Why should they be?
That is not an attack on local authority provision for the sake of it; rather, it is about a genuine desire that as many of our senior citizens as possible benefit as much as possible while we ensure the most effective use of taxpayers’ money.
However, it is not only about money: placing a relative in a care home is often an emotional event for their family members. Therefore, it is essential that an esteemed relative or friend be looked after in the best possible way. Confidence in our care system is one of the marks of a truly secure and civilised society.
I will take an intervention.
It is about 10 minutes late.
Does Jamie McGrigor acknowledge that many local authorities, such as the City of Edinburgh Council, are looking closely at their care-at-home services? If they pay £21 an hour for their in-house services compared to £14 an hour for external services, for example, they are trying to work out what the added value is for the £21 an hour. The solution—I think this is the way those authorities are going—is that in-house care would be focused on more complex care, such as for people with dementia, for which the staff have a higher level of training, rather than some of the more routine tasks that other contracts may cover. Is that not a good way to proceed?
You should close shortly, Mr McGrigor.
Of course that is a good way to proceed, but we must prove that the local authorities get extra value for the extra money that they spend. That is the point. At the moment, there is nothing to show that.
Representatives of the independent care sector have also asked me to raise the issue of bed blocking.
I am sorry, Mr McGrigor, but you must be very brief. Your time was up when you took the intervention.
Okay.
Hospitals complained to me in 2007 about bed blocking. Why is it still a problem? The Scottish Government should act—
Mr McGrigor.
All right, Presiding Officer. Bed blocking is still a scandal.
It is fortunate for all of us that we have a little time in hand.
09:55
How can I follow that?
The legacy of ill health and hard lives is partly why we have had care homes of the sort that we have had in the past. The idea of a differentiated service is one whose time has come, and when it comes to the ways in which it is applied across the country, there must be a mixture of providers. I represent small communities in areas of the Highlands and Islands in which there is great pressure on the public authorities to provide that care—it is noticeable that people can run private sector care homes only where there are large numbers of people to be their clients. However, let us put that to one side and recognise the important role of the local authorities in the provision of care.
In the Highland Council area, there has been a long-running saga about whether the existing care homes should be modernised. For various reasons, some of the buildings are no longer fit for purpose. However, it is worrying to see that the way in which the council has gone about doing that has called into question the ability of the council-run care homes to deal with key issues that the private sector is often unable to cope with. For example, the council-owned care homes have been well geared up to provide respite care.
One such care home, Duthac house, which is in Jamie Stone’s home town, has a section that was built in the 1980s and which has been given very nearly top marks by the care commission. If it were run properly and properly maintained, Duthac house would be able to cope with the general run of older people during the next four or five years, which will be a period of austerity. However, the Lib Dem-Labour led council has wasted quite a lot of money on trying to modernise: it has spent £2 million on plans for that, rather than on maintenance. The care commission has criticised some of the equipment, the kitchens and other areas of the care home. I wonder why that money could not have been spent on looking after the existing facilities in these rough, tough times.
I return to the question of disparity. The figures that Sandra White quoted, for which 2006 was the final year, are not completely up to date, but show a clear trend. The disparity in the figures for 2004-05 shows that that was the point at which the local authority’s expenditure increase was much greater than the expenditure increase—or, indeed, the costs—in the independent sector. In 2006, the average weekly cost of a place in a Highland Council care home was £612, whereas the cost of a place in the independent sector was £442—and we know that the disparity has since grown. We must ask ourselves what was going on at that time in the council-owned care homes that caused such an increase in costs. Were the extra costs due to the provision of pensions, better training and the higher quality of the staff in those care homes, compared with others? In private care homes not far from Tain, there are very poor standards that must be improved rapidly. Dingwall, in particular, has been in the news in our area. It bothers me that such examples seem to crop up again and again.
With the £70 million in the pooled budgets for service redesign and a shift in the balance of care, we must try to bring into play the parts of the health service that enable people to lead more healthy lives, just as much as provision for older people. That is worth considering as part of the debate.
10:00
I very much welcome the opportunity to participate in the debate this morning. As other members do, I recognise the complex picture of care and support that is available to older people throughout Scotland. Each of us will be aware of the wide variety of ways in which older people are supported.
Only last week, I was out with the Women’s Royal Voluntary Service in my constituency. The WRVS provides volunteer drivers to help older people to get about and take part in various activities. Last week, they were swimming and using the local gym at Coalburn. The service allows them to get out and about and to stay active. Another project that supports volunteering enables older people to go into schools to support children who may not have grandparents. They provide role models for the children and it enables the older people themselves to stay active.
The care at home that members have talked about is what many older people want; they want to be able to stay in their own homes. However, it is difficult for many local authorities to provide such a service when Tesco can offer potential carers better wages and better hours. It will be increasingly difficult for councils to compete with such employers when one can work 16 hours a week at Tesco, between 4 and 8, rather than work for two hours in the morning and two hours at night. The shifts at Tesco may be easier for someone who has a family to manage. It is, therefore, not always easy for local authorities to provide the care that is needed in rural communities, and it will become more and more difficult for them to find the staff.
Also, staff who have been trained and who have been in post for a few months or a few years sometimes get another job offer and move on. The council then has to go through that cycle again, which is particularly difficult in rural areas. Finding staff is becoming increasingly difficult for both the local authority sector and the private sector, and it will become a greater challenge as more people look for that kind of care. I acknowledge, too, the important role that cottage hospitals play in my constituency.
I represent a number of care homes that are run by the local authority or are in the private sector, and I very much welcome the invaluable role that they play. The decision to move into a care home is often not an easy one. It is often made after a long period of illness, either when the person has been in hospital or when they live at home but have come to the realisation that they cannot stay in their own home any longer. It can be a difficult decision to face.
Both the motion and the amendment talk about
“value for money ... coupled with continuing high standards of care.”
I do not have any difficulty with that. However, that is about best value, and the key to delivering best value in the sector is having well-trained, highly motivated and fairly paid staff. Of central importance is the whole health care team.
Today, we have seen the two faces of the Tory party. Mary Scanlon made a measured speech in which she talked about the whole range of issues. We also saw the real face of Jamie McGrigor, who talked about local authorities paying people too much. My mother, who worked in the private sector, got a pay rise only when the national minimum wage was introduced. That is wrong. I will not apologise for people who clean or do laundry in the private or public sectors being paid a proper wage. The reality is that, if we do not have cleaners doing a proper job, we will have infection in our hospitals, our care homes and elsewhere. It is right that they be properly paid for the job that they do.
Will the member take an intervention?
I do not have time. I am sorry.
We should have catering staff providing people with well-balanced meals that are appropriate for their conditions. We should have care staff providing people with motivational programmes of activities, and we should have properly motivated nursing staff who are well trained and highly skilled. Yes, I will mention the level playing field, but I will not talk about the playing field being levelled at the expense of staff and their wages or terms and conditions. If we are going to do anything, we must do it fairly, across the board and in a way that treats everybody as equal citizens, whoever they are and wherever they come from. That includes the staff, whatever grade they are on and wherever they work.
10:05
I compliment Mary Scanlon on lodging the motion, and on her contribution. She painted an accurate picture of the changing demographics and how we should plan, and she pointed out the variation in care standards and disparity in charging. As my colleague Ross Finnie said, facts are chiels that winna ding and those are solid facts that we have to look at to see what is happening. What Mary Scanlon said about support for unpaid carers was excellent and, as she also said, there are great opportunities to be realised from telehealth.
In her speech, the minister talked in detail about the independent sector, and acknowledged its contribution, which is important. Jackie Baillie mentioned a national care service, which is interesting to us all. Perhaps the minister will return to that idea in her summing up.
My colleague, Ross Finnie, talked about what I would describe as an holistic view of care, and about taking care for the elderly out of its silo. Opportunities could be realised in that area, and I will return to that topic shortly.
I was most interested to hear Helen Eadie’s ringing endorsement of what is happening in her constituency. I venture to suggest that it will be some time before she needs to be looking to the sector for her own care.
Oh, you sook!
No—I am not a sook.
I return to Rob Gibson’s contribution, but not to take him up on what he said about Duthac house in my home town, which is a problem, although there are reasons for that. It was built in the early 19th century as Tain royal academy, and that was where I went to school. [Laughter.]
That explains a lot.
I pay no attention to sedentary interventions and comments from the member sitting on my right.
The design of a 19th century school is completely inappropriate for a care home for the elderly. That is true of care homes the length and breadth of the Highlands in the public and private sectors. Some private sector care homes find the design of the buildings in which they operate very difficult indeed, and the alterations that the care commission requires, such as en suite bathrooms and so on, can prove to be too expensive within a Victorian or older building.
I was glad to hear Karen Gillon talk about the supply of carers, and I think that she was the first member in the debate to make that point. That is crucial, and we see the problem in all our constituencies. Where are the carers to come from? It is proving to be increasingly difficult to recruit and motivate people. Karen Gillon was entirely correct to flag up the point. Part of the answer is to recognise the contribution that such people make.
Mary Scanlon talked about care home provision in remote areas such as my constituency, which is a seriously important issue. Elderly people who hail from remote and close-knit communities wish to spend their later years amid the sounds and scenery that they know and love, but that is not easy to achieve, as Jackie Baillie and others said. However, by bolting on day and respite care, as Mary Scanlon suggested, economies of scale could be realised that would make local care home provision more attainable. Furthermore, by co-ordinating local services as varied as social work, the NHS and private volunteer-based care organisations, we could extend achievable economies of scale that could make local care homes more possible.
The bottom line, as far as I am concerned, and representing the constituency that I do, is that local delivery is a goal that all agencies, including national agencies and local government, should strive for. I am most interested to see whether the minister has something to say about that. If she has not, I look forward to talking about it after the debate.
10:09
I will not go into the demographics because they are very clear. There will by 2016 be a rise of 23,000 people who require care. The only thing that I take issue with in the programme outline is the fact that it begins by saying that Scots are enjoying better health; they are not. They are enjoying longer life, but not better health.
At one time, I ran two care homes in England on behalf of a Scottish merchant bank, so I have experience of the problems of cost differentials and the care commission requiring adaptation of buildings. One home was excellent, but it was in an old building and the adaptations that the care commission required threatened its viability.
The Scottish Commission for the Regulation of Care is one of the best things that Parliament has created. It is driving up standards and, therefore, costs for the independent sector, but that is entirely appropriate. The debate is about costs, and in the social sector, they are approximately £4.5 billion, of which £1.4 billion is in the hospital sector. The debate is primarily about the variation in costs and whether local authority costs, when they are higher than those in the independent sector, add value, and it is about whether there are other reasons for those costs being higher. Mary Scanlon referred to remote and rural areas, where smaller homes can have higher costs.
Training provision with local authorities is statutory, and it is growing in the independent sector. The public sector provides occupational pensions, with contributions of 15 per cent to 18 per cent from the local authority, whereas the private sector sometimes does not provide pensions at all, although it will be required to do so in about 18 months.
Helen Eadie and Karen Gillon referred to pay levels, which are very important. The minimum wage is being paid in parts of the independent sector. Some of the differentials are accounted for and understandable, but Parliament’s job should be to drive up the minimum wage that is being paid in some places to equalise them with the wages that are paid in other areas.
I turn to delayed discharges, which were raised by Jamie McGrigor and Helen Eadie. In July 2010, we were back up to 62 delayed discharges. We are all agreed that the target was zero discharges by March 2008, and we have achieved that since 2008. Each year, we achieve zero discharges by March, but as the year progresses and we enter the worst time of the year for the hospital sector, the number of delayed discharges increases. In the July 2010 survey, the number of delayed discharges had increased to 708 from 634 in July of the previous year. Those delayed discharges are predominantly within six weeks.
When there are 5,000 empty beds, and 17,000 beds in the hospital sector are being occupied by people whose discharges have been delayed, we have to wonder what we are doing, especially in a period of austerity. The median time for delayed discharges has risen from 19 to 21 days, and the mean time is 24 days. If we could clear some of those hospital beds, we could reduce the £1.4 billion cost and provide better wages for those who work in the public sector.
Care must be all about partnership. Our care sector, whether it be private, independent, or local authority, must provide step-up and step-down care, palliative care, respite care, and enhanced care of the sort that Jamie McGrigor mentioned. The nursing homes that I ran did not have contracts with the local authority but with a hospital, in order to take people out of hospital quickly and provide them with enhanced care, which the nurses in the sector enjoyed providing. We must be able to share the risks, so that there are agreed levels of occupancy, and we do not have all those empty beds. We need joint commissioning.
We also need joint inspection. It is a disgrace that the local authority inspects a home on one day and the care commission inspects it a month later. I say to my Liberal colleagues that the Liberal member of the panel at the care conference in Glasgow actually tried to defend that particular piece of bureaucracy. We must get rid of it; it is a nonsense.
Karen Gillon and Jackie Baillie talked about lunch clubs, yoga classes, day care and social events. They should all be being provided across the sector, and it should not be purely a matter for the community or the care homes themselves.
I will finish by talking about the national care service. We believe that the time has come to enhance the excellent joint working that is being done in some areas by requiring that services be put together. We are not talking about creating a new superstructure at the top: we will work within the existing community health and care partnerships to enhance the excellent joint working that is already being done.
I welcome the opportunity to speak in the debate.
10:15
This has been a largely consensual debate, and a very useful one.
Jackie Baillie was quite right to talk about the voluntary sector and support to unpaid carers. To reassure the chamber in that regard, I say that we have made it clear that when local partnerships are discussing how they are going to spend the £70 million of new pooled budgets in their local development plans, the voluntary sector must be around the table at the very start of the discussions, to ensure that its interests are represented in those plans.
There has been a lot of talk about the integration of health and social care, which, as I have said on a number of occasions, I whole-heartedly support. Further, this chamber—following a debate on another Conservative motion, I believe—previously endorsed the principle of the integration of health and social care. However, we should think carefully about the model that we choose. I am pleased that Richard Simpson has clarified Labour’s position, because I think that it would be a mistake to set up a new bureaucracy. In this financial climate, we can ill afford to spend more money on financial bureaucracy and less on the front line. I also think that we have to think about, for example, the cost of transferring 60,000 people on to agenda for change conditions, which would come with a huge price tag. However, other models could achieve the same outcomes that people want but could do so more quickly and less bureaucratically. I am open to discussing what those models might be.
I remind the minister that Orkney has already set up a social care organisation that involves the NHS and the local authority working together. Would the minister like to consider how that model is working?
We are considering that model, and a number of others. Good commissioning models have been tried and tested down south, such as ones that involve the council commissioning the health service to provide adult social care. All that I am saying is that we should think carefully about which model best serves the needs of Scotland.
Ross Finnie—actually, it might not have been him; I think that it was Helen Eadie—
Members: Aw!
Ross Finnie made a number of good points, I have to say.
Sandra White talked about the other uses of the care home sector, such as respite and intermediate care. She was right to point out that the issue is not just permanent residential places; there are many other important uses.
Helen Eadie and Richard Simpson, as well as others, talked about delayed discharge. That is an important issue, and the Administration has given it some serious attention and has made it a priority. I point out to Richard Simpson that the previous Administration set the zero target but never achieved it—not once. We have achieved the zero target at the last three April census points. I accept, however, that there have been in-year challenges in certain areas, and I will be the first to say to those partnerships—
The minister will remember that the situation that we started with in 2001 was one in which there were 2,000 blocked beds of more than six weeks. We set a target of zero blocked beds by 2008, which the current Administration achieved, and I give it plaudits for that. However, the Administration set a new policy that the figure would remain at zero, and it has not succeeded in that regard. It was the current Administration that set that policy, not us.
When we took over, 650 people in blocked beds were over the six-week limit. We have dealt with that. However, we must sustain it. Richard Simpson is right to point out that some partnerships face challenges. I assure members that I have made it clear to those partnerships that they need to get back on track. We have made it clear that the pooled budgets have to be used to redesign services to make that sustainable. That will be one of the top priorities for the use of the pooled budgets.
Rob Gibson made one of the most important points in the debate when he talked about unlocking some of the resources that are caught up in providing services for older people in those acute hospital beds. He is right that those resources need to be released, which is why we will ensure that the pooled budgets can be used to do that. In that way, we can release another resource that can be used to keep people safely in their homes, which is what many members have said they want to happen.
I thank everyone for their speeches, particularly Jamie Stone, who made an excellent contribution. I assure members that the contributions that have been made in this debate will feed into the reshaping care programme that we are taking forward.
10:20
I, too, am grateful to all members for their thoughtful and informed contributions to the debate and for the local examples that they used to highlight some of their points. As Mary Scanlon said, this debate is not intended to be a matter of partisan political controversy; rather, it is intended to draw attention to the important issue of caring for our older citizens, having regard to the demographics of an ageing population and the demands on the public purse, of which we are all acutely aware.
In this case, we want specifically to focus on the situation of care providers in our care homes, whether the homes are run by councils, the private sector or the voluntary sector. Helpfully, the minister earlier set out some of the statistical background and talked about the fact that the overwhelming preponderance of homes are in the independent sector—three quarters of all care homes are in the private sector and 11 per cent are in the voluntary sector, compared with the 14 per cent of homes that are run by councils. In total, those 943 homes provide 39,000 places across Scotland. However, the number of homes has declined by more than 11 per cent over the past 10 years. For our older people who require to be looked after in a care home—notwithstanding our efforts to ensure that people can be looked after in their own homes, through care packages—the key questions to be addressed are how we fund and sustain care home provision and deal with some of the stark disparities and anomalies that exist today, which are neither fair nor equitable, between various categories of provider and between various residents. Those are the questions that we have posed in our motion.
As many have said, why is it that there is such a vast gulf between the amounts that are paid by councils when commissioning care from an independent sector provider, which is done in accordance with nationally determined rates and amounts to just more than £550, and the amount that is spent on care that is provided by a council in one of its own homes, which is funded on a full cost recovery basis and amounts to an average of more than £800 for every resident? Equally, someone who fully funds their own care out of their own savings may well ask why their care charges are significantly higher than those that the council pays on behalf of a fellow resident, in a neighbouring room, who is receiving exactly the same standard of care. Is one, in effect, cross-subsidising the other?
It appears that, at the recent care conference that was attended by the minister, Mary Scanlon, Sandra White, Richard Simpson and possibly other members, the matter that I have just discussed was, unsurprisingly, a hot controversy. Earlier, the minister talked about the controversy and said that we do not want to have an adversarial approach to the negotiation of rates between the providers and the councils, as that would not be helpful, and she is quite right. However, equally unhelpful would be an approach that led to care homes going out of business and the loss of places that we need for our older people, as that would serve only to put far more pressure on our national health service and on domiciliary care costs and would end up costing us more, not less, which is a point that Richard Simpson made effectively in his speech.
Some members tried to explain the disparities, but like Ross Finnie I did not find those explanations wholly convincing. Karen Gillon referred to rates of pay and made some valid points about the impact of the introduction of the minimum wage. She went so far as to suggest that somehow standards of cleanliness vary according to rates of pay and who the employer is. However, as we all know from the tragic instances that have been investigated in many hospitals throughout Scotland, it makes no difference who employs the people who clean the hospitals. We need to learn that sad lesson, rather than make assumptions that are not based on the facts and an analysis of the situation.
I was making the point that we should seek to raise rather than lower the standards of pay for members of staff, particularly those at the lowest level, and make them valued members of the health care team rather than trying to devalue their work.
That is a fair point, but Karen Gillon also criticised the standard of work and said that there was a disparity in that regard, and I was correcting that point.
Will the member give way?
No. I am sorry, I must conclude.
In the consensual spirit in which the debate has been conducted—at least until the last 60 seconds—I am happy to accept on behalf of my colleagues the minister’s amendment to our motion. We look forward to the outcome of the reshaping care for older people consultation and review.
All members will have received in their mailbag this morning a copy of the Scottish Care manifesto “Making the case for care”, to which Jamie McGrigor referred. The manifesto draws attention to some of the problems in the independent care sector, which looks after 35,000 people and employs 100,000 people. We must address those problems and concerns, and ensure not only that those 100,000 people are properly paid but that they continue to work in a sector that is sustained and sustainable.