Plenary, 19 Jun 2003

Meeting date: Thursday, June 19, 2003

Official Report 752KB pdf

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Care Homes for the Elderly

The next item of business is a debate on motion S2M-161, in the name of David Davidson, on care homes for the elderly. There are three amendments to the motion. I invite members who want to speak in the debate, the timing for which will have to be precise, to press their request-to-speak buttons now.

We all acknowledge the fact that we have an aging population, in large part because of improved medical care, which was probably provided in the 18 years of Conservative rule. It is essential that those who need it have the comfort, protection and support of a care or nursing home place when they can no longer be supported or cared for at home or with their family. I am sure that we all agree that our older people deserve to keep their dignity and quality of life in their later years.

My motion begins by referring to the current funding crisis in the Church of Scotland homes, but that is just an example, because the motion applies equally to the rest of the voluntary and private sector homes. Those two sectors have contained their costs and operate more efficiently than do many council homes. However, many are being squeezed further, in that they are losing relief on water charges over a five-year period, which will cost them several thousands of pounds a year. They are now charged around £1,000 a year for waste collection and of course there was the iniquitous national insurance rise last year from the Westminster Government.

Despite the review group that was set up in 2001, which stated that both nursing and residential homes in Scotland were being publicly underfunded, we still have a crisis two years on. In February 2003, after a stand-off, the care homes reluctantly agreed an interim £80 million package. That gave a £332 to £360 per week range for residential support and £390 for a nursing place. The review group is due to report back in September this year.

The homes themselves want to use a report from the Joseph Rowntree Foundation, which recommended that to cover costs payments of £400 per week for residential homes and £459 for nursing care would be required. Joe Campbell, the Scottish Care chief executive, said:

"My view is one of disbelief that the Executive and COSLA have talked incessantly about the need for discussion, yet refuse to talk about the real costs involved in caring for the elderly and vulnerable members of our society."

Ian Manson, director of social work at the Church of Scotland, said:

"While we believe that the cost of residential care is significantly greater than £346 per week, we have reluctantly agreed to accept this baseline figure".

This week, however, Mr Manson tells us that the offer for 2003 of £346 for a residential place and £406 for a nursing place does not compare to the church's own costings, which show a need to recover costs of £390 and £460 respectively. Church spokesmen are quite honest about the fact that if that cost is not met, they just cannot go on. The church's resources have been bled dry, it has spent millions on updating homes and it just does not have the cash flow to offer a service to nearly 900 people in its homes, to say nothing of the people who work there.

Despite matters coming to a head in the church, it seems from the answer to a parliamentary question that I got from the Deputy Minister for Health and Community Care that the Executive, the Convention of Scottish Local Authorities and the independent homes will not meet until 29 July. In the light of the current crisis, I call on the minister to announce today that he will bring forward that meeting and agree to meet urgently with all parties concerned.

Why is it that, despite all homes having to meet the care commission's standards, local authorities—particularly Labour ones—appear to pay themselves more for places in their own homes? Why, if we need the places, is the Executive allowing that inequality to continue? How can the minister see that one home system pays one rate to itself, while looking at other home systems, enforcing care standards on them and agreeing that they do not need so much money?

The Executive must take an interest. We need a sustainable funding agreement, so that our elderly and those needing care are not unsettled or displaced if non-council facilities are forced to close. As Sir David Steel said when he was the high commissioner at the Church of Scotland assembly:

"The crisis in these care homes has become a national scandal".

That is indeed where we are headed, and I do not believe that the church is just playing hardball to get a settlement. It has encapsulated quite neatly and fairly the views of many, many care home operators.

In some areas, the only homes are in the voluntary or independent sector. If they cannot recover their costs, what future is there for them, and what provision is there to keep people near to their family and friends? That is a big problem up in the Highlands. The SNP amendment is similar to my own motion except that it ignores completely the inequality between payments for council homes and payments for other homes. Although we appear to have SNP support, I cannot accept that they do not understand the scandal of the inequality in payments.

In the last part of my motion, I call on the Executive

"to consult with Her Majesty's Government on how people might be encouraged to make greater provision for their own long-term care."

Savings are down, and it is iniquitous that those who scrimp and save seem to be penalised while those who do not bother are looked after. We have a huge problem coming up. John Swinburne has raised part of the issue, although I am not totally in agreement with what he says, as what he proposes is not a substitute for the action that I seek from Government.

We are storing up a future funding-for-care crisis, which will hit us if the situation is not tackled soon. The Government is not doing enough to promote savings or to encourage people to look forward. In its amendment, the Executive demonstrates the Pontius Pilate approach to a problem. It pretends that it has done enough through the interim settlement and, at a time when it is needed most, it washes its hands of the problem. As a result, it even suggests that there are people in homes who need not be there. I look forward to hearing the minister's proposals to assist carer support, because I presume that we will hear how he would help people at home.

The kirk has demonstrated that its reserves have been dissipated with no hopes of recovery. Those arguments hold for other independent and voluntary providers. Will the minister give an assurance to those operators and to those who need the care, along with their families, that the Executive will take immediate action to review the payments on an even-handed basis? I ask the minister to seek the quality of care, monitor it and pay for it evenly, regardless of who provides it. Scotland is watching him today.

I move,

That the Parliament notes with concern the threat of closure to the majority of the Church of Scotland's care homes; further notes that this crisis has occurred against a background of the Scottish Executive's assurance in the last session of the Parliament that funding issues had been resolved; believes, therefore, that this matter needs to be re-examined as a matter of urgency with a view to achieving a sustainable funding agreement and ending inequality in funding between local authority-run homes and independent homes; recognises that there is a longer term issue to be addressed by government, and calls on the Executive to consult with Her Majesty's Government on how people might be encouraged to make greater provision for their own long-term care.

It will come as no surprise that I entirely reject the motion that the Conservative party has placed before Parliament today.

In our ever-changing world, people now live longer and are more likely to survive chronic illness. Many of us are far more likely to use some form of social care service. Some will need those services more than others and some will become frail and need different kinds of care, including the kind of care that is provided by care homes. Our nation's older people deserve a reliable, dignified quality service.

Unfortunately, over the past few years, there have been a number of care home closures. The sector has been reluctant, and sometimes unable, to invest to meet future needs. In 2001, we saw regrettable disruptive action. Selected areas started a programme of action to refuse further referrals from local authorities and in some cases gave notice of withdrawal of service. The real casualties were older people themselves. The threats and counter-threats seriously disrupted the lives of many older people and their friends and families. The situation caused a great deal of uncertainty and worry, which was wholly unacceptable to a great many people and is wholly unacceptable to the Executive.

What we need is stability and confidence in the sector, gained through establishing a proper mix of care provision.

I agree with Tom McCabe's point about the need for consistency and stability in care home provision. I am sure that he will be familiar with a project that is emerging in the Highland Perthshire area of my constituency. We have a Church of Scotland nursing home that faces a very uncertain future in the light of the board of social responsibility's discussions in the past couple of days. However, there is a proposal to reprovision that care in a much wider health care project in the Pitlochry area, involving the health service, the Church of Scotland, the local general practice and a variety of other service providers. In trying to bring stability to the area, would the minister say that that type of project is consistent with the Government's ambitions and aims in relation to the provision of care in Scotland's rural communities?

I hope that you will allow me some additional time, Presiding Officer.

Yes. That was a long intervention.

Thank you.

I do not have a great deal of knowledge about that specific project, although I accept and understand the explanation that Mr Swinney has given of the services that it provides and the way people have come together to provide them. That is exactly the model that we would like to see sustained, both in the Pitlochry area and throughout Scotland.

On the theme of establishing stability and a proper mix of provision, implementing the recommendations contained in the national review group report will go a long way to stabilising the overall market. We have done everything possible to find significant new resources to increase fee levels. That remains a priority for the Executive and I want to see a financial structure for the care home sector that secures a better future for older people and for the care home industry.

The independent expert review group was in no doubt that both nursing and residential homes in Scotland were being publicly underfunded. Before those on the Conservative benches forget themselves, however, I remind them that those homes have been underfunded for a very long time. We have accepted that, as has local government in Scotland. That is why we have worked hard to bring local authorities and care home owners together. We recognise that care homes have faced real difficulties over the levels of fees that they receive. We also recognise that righting the wrongs of the past must be done in a way that does not adversely impact on vital services. That is why we have made an unprecedented national contribution—in time, effort and money—to improve the situation.

The independent care sector, including the Church of Scotland, accepted the Executive and local authority offer to increase care home fee levels for older people from 1 April 2003.

The minister seems to be talking about the future, but there is a crisis now. Is he prepared to have an urgent meeting with those whom he has mentioned, to listen to them and examine their evidence? Many homes might not exist at the end of September, never mind next year. Will he also assure us that he will deal with inequality in the funding system between council homes and other homes?

I will go on to explain exactly how we have tackled the situation and reached agreement with all parties in the sector on what we will do in the future.

The agreement honours the earlier commitment of ministers to meet the fees that were recommended by the national review group. In the light of that group's findings, the Executive made available £52 million of taxpayers' money to local authorities from 1 July 2001 to 31 March 2003.

The agreement on the uplift of fee levels from 1 April 2003 amounts to almost £80 million above the 2001-02 baseline and provides for a 1 per cent real-terms increase a year to the fees that were recommended by the national review group in autumn 2001. That is what we have done to stabilise the market. A significant amount of taxpayers' money has been applied to address the situation.

Since 2001, average fees in homes without nursing care will have risen by 33 per cent, and there will have been an increase of nearly 21 per cent in homes with nursing care. That takes extra expenditure on the care home sector to more than £130 million from mid-July 2001 to March 2004. Such substantial increases carry forward into the baseline for future years. Therefore, how can any member accuse the Executive of having failed to deliver on care homes? The national review group made eight important recommendations and we have jointly delivered on each and every one of them.

We are committed to ensuring that quality care home services that are regulated within the framework of the national care standards can continue to play a vital role in meeting the community care needs of Scotland's older people—I know that the Church of Scotland is committed to that, too.

Will the minister give way?

No—the minister is over time.

I assure the Parliament that I am fully aware of the Church of Scotland's financial plight. I also recognise the long and distinguished record of social care provision that the Church of Scotland has established. A review of services for the elderly is under way and a report will be presented tomorrow. I met the kirk's director of social work only yesterday and we discussed some of the church's concerns and the review. I know that the Church of Scotland is committed to a genuine effort to ensure that its care services are fit for the 21st century.

Minister, you are well over time.

However, it would be wrong to speculate about the detailed contents of the report. I know that the Church of Scotland intends to conduct a full consultation on the report and that no firm decisions will be taken until October. I warmly welcome that sensible approach. It is only right and proper that all who are concerned are given adequate time to consider and discuss the issues that the report will raise. I believe that the care home sector can now look forward to a brighter future, as can many of Scotland's older people.

I apologise for being over time. I move amendment S2M-161.4, to leave out from first "notes" to end and insert:

"acknowledges the problems faced by some Church of Scotland care homes but recognises that the Scottish Executive has met in full the recommendations of the National Review Group on care home fees which resulted in an extra investment of over £130 million in the care home sector since July 2001; welcomes the work currently being undertaken by COSLA and the care home sector in establishing a framework for assessing the cost of providing care for older people from 2005-06, and notes the continuing commitment of the Executive to shift the balance of care from institutional settings to providing care at home and its setting up of the national care standards which provide a quality framework."

I need to draw attention to a personal interest that could be seen as relevant to the debate—both my sister and my wife's sister are employed as nurses in private care homes.

That the Executive recognises that there is a problem is great, but it has not yet found a solution. It is also great that the minister focused on people, as they are at the core of the issue. By contrast, the Conservative motion speaks about people only in relation to funding.

It has been said:

"The crisis in these care homes has become a national scandal".

Those are not my words—they are the words of David Steel. The abandonment of our elderly people and the neglect of residential nursing homes are a badge of shame for the Executive. If only it raised the amount that was paid by the 60 per cent that Mr McCabe raised his speaking time in the debate, we would not have the current problem.

The Scottish National Party has just fought a general election and promised not one penny extra to the care home sector. Therefore, how on earth can the member criticise the Executive?

If the member goes to section 3.1 on page 6 of our manifesto, he will find the appropriate references at the paragraph at the bottom. [Interruption.]

Order.

Today, we must consider the decline in the effective funding of the sector and the decline in the number of care homes from 681 in 1998 to 605 last year. The number of beds has declined from 16,677 in 1998 to 14,851 last year, which is the lowest level since 1984. Another 880 will also leave the sector shortly if the Church of Scotland closes its homes.

As a consequence of the lack of places that are available in homes, the number of people who are waiting for discharge from hospital is at record levels—some 514 are now waiting for discharge; three years ago, 334 were waiting. There has been a dramatic uplift, which has taken place against a background of a rising trend of older people in our society.

We do not have to look far for the cause of our troubles. I say to the minister that there is more money in the sector, for which the sector is grateful, but that it is clear that there is not enough money. Weekly charges that are paid to care homes by local authorities for looking after residents fall short of the amount that is needed per resident to provide a decent level of care.

What amount is required? The figures of £390 for nursing care and £332 to £360 for residential care were mentioned by Scottish Care, COSLA, the Church of Scotland, the Salvation Army and the Scottish Executive, but it took two years for the Executive to get to the appropriate level. With money already short, we are now looking at another review that will come in only in 2005-06. If the Church of Scotland closes homes in the voluntary sector, it will make matters dramatically worse, as the people in question will have to go somewhere. Utilisations in other homes will rise. The costs that are borne by voluntary organisations will rise and there will be a cascade of further closures. The three-legged stool of the local authorities, the private sector and voluntary organisations will be unstable if one leg is sawn off.

Our elderly population deserves better than to be treated in the shabby fashion in which the Executive has treated them. The Executive must thoroughly review the true cost of care in Scotland now and take the necessary steps to do so in early course.

I move amendment S2M-161.1, to leave out from "believes" to end and insert:

"regrets that the present funding levels to the voluntary and private sectors leave vulnerable older people exposed to disruption and distress at a point in their lives when they deserve support and stability; believes that the Executive should undertake an urgent review of funding for the care home sector based on an analysis of the true cost of care, and calls on the Executive to carry out an urgent review of bed provision in care homes in order to establish and commit to a long-term plan for the sector."

I thank David Davidson for using the Conservatives' parliamentary time to raise one of the issues on which our party fought the recent election. Residential care was one of the most sensitive issues that was raised at our meetings and we touched a raw nerve among the elderly every time that the topic arose. It was harrowing to listen to the anguish with which some people of my generation expressed their disgust at the manner in which some of their friends or relatives were being treated by the so-called welfare state.

I fully support the sentiments that have been expressed about the crisis that is being experienced by care home providers, particularly by the Church of Scotland care homes. Without doubt, there is a need for a re-examination of the exact costs of providing care for the elderly in care homes.

David Davidson's motion calls on the Executive

"to consult with Her Majesty's Government on how people might be encouraged to make greater provision for their own long-term care."

The Chancellor of the Exchequer advocates prudence at every opportunity but, sadly, all those senior citizens who exercised prudence throughout their working lives are now being penalised in their retirement by means testing, which is a throwback to the dark days of the depression of the late 1920s and early 1930s.

Means testing has no place in the 21st century. Even the World Bank does not consider it to be feasible, due to its complexity, inefficiency and high administration costs. For example, how can anyone justify two neighbours who lived in identical council houses and are now in residential care finding that the one who owns her home must sell it to pay for her care, while the neighbour who does not own her home has her fees paid by the state? That is discrimination. I implore the Executive to remedy that by removing means testing or we will seek action through the courts—we will take the matter all the way to the European Court of Human Rights if need be.

Means testing is an anachronism. A whole stratum of bureaucracy, which is maintained at a ridiculous cost to the Exchequer, is dedicated to making elderly people's lives a misery as their hard-earned savings are plundered and they are robbed by the so-called welfare state. That has gone on for far too long and it must be brought to an end now. I believe that there is now a deferred payment scheme, which indicates that some civil servants have a conscience. They will now, in certain circumstances, wait until people are dead before they plunder their resources.

Another issue that is raised continually is the variation of care from one home to another. I emphasise that the vast majority of residential homes are excellent. However, there are more than 35,000 residents in care homes in Scotland, so if 1 per cent of them are not receiving the care to which they are entitled, that means that 350 elderly people are being neglected at a time in their lives when they are at their most vulnerable.

The operation of the care commission in setting care standards is very welcome, but we must be concerned about the charging implications for homes that register with the commission. Service providers are facing greater costs because of the registration fees that are charged by the care commission, which it is anticipated will be self-financing by 2005 through the recovery of those fees. Will the Scottish Executive give an assurance that the fees will not be passed on to the residents?

I understand that visits to residential homes by the care commission should take place at least twice a year and that one visit is at an agreed time and the other is a random check. Residents would be happier if all visits were made random. I have had correspondence that urges me to advocate that relatives and friends who visit people in residential care should occasionally visit outwith normal visiting times; they may be shocked by what they see on the odd occasion.

The problem will only get worse as time goes on, because by 2040 it is anticipated that there will be more than 16 million people over pensionable age in the United Kingdom—that could include some of the members in the chamber today, so take care.

I move amendment S2M-161.3, to leave out from "there is" to end and insert:

"means testing discriminates against residents who have made provision for their long-term care and calls on the Executive to provide long-term care for the elderly without such discrimination."

I am glad that the Conservatives have given us the opportunity to debate the crisis that faces the Church of Scotland. My only regret is that they have failed to allocate enough time to have the issue properly aired and debated in the chamber. The issue deserves much more than the mere 75 minutes that the Conservatives have allowed. Frankly, I go so far as to say to the Presiding Officer that there should be rules in the Parliament to end the practice whereby the Opposition parties can divide up their debating time like this. It has more to do with media soundbites than with getting a serious and detailed examination of all the issues involved. The issue is far too serious to be dealt with in this way.

Will Mr Rumbles give way?

I would love to take interventions, but unfortunately I have only four minutes because the Conservatives are not allowing sufficient time for the debate.

There is no question but that the Church of Scotland, which is the largest of the voluntary sector providers of residential care, is facing a crisis as it strives to cope with the cost of running all its 29 residential care homes.

The church's board of social responsibility has for many years highlighted its problems in running its homes within the budgets allocated from our local authorities, and the church has run with a deficit of about £6 million a year. Last week I met Ian Manson, the director of social work of the church's board of social responsibility. He outlined the crisis that the church faces. Earlier this week I met the Deputy Minister for Health and Community Care to examine the issues that Ian Manson raised.

The Executive has not been slow in addressing the issues. Back in 2001, a national review group, which included the Scottish Executive, COSLA, Scottish Care, the Salvation Army and the Church of Scotland, agreed that care home fees should be raised from £295 to £390 a week. That was a substantial rise. As recently as three months ago, a further agreement raised the fees to £406 a week for nursing and £346 a week for residential care. In addition, those figures will now be regarded as a minimum payment for local authorities and not as a guideline figure that could be undercut. Furthermore, ministers agreed to establish a working party to examine the true costs of care for the elderly, which met for the first time last month.

The well-respected Joseph Rowntree Foundation recently undertook its own research on care home funding. It came up with the figure of £459 a week for nursing care and £353 a week for residential care. Although there is little difference—£7 a week—between its figure for residential care and the agreed figure, there may be a funding gap of £53 each week for nursing care. The true gap could be more or less than that, but that is precisely the point. We need an accurate and agreed measure of the costs of residential and nursing care and we must be determined to achieve that.

The Church of Scotland has now completed its own review, which assesses the viability of all its homes throughout the country, and its report will be examined tomorrow. The important point to remember is that the church will not be rushing into the closure of any of its homes, but will be leaving no stone unturned in trying to deliver a sustainable future for them. I hope that at the very least the church will not rush to make any final and irrevocable decisions until the Scottish Executive has had the opportunity to examine the conclusions of the working group on finding the real costs of care and to take action on its recommendations, whatever they are.

I am sure that the Parliament notes with concern the threat of closure that faces some of the Church of Scotland's care homes, but the facts are that the Scottish Executive is committed to finding out the true costs of care and then tackling the issue.

I urge the church's board of social responsibility not to take any action that threatens the well-being of the many elderly residents involved before it has had the opportunity to assess the results of the working party on care costs.

Members are aware that this is a short debate. I am looking for speeches of four minutes.

As we have heard, demographic data suggest that we are all living longer and that the number of elderly people is growing. We must keep that context at the forefront of our minds when we debate the provision and funding of care homes.

We are fortunate in Scotland to have a diversity of care home provision from local authorities, the private sector and the voluntary sector. As we have passed the Regulation of Care (Scotland) Act 2001, we can be assured that the standards of care in each and every home, irrespective of provider, will be the best possible in the interests of our older people.

The key issue that is before us today is funding. That has been highlighted by the fact that the Church of Scotland is considering the future of its care homes throughout Scotland. It is doing that because it cannot afford to continue running its care homes at a loss. We all acknowledge that over the years it has dipped into its reserves to the point where very little is left.

I declare a constituency interest, which I know the Deputy Presiding Officer shares; it is Clydeview Eventide nursing home, which is a possible candidate for closure. It celebrates its 50th anniversary this year and is located in Helensburgh. There is concern locally about the prospect of closure. There is concern, as would be expected, among the families that are affected, but also among the wider community. There are no local authority-run homes in Helensburgh. There is insufficient capacity to meet current demand, never mind demand in the future, which, we all acknowledge, is likely to increase.

Closing Clydeview Eventide nursing home will seriously affect the quality and capacity of service delivery. Let us not forget that another consequence of closure is that hospital delayed discharges will increase in the local area.

It is worth noting, as some members have said, that there is a discrepancy between the cost of local authority-run provision, at an average of £374, and that of private and voluntary sector-run provision, at an average of £288. Although those figures are from 2001 statistics, it is still true that there is a differential. That remains the case in Argyll and Bute Council's area, which has one of the worst differentials in Scotland, with a unit cost for local authority provision of £483 and a unit cost for everyone else of £265. We need to understand why that is and address the inequality.

I recognise that the Executive has provided substantial additional resources—£130 million since July 2001—to implement the national review group report in full. Coupled with investment in free personal care and nursing care, that means that we are now delivering unprecedented resources so that older people can live with dignity and security.

I welcome the establishment, with COSLA, of the joint working group that will further examine the true costs of care and develop a method of assessing costs for the future. It is essential that we plan for the future as well as dealing with current challenges.

I urge the minister to press Argyll and Bute Council on the need to take urgent action to retain the Clydeview Eventide nursing home in Helensburgh. As I have said, the area has an increasing elderly population, already lacks capacity of delivery and, in any case, has no local authority provision.

I know that the local authority is concerned about the financial implications of funding the Clydeview Eventide home—although that would require only a small revenue commitment—because of the impact on the issue of equity for other providers.

The retention of the Clydeview Eventide home is an urgent issue. If the minister can intercede with the council, I am sure that the Church of Scotland, older people and the wider community would be most grateful.

To allow as many people to speak as possible, I will try to obey your time stricture, Presiding Officer.

Today's debate takes place against a background of an aging population and the fact that the elderly are living longer—issues that will not go away. A financial crisis is affecting all the sectors and the Scottish Executive will have to grasp the problem.

When the churches offering the highest standards of care and Christian service find that their care homes are bankrupting them, it is time that we all paid attention. Arguments about whether private, public or voluntary provision is best are completely sterile and detract attention from the real issue of standards of care and what those standards really cost to maintain.

The problem will not be solved simply by throwing money at it; the Executive has to take on the task of objectively calculating and ensuring the correct level of finance required. If we allow there to be a continuing decrease in the number of homes and available beds, allied to increases in the number of people waiting to be discharged from hospitals, the problem will be even more difficult ever to solve sensibly.

I have first-hand experience of the high levels of care in the range of Angus care homes that I have visited or officially opened. Angus Council provides resources at a level above nationally set levels, including the provision of care workers and domestic assistance services that the social work inspectorate describes as excellent, a care package including shopping, domestic care, social meals and a major increase in meals-on-wheels provision and a community alarms service. The council's belief is that one hour of domestic service provided at an early stage can be crucial in allowing people the choice of remaining in their homes.

The Executive must recognise demographic reality. The balance in the provision of service is shifting from residential or nursing home care to allowing people to receive the required level of care in their homes. That shift in emphasis, allowing independence and a high level of service away from the residential home setting, will free up spaces for those who require care home service provision. I commend the Angus Council very sheltered housing project to the Parliament.

By concentrating only on the—albeit substantial—financial and other problems of residential homes, there is a danger that we will miss out on the wider picture and the needs of our elderly population. We need from the Executive a recognition of demographic variety and the proper balance between residential nursing home care and the provision of services that allow people to receive the required and appropriate level of care while remaining in their community.

The care commission must strike a balance between moving standards forward and the reality of what can be afforded in achieving a proper mix of care provision.

There are no easy solutions to this complex and growing problem, but the goal should be to aim at a solution that provides what is best for the client and gives them a choice.

The Executive's opening response to this debate was brutal, disappointing, inadequate and lacking in any apparent understanding of the crisis facing the system. I urge the Executive to listen to the Church of Scotland and the other providers. The Executive must think again and act.

I must remark on the cheek of Michael Rumbles, who used a quarter of his precious time to complain that we had not given him long enough to speak. He supports the Government, which is his choice. If he joined the Opposition, he would have more time to speak and more opportunity to influence the length of debates.

The minister tells us that the market has been stabilised, but homes have closed and more closures are threatened. The market—a market that is distorted by the state's dogmatic intervention—is anything but stable. What has gone wrong? The facts do not lie: private and voluntary homes are being paid less than cost to take residents. There can be no justification for that. The state funds local authority homes by, on average, £150 per person more than other homes, even though standards are expected to be the same in all homes.

The minister gave an interesting answer to Mary Scanlon's question about whether private and public sector homes would be paid the same, given that standards are meant to be the same. The minister said that they would not be paid the same, and that local authority homes were entitled to recover the full cost of care—that is an admission that private and voluntary sector homes are not receiving the full cost in funding.

What is the full cost?

I inform Mr Rumbles, although he asks his question from a sedentary position, that the full cost varies among homes. However, it is clear that the difference between the average funding for the various homes is different. It is therefore possible that, if we raised the unit funding by £50, far more homes would stay open.

In Stirling, the unit cost for local authority provision is £450, but it is £280 for private and voluntary provision. There are two reasons for the difference. One is the inefficiency of local authority care homes, which means that it makes sense to raise the payment to private—

Will the member give way?

I do not have time.

No time!

One of the reasons I have no time is that I have already dealt with Mr Rumbles's sedentary intervention.

It makes sense to raise the payment to private and voluntary homes, so that they can not only meet their costs, but expand and drive costs down.

Examining the facts shows us that funding the costs of the private sector—even on an average basis—and therefore allowing it to expand, would enable more care to be provided for the coming demographic bulge.

There must be a recognition that overall provision must grow. At the moment, provision is shrinking. By changing the funding mechanism and doing more to ensure that people who are looking forward to their later years make savings now, we can ensure that provision is made for spending, that provision grows and that there is funding for that. That will mean that the local authority homes' call on public funds will not be as demanding as it is now.

The minister's and the Scottish Executive's resistance to implementing those solutions is the result of a dogmatic approach and ensures that this crisis will only get worse.

I want to make one short-term point and one longer-term point.

I would like an assurance that, if affairs come to a crisis—if talk of a crisis is not just brinkmanship and blackmail—and some old people are going to be put out on the street, the minister will intervene and give some money to the local authority or to the home directly, without any prejudice to a longer-term settlement, to ensure that that does not happen. I know that we cannot indefinitely bail out people if we do not have the money, but it is essential that, while the matter is being sorted out and a proper investigation is being carried out into what costs are fair and real, we ensure that nobody suffers in the short term, which would be a real disaster for all concerned.

Does Mr Gorrie accept that Ian Manson, from the Church of Scotland's board of social responsibility, has said repeatedly that there is no prospect of old people being "put out on the street", as Mr Gorrie puts it? The church has been very careful in its use of language. We should try not to scare people unnecessarily in a situation that is already difficult.

I certainly do not intend to scare people. I am trying to get an assurance that, if a crisis occurs for whatever reason—things are not always in our control, whether Holyrood buildings or other things; we cannot guarantee the future—the need will be met while the longer-term issue is sorted out.

Elderly people who live longer and therefore often have to be supported are a major issue affecting our society and I suggest that we explore some all-party approach to the issue. I do not mean political parties only, but an approach that involves central Government, local government, even our colleagues at Westminster—we might have some sort of joint body, which would be a step in the right direction—and those who supply the services to consider a proper long-term strategy for dealing with the issue. In politics, it is hard to look beyond the next election, but this issue will run for many years. We should try to achieve a settled way of dealing with it and get that geared up. I suggest that we investigate the possibility of having a wide-ranging review in the long term to try to get a consensus to deal with this important issue.

There seems to be general agreement that there is a crisis in the provision of care for the elderly. I would like to hear the minister's view on the matter. Does he agree that there is a crisis?

The point that I wanted to make in an intervention on Brian Monteith is that I am waiting for the Tories to spell out what the last line of their motion means. I hope that that will happen in their closing speech. That line reveals what the Tories are all about. They hang on to the crisis in provision of care for the elderly and bang on about the faults, numerous as they are, but then comes the killer punch:

"how … to make greater provision for their own long-term care".

Now we know what their intention is.

I will answer briefly. What we anticipate is Government encouraging participation in the discussion as to how those who earn a good wage and do not necessarily need much state provision are encouraged to make savings for themselves. There will always be people who cannot cope. We have to identify a big problem for them too.

There is an easy answer to that without means testing: tax those who earn more money to pay for national provision.

A disgraceful situation exists. The Church of Scotland has subsidised care homes to the tune of £23 million of its reserves since 1990. Estimates require a further £50 to £100 per resident, which means that the increased investment that is referred to in the Executive amendment needs to be doubled to save those homes and maintain current provision.

The Executive amendment also refers to shifting care into the community. That is a good idea until we examine the reality of the provision. People are waiting for perhaps four hours for their allotted care package to arrive so that they can go to the toilet. That is happening daily. Only last week, a new employee of a private agency contracted to a local authority reported to me that she, who was untrained and unprepared, was sent into homes to move and lift clients and operate hoists. Clients were desperate for her arrival, but her inability to operate equipment effectively left them hanging on even more desperately to pass urine. That is the reality of current provision in the community.

My mother has struggled to have her needs assessment implemented. As for aids and adaptations, when she came out of hospital after suffering a stroke, she waited for six months to be able to have a shower. She spent six months without a shower or a bath and was only able to be bed-bathed. That is the reality of current provision in the community.

We face a demographic time bomb. The Scottish Parliament has no powers over income tax banding, no powers to raise the higher rate and no powers over corporation tax. However, without radical taxation and redistributive measures in the long term, our senior citizens will face even more hardship and indignity in future. Care of whatever kind for senior citizens should be free at the point of need for those who require it and should be of high quality. That is a great challenge and we must recognise it honestly. There must be a commitment to provide a decent and dignified future for our senior citizens and for all people who require long-term care—not only senior citizens—without means testing. That is why I support John Swinburne's amendment.

In the meantime, catastrophe could be avoided in the short term by bridging the current financial gap. I believe that there was an underspend of £640 million last year. Labour members can tell me how. Some of that money would go a long way to alleviating current pressures. What will the minister do to solve the current crisis? Does he agree that there is one?

I am pleased that we have the opportunity to debate the subject today. My first point is the need for increased provision over the wide range of care that care homes cover.

It is interesting to think of Brian Monteith as a demographic bulge. He was right when he spoke of the growing need in Scotland over the next 20 to 30 years. Whether in the private, local authority or independent voluntary sector, we need to put our collective heads together to determine how that provision can be made, can be made sustainable, and can be made to suit the needs of those who use it. That is the basis of the work that COSLA and the local authorities are doing in a review, which is being carried out together with the care home providers. The review aims to find out what the issues are, local authority by local authority; as was pointed out, the issues are different in each area.

In spite of the Tories' public bluster in the chamber, they know that many of their supporters in the private care home sector are delighted with the Scottish Executive's £130 million investment, which will bring fees up to £346 for residential care and £406 for nursing care and which are designed to achieve equality across the range of sectors and providers. I understand that some of those who were active in the Scottish campaign have been recruited south of the border to see whether they can get the same deal down there.

In addition, there has been investment in "Fair Care for Older People", which is not means tested, so that all residents of homes, irrespective of income, are able to get personal care or personal and nursing care after assessment. That has meant that they are helped to meet the cost of their care needs.

When I spoke to the Church of Scotland in Inverness earlier this week, it mentioned the £346 but said that councils paid over twice that amount per person per week in their homes. Is that equality?

I will address that point in a moment.

I contend that the argument about whether local authorities favour their own homes over those of other providers is a spurious one because community care legislation offers choice to individuals. Therefore, positions in homes are often determined by the choice of those individuals. Nationally, 42 per cent of homes for older people are privately run, compared to 33 per cent that are run by local authorities. That choice must be expanded so that there is a range of provision.

My second point concerns nursing care, which has the fastest-growing need. Throughout Scotland, nursing care is provided almost entirely by the independent voluntary sector and the private sector. Discussions are continuing between my local authority care home providers and NHS Fife to increase that capacity.

Members will know that one of the biggest success stories is developing measures to keep people in their own homes and to prevent their going into hospital or into care so that their quality of life is sustained and their longevity is assured. That is an area for which the private sector makes virtually no provision; it is almost entirely local authority provision. That means that the number of places is greater.

I have read the briefing from Ian Manson and the Church of Scotland's board of social responsibility and I have considered the range of its review. I urge the chamber to allow time for the review to be examined so that the capital and revenue issues that the church faces can be discussed.

I support the amendment in the name of Tom McCabe.

Four years ago, I was my party's spokesperson for older people. There was a crisis for elderly people in care at that time; the crisis has simply worsened. There is no time for reviews. We have been in this chamber for four years and things are getting worse for Scotland's elderly people. We do not need to look at the statistics.

Members should read the petitions that come to the Parliament from people who are concerned about their elderly relatives. St Meddan's in Ayr has closed. Cockenzie House in Prestonpans is threatened with closure. Human misery is the result. There are people in Cockenzie House who have been moved twice already from other homes that have closed and now they are under threat of it happening again. They are frail, elderly people.

The benefit for the establishment is that those people might die off and solve the problem for them. That often happens when people are decanted.

I come to the question of the discrepancy between local authority payments and private sector payments. The private sector provides nursing care that is more intensive and that costs more, yet it gets less money. I have never yet heard an explanation of that differential of £50 a week. However, I know that when a private nursing home does not have enough money, it often has to approach the families to make up the difference. That subsidy should not come from taxpayers.

There are horrific stories on my desk about what is going on in some of the care homes in Scotland. There is a home in the Borders which, if half the stories are true, will be closed. I will not go into the details because they have to be corroborated elsewhere, but the home has already been reported to the care commission. Carolyn Leckie referred to part of the problem. People are being taken off the streets to work in care homes for low pay. They act as care assistants, but they are not able to do the work; they know nothing about caring for the elderly and certainly not for those with dementia.

Does the member share my condemnation of the fact that, because of tight financial constraints, those who are self-funding in care homes are being asked to pay between £100 to £200 a week as a subsidy. Is that fair?

I never thought that I would defend private enterprise in this way, but the only place that people can get nursing care is in the private sector because local authorities do not provide it. They have been left with a dirty deal.

We could have used the benefits clawback from implementing free personal care. It was an absolute disgrace that Westminster got all that money that could have been retained for Scotland and distributed to elderly people who want to stay at home. Let us get the money back, let us fight for it. Westminster has no right to keep that money. It came from Scottish taxpayers, and our elderly people must get it back to ensure that they receive the care that they have earned and deserve.

Everyone is right to be desperately concerned about the predicament faced by the residents and staff of Church of Scotland homes. Indeed, members throughout the chamber are united in their concern about the implications of the decision that might be announced on Friday.

Two homes in my constituency will be affected by tomorrow's announcement. Forty-two residents and 50 skilled staff will find out their fate. The prospect of closure is hanging over them. However, I must emphasise that, even if the closure goes ahead, the Church of Scotland has left the door open for a rescue plan. As Kenneth Macintosh rightly pointed out, tomorrow's decision will not be definitive.

That said, if the closure goes ahead, 42 residents will have to find alternative accommodation. As only 13 places are available in my constituency, many of them would have to move out of the area.

Will the member give way?

I am sorry, but I have only three minutes.

The real fear for the residents is that they will have to move. Certainly that would be a huge challenge for those in the Auchinlee Eventide Home in Campbeltown, who might have to move to a care home in the central belt. The impact of travelling and on friends and relatives would be quite severe and it would mean that we would lose another vital service.

We have to hope that, in September, the working party will make recommendations that can be agreed. The Executive's track record shows that, once agreement is reached, we fund it. Indeed, we have already done so.

Will the member give way?

I am sorry. I have only three minutes and I need to get through these points as best as I can.

Tom McCabe made it clear that we have already allocated substantial amounts of money. I hope that, when the working party's recommendations are published, we will be in a position to meet its requirements.

Jackie Baillie highlighted real concern that, according to Argyll and Bute Council's figures, the area has the biggest inequality in care home funding: the council's homes have a unit cost of £483 whereas homes owned by the private or the voluntary sector receive an average of £265. Some of that inequality is due to the fact that the two council-run homes are on islands, but no one could substantially argue that that factor accounts for the whole inequality. It cannot be explained by additional costs because of location alone. The council faces a big challenge in dealing with that matter.

I listened to the scaremongering and righteous indignation of Stewart Stevenson, Andrew Welsh and, of course, Christine Grahame. This issue is too serious to be politicised in such a way. In fact, when I challenged Stewart Stevenson on what the SNP would do with the extra money he mentioned, he referred me to the SNP manifesto. But all it says—

Mr Lyon, there really is no time for a long quotation.

The manifesto says only that, as a matter of urgency, the SNP will look to see what action requires to be taken to resolve the problem.

I was about to start my speech by saying that we have had a very good debate—[Interruption.] If George Lyon wants to go on, that is fair enough, but I for one do not want to listen to any more of his ramblings.

The debate has been very emotive. Indeed, I see that George Lyon is getting emotional himself. We must ask a number of questions, one of which has already been answered by several speakers. If the Labour and Liberal Democrat coalition is really spending more money on care homes, why are they closing down and why is the number of places decreasing?

I think that all members know the answer to that question—I hope that I will have time to address the points that Duncan McNeil has been making—which is that the Labour and Liberal Democrat Executive's financial contributions are just not enough.

In its amendment, the SNP calls for an urgent review not only of the Executive's financial contribution, but of its long-term plans for and commitment to care homes. We should all support the call for such a review.

I agree with David Davidson that the meeting that is to be held on 29 July must be brought forward. Even the care home owners and the Church of Scotland say that the meeting must be held sooner rather than later. I sincerely hope that the minister will agree to hold the meeting sooner.

Stewart Stevenson was absolutely right to talk about people and not profit. We should not forget that care is about people and that people are much more important than profit.

The SNP fully supports John Swinburne's amendment, which mentions means testing, and we will vote for it at 5 o'clock. John Swinburne mentioned the announcement of inspections of care homes. I remind him that there are two types of inspection—announced and unannounced. The care commission has admitted that it has not been able to follow through the system of inspections. That is unfortunate. Will the minister examine that issue? I believe that it is not enough to have two inspection visits—and even those visits are not always carried out at present. There should be more visits, especially unannounced ones. That issue is a great anomaly in the work of the care commission and it should be considered.

Andrew Welsh and Carolyn Leckie mentioned care in the community, which is a good concept that has never been funded properly. Care in the community must be considered carefully and properly costed and funded.

I have a couple of seconds of my speech left, so I will mention Duncan McNeil who, as usual, has been muttering under his breath about spending, spending, spending. I remind him of one point: when Gordon Brown decided to go to war with Iraq, he had no qualms whatever about spending millions of pounds.

I remind members that some of the people who are in care homes have been through two world wars. It is time that we got the finger out and owned up to our responsibilities for those people.

This subject is important and deserves more objective consideration than it received in the speeches of Conservative and SNP members. In response to Andrew Welsh's rather ungracious comments, I point out that any brutality has come from the blatant distortions in the SNP amendment, not from the Liberal or Labour parties. The sooner Mr Welsh dissuades himself from using a soft voice to play games with peoples' lives, the better it will be for everyone.

We have heard enough of Mr Welsh's distortions—he should sit down.

It might be useful if I try to summarise our achievements to date and where we are prepared to go. On care homes, we have honoured in full our earlier commitment to meet the fees recommended by the national review group. Frankly, it is simply not good enough for organisations to sign up to those recommendations one day and then to claim that they reject them the next. Since July 2001, we have made available an additional £130 million of taxpayers' money to uplift fees in care homes. Under any interpretation, that is a significant amount. In partnership with our colleagues in local government, we have provided to care homes nearly £80 million in this year alone to increase fees. That money will be carried forward into the baseline for future years.

Our achievements since 30 November 2001—the day on which we received the national review group's report—are nothing short of remarkable. We have done our bit and I am pleased that our commitment to care home owners has been matched by that of local authorities.

Will the minister take an intervention?

No, I will not.

Local authorities have made an appropriate investment that underlines their long-term responsibility to care home owners. Once again, I put on record our appreciation of the way in which Scottish local authorities have responded to the challenge. I know that they will continue to do so as they discuss individual local circumstances with the Church of Scotland. I have no doubt that that will be the case with the care home in Helensburgh.

Substantial increases in fee levels have been delivered and the benefits for care home owners will continue in the years to come.

Will the minister give way?

No.

I know that the care home sector recognises the huge financial commitment that we have made to it. I also know that the sector recognises that the approach that the Executive has taken has been both reasonable and constructive.

As part of the agreements with the care homes sector this year, a working group has been established to consider a mutually acceptable framework for assessing the cost of providing nursing and residential care for older people in different parts of Scotland from 200506. The working group consists of representatives from COSLA and the independent sector, including the Church of Scotland, and will report by the end of November. In response to Mr Davidson, it is up to them to set their own timetable; it is not for the Executive to dictate that.

We have made it clear that we want a stable and sustainable mixed care home sector, now and in the future. That is why we have invested so heavily in the industry and it is why we want the working group to which I have referred to come up with a formula that will remove the need for annual bargaining and for the annual posturing from people such as those in the SNP.

If the Church of Scotland announces a number of care home closures tomorrow, it is important to see that in context and to consider the changing nature of social care provision. We know that the balance of care has moved. That has informed the work of the kirk's review and the forthcoming report.

The determination of the coalition Executive to stabilise the sector for the long term is as strong as ever, but I must balance any calls for future improvements in fees with other priorities in health and social care. We must balance the main priorities that we face. That is the real choice that we face, and no amount of rhetoric from forgetful Conservatives or opportunistic nationalists will allow anyone to avoid that.

We have stabilised the care home sector and we have reached an agreement that will see us through to March 2005. We are working hard to get things right to ensure that we have a new framework in place from 1 April 2005.

To summarise, we have invested more than £130 million since mid-2001 and we are spending £30 million on bringing down the level of delayed discharge, because we recognise our obligation to Scotland's elderly. We are supporting the generation of people who struggled to set up the national health service. We are repaying our debt to older people and we are acting on our promises.

The care home funding story is a sad one. Over many years, it has caused distress to the many elderly people who had their lives disrupted when their homes had to close, or who lived with the fear that their homes might disappear in the future. The situation has caused worry and stress to the families of elderly people and to the owners and operators of independent or voluntary sector care homes, who do not want to ruin the lives of their elderly residents, but who, through no fault of their own, are forced to close down their businesses if they have become unviable. Local authorities' preferential funding of their own care homes over independently run homes has resulted in the latter closing down at a rate of three a week. That will continue until the funding gap is closed.

I welcome Christine Grahame's support for the case of private homes that provide nursing, but with inadequate funding. Her points were well made.

Will Nanette Milne support our call for the reallocation to Scotland of the benefits funds that were clawed back to Westminster as a result of implementation of free personal care for the elderly?

I do not propose to answer that question at this point in time. [Laughter.] I am a new member, after all.

The Church of Scotland is a case in point, as we have heard from most members who have spoken in the debate. For many years, the church's board of social responsibility has absorbed the funding deficit, but as the deficit is now running at about £6 million a year, and as its reserves are hugely depleted, the church is facing some hard choices about the future of its 29 residential care homes and of the 880 elderly people who live in them.

The benchmark funding sum of £346 per person per week, which was agreed last year between the Scottish Executive, COSLA and the Church of Scotland board, is not enough to cover the homes' £40 million running costs. A further £50 to £100 per person per week is needed to overcome the shortfall.

The continuing work between COSLA and the independent and church care home sector to examine the true costs of care for older people is welcome. I hope that it will produce positive results in time.

There is, however, a crisis now, and many frail, elderly people could find their lives disrupted in the meantime. The Scottish Executive's amendment is simply not acceptable in the face of the current crisis. While its commitment to shifting the balance of care from institutional settings to providing care at home, and to providing a quality framework, is commendable, it does nothing to solve the immediate problem.

Members have heard David Davidson's reasons for not accepting the amendments from the SNP and John Swinburne, although we have some sympathy with them. [Interruption.] Does Mr Rumbles want to interject?

I thank the member for giving way. Is she confirming that the current Conservative party policy is to fund hotel costs as well as personal care and nursing care?

Mr Rumbles well knows the Conservative policy.

The introduction of national care standards via the Regulation of Care (Scotland) Act 2001 means that there is no longer a tenable argument that councils provide a better service. Any justification that there may have been for a funding gap has now gone. Moreover, in a recent case accepted by the Office of Fair Trading, it has become clear that the public sector is subject to the provisions of the Competition Act 1998 and may not subsidise its own care homes at the expense of the independent sector, a ruling that I am told applies in Scotland as well as south of the border. There is no excuse for differential funding continuing and it is high time the situation was resolved.

The short-term solution is obvious: the Executive, local authorities and the voluntary sector must thrash out a deal to keep church and other vulnerable homes open. That must be done immediately.

For the future, adoption of Scottish Conservative proposals for a unified budget for health and social care, controlled by general practitioners via our fundholding policy, would allow patients' own practitioners to procure health-related social services for them. In that way, the most appropriate care for patients would be commissioned from providers in either the public or the independent sector. That would help to reduce the problem of delayed hospital discharge and ensure a level playing field for care home providers because local authorities would not be able to discriminate in favour of their own services.

A long-term solution will also have to be found, as demographic change will result in two thirds of our population being of retirement age by 2050. To answer Carolyn Leckie's comments, people of working age must be encouraged to make provision for their own long-term care. That will entail better tax incentives designed to encourage greater savings and giving for funding residential care.

Quality care for older people costs money. Staff need to be properly trained and rewarded for a difficult and demanding job. Care standards need to be raised continually. It is in the interests of the increasing population of older people that the Scottish Executive and local authorities ensure that there is a thriving and sustainable provision of care homes in Scotland, regardless of sector, and that they plan for the future. As Christine May indicated, that future planning is essential. There is enough demographic information to allow reasonably informed decisions about future need.

The current crisis in funding for care homes is a national scandal that could have been avoided with appropriate planning and dedicated financial resources. That crisis must not be allowed to continue. I support the motion.