Free Personal Care
The next item of business is a debate on motion S3M-6633, in the name of Ross Finnie, on free personal care for the elderly.
10:27
Liberal Democrats were very proud to play a prominent role in the introduction of free personal care, which we did as part of the previous coalition Government with the Labour Party. It was a landmark social reform, which is why I am pleased to address the motion.
The motion is predicated on a view that is strongly held by Liberal Democrats—which I think is shared by everyone in the Parliament—that older people in our society are an asset, not a liability, and that as their requirement for care and support increases, the mark of a civilised and compassionate society is to commit to their care and to face up to the challenges that are presented by demographic change and fiscal consolidation.
The motion’s objectives are threefold. First, it seeks to allow the Parliament to reaffirm its commitment for the long term to free personal care. Secondly, it seeks to acknowledge that the policy is uneven in its delivery, so more work needs to be done on that, and that there needs to be greater collaboration among local authorities, the health boards and the Government to ensure that all elements of free personal care—which is a thoroughgoing policy—are delivered uniformly throughout the country. Thirdly, it seeks to recognise that in facing up to the demographic and fiscal challenges, there are—to borrow from Lord Sutherland—no sacred cows when it comes to reviewing and re-engineering how free personal care is delivered. I had intended that third point to be implicit in our motion; we are content to make it more explicit, so I am happy to accept the amendments of the Government and the Conservative party.
Free personal care is a policy that is of huge importance to older people in Scotland: between 9,500 and 10,000 people in care homes in Scotland receive free personal care and—more important—the number of people whom the policy has enabled to remain in their own homes is getting on for 45,000. Those figures are hugely significant not just in terms of the care that is offered, but in terms of the totality of the care services that we can provide to our elderly people in the community. Those services are hugely important.
We know that free personal care has not been easy to deliver, as the three reports on the issue have shown. The Government asked Lord Sutherland, one of the policy’s originators, to look into its delivery. He made recommendations that were accepted by the Government and endorsed by the Parliament, but there is some evidence to suggest that not all of them have yet been fully implemented, which is a cause for concern. In particular, one of Lord Sutherland’s recommendations was that we should establish clear national priorities and outcomes. That recommendation has not yet been fully put in place, which makes it difficult for us to establish the necessary measurement techniques that will allow us to assess and evaluate whether some aspects of the policy are being implemented. I hope that the Government will address that issue.
Lord Sutherland’s work was followed by the Audit Scotland report which, by and large, endorsed Lord Sutherland’s recommendations. It highlighted the need to clarify ambiguities, the need for consistency in the application of guidance and the need to set substantive outcome measures to evaluate the effectiveness of the policy, which reinforces my earlier point. Most recently, we had the University of Edinburgh’s report “Older People, Public Policy and the Impact of Devolution in Scotland”.
All that work has indicated that it is imperative that we retain free personal care as a crucial part of our policy framework. I acknowledge that the Government’s document “Reshaping Care for Older People” will play a critical role in our ability to deliver on the policy. As Lord Sutherland pointed out, free personal care accounts for only one tenth of all the care that we provide for the elderly. If we are to address the cost of that to society, we must take an holistic view of the provision of care for our older people, which is why I commend the Government for its work on reshaping care. I do not necessarily agree with every jot and tittle of what is proposed, but in attempting to take an holistic view of how we provide such care and how we can re-engineer much of that provision so that we drive down costs and therefore make it possible for us to sustain the delivery of free personal care, the Government is performing an urgent task.
That is the motion’s purpose. Given the way in which the amendments are set out, at 5 o’clock this evening I hope to obtain absolute endorsement of the principle of free personal care for the longer term, and an acknowledgement that sustaining that policy will require a lot of hard work to be done on how we deliver it and on how we will drive costs out of that delivery.
I move,
That the Parliament believes that free personal and nursing care for the elderly has widespread support and continues to deliver real benefits for tens of thousands of Scotland’s most vulnerable older people, allowing them the dignity and independence of growing old in the comfort of their homes; recognises that budget constraints and demographic change present challenges for Scotland’s social care and health services, but, in order to protect the elderly, reaffirms its commitment to free personal and nursing care for the long term so that Scotland’s elderly population can continue to receive the care to which it is entitled.
10:34
I welcome this debate on free personal and nursing care. It provides us with an important opportunity to reflect on the original policy aims and to consider how they fit in the current environment.
Let me be clear from the outset: the Scottish Government remains absolutely committed to free personal and nursing care and has reiterated that commitment on a number of occasions. Only last week, the First Minister reaffirmed our commitment to this important policy in reply to a question by Murdo Fraser during First Minister’s question time. The reason for our commitment is that the policy delivers real benefits and better outcomes to more than 50,000 older vulnerable people throughout Scotland.
We remain committed to the policy despite the budget announcements by the Chancellor of the Exchequer. It was always going to be challenging to continue to deliver on the policy, and after Tuesday’s budget it has become even more challenging, but it is a challenge to which the Scottish Government is determined to rise.
As Ross Finnie said, the policy is one of the great achievements of the Scottish Parliament, but its proper administration and funding have been one of the great achievements of this Government, with £40 million investment to stabilise the policy and a clear framework and set of eligibility criteria having been established.
As everyone, I am sure, is aware, the value of providing free personal and nursing care has been questioned in certain circles as a result of budgetary pressures. Lord Sutherland made it clear in his independent review in 2008 that the policy was sustainable at that time for the next five years. However, he also concluded that we need to adapt the policy to address demographic changes in the medium and longer terms, and that changes are necessary to ensure the sustainability of the policy. That is why the Scottish Government is actively working with local government, the national health service and the voluntary sector to agree what we need to do now to shape the future of health and social care as part of the “Reshaping Care for Older People” programme, and thereby to ensure that the free personal and nursing care is sustainable into the future.
At local level, much is happening across Scotland to reshape and modernise care services to make them more outcomes focused, more personalised and more responsive. Since April this year, we have undertaken a process of public engagement to consider how best to address the challenges of an ageing population and diminishing public funding. We are currently asking people across Scotland to consider the future care demands and needs of older people, and we will listen to what people have to say in that consultation. That engagement has been commissioned by the ministerial strategic group for health and community care, which I chair and whose members are NHS chairs and senior local authority councillors.
I stressed during a debate on reshaping care for older people in October last year that
“We, as parliamentarians, must work together to put down a marker of the Scottish Parliament’s”
continuing
“will on how best to provide care for older people that is sustainable, deliverable, appropriate and fair.”—[Official Report, 28 October 2009; c 20544.]
We must have a care system that takes account of not just personal care but all social and health care.
How we organise, integrate and deliver all social services and the health service is a substantive point for debate. It might well be that better integration could produce a more efficient service without jeopardising the care that is given to older people. We are looking at that, and on that basis I am happy to support the thrust of the Conservative amendment.
In terms of efficiency and the background of the financial challenges that we face, is it reasonable and fair that councils pay 80 per cent more for a placement in a council home than they do to place someone in the independent or voluntary sector?
As I have said to Mary Scanlon on a number of occasions in the chamber, those are all things that we should consider as part of the agenda in reshaping older people’s care. What is the role of the independent sector, whether in the provision of care homes or care at home? What is the role of local authority services in the same context? We must ensure that we have the right fit of services, with the right skills to provide the services that people need.
Published expenditure figures for 2007-08 show that total spend on free personal and nursing care was £358 million, which was less than 8 per cent of all health and social care spend on people over 65. As Ross Finnie said, it is important to put in context the spend on the free personal and nursing care policy. It is too simple to imagine that removing a popular and landmark policy such as free personal care would achieve major budgetary savings. Indeed, it might have the opposite effect by pushing up the number of people who seek to remain in hospital beds free of charge because they cannot immediately find the money to pay for their care-at-home packages.
Furthermore, if Parliament is looking to achieve greater leeway in the budgets, I remind members that the review that was chaired by Lord Sutherland also recognised the long-standing imbalance between Scotland and the UK’s finances going back to when the policy was introduced. That is, of course, the issue of the savings that were made by the United Kingdom Government by removing the payment of attendance allowance to Scottish self-funders in residential care, which is currently saving the UK taxpayer around £35 million a year. I hope that the Parliament will support a call for the UK coalition Government, under the respect agenda, to take a fresh look at that imbalance.
In conclusion, let me reiterate that, as long-term advocates of the policy of free personal care, we remain committed to its principles and long-term success. It is a policy that gives help and peace of mind to thousands of people at a time in their lives when they need it most. I am happy to move the amendment in my name.
I move amendment S3M-6633.1, to insert at end:
“, and welcomes the wide-ranging Reshaping Care for Older People programme, which is developing innovative and practical ideas for change to meet the needs of Scotland’s population that are sustainable, deliverable and fair.”
10:40
I start by thanking our friends in the Liberal Democrats for giving us the opportunity to debate this important subject, and I congratulate Ross Finnie on his magisterial opening speech.
The Scottish Conservatives are proud of the policy of free personal care, which was introduced with our support in 2002. Free personal care means that, regardless of income, capital assets or marital status, all those who are assessed as needing personal nursing care will have it paid for for them. It is an important policy, not just because it protects those who have worked hard all their lives, acquired property and saved for their retirement in order that they can protect themselves and pass money on to their families, but because it protects the dignity and independence of our older citizens, to whom we owe so much.
It is worth mentioning as an aside that the policy of free personal care is one area in which we in Scotland do things differently from our counterparts south of the border. That applies to the Conservative party as much as it does to others. Free personal care is a policy that we support but which is not supported by our UK counterparts, and it is therefore one of a number of areas of difference between us. Cynics might suggest that, unlike our colleagues south of the border, the Scottish Conservatives support personal care while, unlike us, our colleagues in England and Wales have success in winning elections—but I would not want to make that point.
I am sure that all of us from our constituency mailbags can remember having been contacted by elderly people, or perhaps their relatives, who are in a state of real distress at having to sell family homes to fund expensive long-term care. The introduction of free personal care has not solved those problems entirely, as food and lodging costs still have to be paid and can be extremely expensive, but a major contribution has nevertheless been made to removing what was often a heartbreaking situation for many families.
That is not to say that the policy is without its challenges. Free personal care is an expensive policy to implement, and it is becoming more so. As we have heard, the major driver for that will be demographic changes. The fact that people are living longer is a good thing, but it comes at a cost. In his independent review of free personal and nursing care in April 2008, Lord Sutherland found that, although the cost of the policy was anticipated to be £136 million in 2006 rising to £227 million in 2022, in reality the total bill was £256 million in 2006 and it was estimated that it would rise to £813 million in 2031. No one can deny that there are serious financial challenges ahead.
Notwithstanding all that I have said about costs, the Scottish Conservatives value the policy, and for that reason we are pleased to support the terms of the Liberal Democrat motion. However, if the policy is to be affordable in the long term, we will have to find savings elsewhere to help to pay for it, which is the point that is addressed in my amendment.
We have to find more savings within administrative costs throughout the NHS in order to protect front-line services. The Audit Scotland report on locum doctors that came out last week gave a very good example of where savings can be found, when it identified £6 million that health boards could find quite easily if they were to operate more efficiently.
On free personal care, Lord Sutherland suggested a single budget for health and social care and a common commissioning policy to eliminate duplication. That reflects a measure for which the Scottish Conservatives have been calling for years. It was also the unanimous recommendation of this Parliament’s Health and Community Care Committee when it looked at the issue as far back as 2000. It would represent a way of doing things differently and would result in a transfer of social care budgets from local authorities to the NHS or possibly to some other body. However, we believe that we need to consider that seriously if we are to free up the savings that are required. That is the point of our amendment.
The Scottish Conservatives are proud to support free personal care, and we support the Liberal Democrat motion. However, if the policy is to be affordable in the longer term, we need to find savings. For that reason, I have pleasure in moving the amendment in my name.
I move amendment S3M-6633.2, to insert at end:
“; urges the Scottish Government to continue to identify savings in administrative costs that can be reinvested in frontline services, and, in this context, calls on the Scottish Government to give serious consideration to the proposal from Lord Sutherland to merge health and social care budgets.”
10:45
Like others, I welcome the opportunity to debate free personal care, and I welcome the unanimity of opinion that has broken out in the chamber, particularly between Murdo Fraser and Ross Finnie—I am sure that we will see more of that in the future.
I start from the premise that a society is judged by how it treats its young people, its older people and its most vulnerable. I spent some of my early years in Hong Kong, where I witnessed a culture where the old were revered and valued for their knowledge and experience. That has shaped my view of older people and my belief that we should treat them with dignity and respect.
Regrettably, all too often we think of older people in terms of challenges—for example, the challenge of an ageing population and all that that means for public policy, and the challenge of providing the care that older people require. In some areas, older people are treated almost as the passive recipients of care and are given little choice or control. We need to stand all of that on its head because, after all, only one in 10 older people needs on-going care and, in the 65 to 74 age group, the figure is only three in 100. We are living longer, thanks to advances in medicine, and it is incumbent on us to think through how we can best and most effectively provide care for the growing numbers of older people in the future.
I am proud that it was the previous Labour and Liberal Democrat Scottish Executive that introduced the policy of free personal care. It was Henry McLeish, as First Minister, who drove that policy forward and made it one of the defining features of his Administration and, some would say, of devolution.
There is no doubt that free personal care is greatly valued by those who receive it. We on this side of the chamber are clear in our view that free personal care should remain.
That said, we would all acknowledge that free personal care is but one part of a much wider system of health and social care that is provided for our older people. I welcome the work that the Scottish Government has started with the Convention of Scottish Local Authorities and the NHS to reshape the care of older people. That work is at an early stage and elements of the different workstreams are out for consultation. However, one workstream, on the future funding of care, is not yet in the public domain although, in the context of tightening financial budgets, it is, perhaps, the most significant piece of work that we need to engage in. I invite the minister to state, when she sums up, that she will give us an opportunity to debate the options around that issue. I specifically ask her to allow us to do so in the context of our budget deliberations, which will start in the autumn.
There is a postcode lottery of care across Scotland, with local authorities having different levels of charging for the same service, different criteria on which to assess eligibility for a service and even different thresholds for income disregard. It is simply not fair for someone in one local authority area to pay 10 times more than someone pays in the same circumstances in a neighbouring local authority for exactly the same service.
I believe that there are a number of key principles on which we should base any future system of social care for older people. First, there should be fairness and equity. Wherever someone lives in Scotland, they should have the best possible quality of service, and people whose circumstances are the same should pay the same. That would deal with the situation of people who live in neighbouring authorities paying different charges, as is the case in Argyll and Bute Council and West Dunbartonshire Council, and in Moray Council and Aberdeenshire Council. Labour is absolutely committed to ending the postcode lottery that currently exists in relation to the care of our older people.
Secondly, we should acknowledge that prevention is better than cure. It is much better to provide the support that enables older people to remain in their own homes than it is to fund admissions to hospital, which are costly not only to the NHS but to the individuals and families involved. I have seen older people being admitted to hospital after a fall at home that was caused because they have had to wait months for a necessary aid or adaptation to their home that would have prevented the fall in the first place. We need to get better at ensuring that we get the balance right and move, where possible, towards prevention.
Will the member give way?
I am not sure whether I have time. Do I, Presiding Officer?
You do.
On getting the balance right, does Jackie Baillie accept the need for MSPs of all parties to support local changes that will shift the balance of resource, including the closure of some beds in acute hospitals to fund community services?
I have no problem with ensuring that prevention is properly resourced and that we shift the balance of care. However, I will not sign up to the Scottish National Party’s programme of cuts to the NHS, which is going on as we speak.
Thirdly, we need to start thinking differently about our older people and begin to regard them as a resource, not a burden. Their experience should be harnessed for the benefit of local communities, and we need to help them to help themselves to keep fit and healthy, so that the need for formal care is delayed. Further, we need to support those who care for them on an informal basis. It is a matter of much regret that carers assessments, for example, have not been taken up across Scotland.
I welcome the opportunity to send a strong signal about Labour’s continuing commitment to free personal care for older people, one of our flagship policies, which we share with the Liberal Democrats. The policy has been a welcome addition to the system of social care provision, but the debate needs to widen. The Parliament needs to consider how we provide for the growing number of older people, how we fund their care and how we can deliver a policy that is sustainable.
10:51
I congratulate the Liberal Democrats on using their limited debating time to allow us to debate this motion.
In March 1999, when the report on long-term care of the elderly that recommended that personal care, wherever delivered, should not be charged for came out, I was a green back bencher. On reading the report, I phoned Sir Stewart Sutherland—as I did, in those days—and that autumn visited him in his office in Old College to discuss how his recommendation could be implemented. My boldness matched my naivety. However, some now consider that the Parliament, though bold, was also naive when it introduced that policy in 2002.
Again, I commend the Liberal Democrats for their conduct during the period from 1999 to 2002. I am well aware that they were the coalition members who drove the policy through—if I recall correctly, the minister with responsibility for health at the time, Susan Deacon, was not in favour of a universal scheme and would have preferred there to be some form of means testing.
Implementing free personal care for people aged 65 and over, particularly in an era when the shift is from hospital and residential homes to people’s own homes, was, in principle, the right thing to do, because that care is just another facet of the universality of our health service.
As others have said, the implementation of the policy has not been without flaws, and David McLetchie has quite rightly campaigned to end the situation whereby his constituents are charged for food preparation, which was also charged for in the Scottish Borders. In April 2009, the Government introduced legislation to try to end that invidious practice and, in September 2009, guidance on a common eligibility framework and a consistent approach to waiting lists was introduced, in an attempt to close loopholes that councils were busy trying to open up.
Currently, 47,000 Scots receive free personal care at home and 9,000 long-stay residents in care homes also benefit from the policy because they are self-funders. Given that the number of elderly people is always increasing, cost will always be the main issue. However, as a Parliament, we have choices to make, and the right choice is to protect the most vulnerable in society.
The bill will rise, and I agree with the comments made by other members about merging social work and health budgets, where possible, to enable us to deliver services and aids and adaptations in a sensible fashion that avoids duplication; that is an issue to which the Health and Sport Committee returns regularly.
The issue of the lost attendance allowance has become imperative. On 15 May 2008, Conservatives, Liberal Democrats, Greens and independents backed a Government motion that said that Parliament
“notes Lord Sutherland's clear conclusion that the UK Government should not have withdrawn the attendance allowance funding in respect of self-funding clients in care homes, currently valued at over £30 million a year, and urges the Scottish Government to pursue vigorously with UK Ministers the reinstatement of this funding while longer-term work to re-assess all funding streams relevant to the care of older people in Scotland takes place.”
It is ridiculous that we are still losing £40 million per annum in attendance allowance that could be put back into systems for the care of our elderly.
I note the individual members who supported the reinstatement of attendance allowance. Malcolm Chisholm said:
“I agree with the cabinet secretary on the specific attendance allowance issue”.—[Official Report, 7 May 2008; c 8293.]
Alison McInnes—whom I will quote as she is in the chamber today—said:
“The UK Government was wrong to withhold the attendance allowance. It is surely time for UK ministers to acknowledge that and pay up.”—[Official Report, 15 May 2008; c 8720.]
We should go with that calling card, now that we have a Conservative-Liberal Democrat Government at Westminster.
When our Liberal Democrat Secretary of State for Scotland, Michael Moore, visited the Parliament, I raised the issue with him. I said to him that I hope that he is Scotland’s man in the Cabinet, not—to use the old phrase—the Cabinet’s man in Scotland. He should put his money where his mouth is and say to the Chancellor of the Exchequer, “Here is the respect agenda for Scotland: we will deliver respect for the elderly not just through words, but by getting the attendance allowance back and putting it towards the care of Scotland’s elderly.”
I hope that there is movement on the issue. I am glad that the Liberal Democrats and Conservatives agree with free personal care for the elderly, on which Scotland led the way. We should ask ourselves what would have happened to attendance allowance if free personal care had been introduced in England. It would have been kept and ploughed back into care for the elderly there, so we should have justice for the Scottish elderly here.
10:56
Our debate today takes place against a background of budget cuts that are—and will continue to be—the severest that we have witnessed for decades. That is a crisis for the NHS in 2010, and it will be more far-reaching still because there are higher public expectations and more programmes, and the NHS is much larger.
Our political leaders will have a natural inclination to ignore the unpleasant realities to come, but if we are to reduce the human and social cost, it is essential to face up to those. The funding crisis is likely to lead to a covert rise in yet more waiting times. As we know, there are currently waiting lists to get into homes, which is rationing by stealth. The information revolution and more explicit quality standards will raise that crisis for the NHS to near the top of the political Richter scale.
Our policy is not shaped in a vacuum and we have a duty to keep an eye on policy that is developing in other parts of the UK. However, I am proud that a Labour-led Scottish Government in coalition with the Liberal Democrats developed the policy to establish free personal care for the elderly, which has been in place since the first session of the current Scottish Parliament.
I am also proud that 62 years ago, Labour’s great Aneurin Bevan established the NHS to end the unfairness of people with the greatest needs facing the highest costs and the people who had the least being in danger of going without having their needs met at all.
Today, our challenge is that the same unfairness exists in social care. If someone happens to develop dementia in old age, rather than cancer or heart disease, they are yet to find the “freedom from fear” that the NHS promised all those years ago. Free personal care for the elderly is—as Ross Finnie said at the start of the debate—a landmark social policy, but we must remove the postcode lottery of care provision throughout Scotland.
There are now 36 per cent more old and vulnerable people receiving free personal care in their own home than there were five years ago, but we have much to do. Scottish Labour plans a policy of continual review and improvement, and it is welcome news that the other parties have reaffirmed their commitment today to continue the policy no matter what happens.
Many critics, some of whom appear to have wanted our policy to fail, have raised concerns about the sustainability of such a package and the limitations of our Scottish model. They have argued that elderly people in many parts of Scotland have experienced delays before receiving their care as local authorities struggled with competing demands on their resources. In looking to the future, we must learn all the positive lessons from the experience that we have gathered from implementing the policy, while acknowledging all the concerns.
However, we need to keep an eye on what has happened at Westminster. With the election of a Con-Dem coalition Government, voters across Scotland have much to worry about. Just two years ago, David Cameron wrote a manifesto in which he proposed that the NHS would be drained of funds as money flowed into subsidising private health care. Will Nick Clegg follow that? Will the Scottish Liberal Democrats follow the example of their leader at Westminster?
Who can trust the Tories? Scotland knows that it cannot trust the Tories, and the wounds from the previous period of Tory Government are still raw and run deep in the history of our towns and villages. However, the much bigger question for voters now is whether they can trust any Lib Dem in the UK or in Scotland.
There are radical thinkers in the Liberal Democrats whose ideas include breaking up the NHS and funding health through social insurance as opposed to general taxation. They advocate that the state should cease to manage the NHS on a daily basis.
Does Helen Eadie accept that coalitions sometimes do the right thing? It was thanks to the Liberal Democrats in coalition with the Labour Party that Labour did the right thing on free personal care, because Susan Deacon, Sam Galbraith and various other Labour figures fought tooth and nail against the former Health and Community Care Committee, which I chaired at the time.
Labour has always done the right thing through the ages, something which the Liberal Democrats cannot hold up their hands and claim to have done.
Those radical Liberal Democrats have said all that while claiming that during the past three decades their party has mislaid its traditional economic liberalism, partly due to its association with Thatcherism, and allowed itself to be captured by what they call “soggy socialism and corporatism”. They say that the
“new challenge is to what extent we can utilise choice, competition, consumer power and the private sector to deliver a better deal for those on low incomes, as well as for those who can fend for themselves”.
That is what the Liberals are saying at their party conferences, and what the Scottish Liberal Democrats are signed up to.
Some of the contributors—not all of whom agreed on the details—included Vince Cable, the then shadow chancellor, Mark Oaten, the then shadow home secretary, Ed Davey and all the other celebrities in the Liberal Democrat party.
The Liberal Democrats must tell us the extent to which they subscribe to those policy proposals, because we need to know. The Liberal Democrats’ long-standing commitment to free personal care does not preclude people paying for services; its health spokespeople are on the record as saying that that is the way forward.
The Liberal Democrats support the stakeholder model, which is intended to preserve and enhance equity by making it impossible to queue jump and by guaranteeing a core package of services for all. However, according to John Chisholm, the former chairman of the British Medical Association general practitioners committee, the mixed funding stream with top-up packages that the stakeholder model creates undermines the fundamental values of the NHS.
We need answers from the Liberal Democrats on the extent to which they will distance themselves from Nick Clegg, and I hope that we will elicit those from them today.
11:03
I remind Helen Eadie that her party told the Scottish people that they should vote Labour to keep the Tories out. They voted Labour, and they got a Tory Government, so the Labour Party has some explaining to do.
I congratulate Ross Finnie on his contribution, which was moving and sincere. As convener of the cross-party group on older people, I, like others, was delighted when the legislation on free personal and nursing care was passed. The cross-party group was very involved in the legislation as it went through the various stages, and I saw it as democracy in action on the part of Lord Sutherland and others.
Without free personal care, particularly at home, an increasing number of elderly people would be forced to move into care homes. Not only does that deprive them of their home comforts, but the cost of care homes is greater than that of home care. It is estimated that home care costs £5,754 per person per year, whereas care homes cost around £23,000 per person per year. Despite what some members may say—and have said—free personal and nursing care, particularly at home, saves money in the long term by reducing the cost to the NHS and to the whole country.
I will expand on the issue, and give an example of what I am trying to get at. Without free personal and nursing care, older people may put off receiving treatment, which increases their chance of having accidents or of health conditions worsening. That would only add to the £1.4 billion price tag for unplanned emergency hospital admissions, 31 per cent of which—the largest percentage—is already spent on older people’s care. In the long term, free personal nursing care saves Scotland and its NHS money, and I certainly do not believe people’s claims that caring for older people is too costly. Yes, we have to be realistic but, as Ross Finnie so eloquently put it in his speech, what kind of society are we if we cannot look after our older people?
As members have acknowledged, there have been problems with the delivery of free personal and nursing care, not least because of how some—though, I point out, not all—local authorities have interpreted the provision of services, in particular food preparation. I welcome the Scottish Government’s move to introduce secondary legislation to clarify that issue because, as other members have made clear, free personal and nursing care cannot be subject to a postcode lottery. Clarity is also needed on entitlement, and a common framework must be implemented to ensure that people throughout the country are not affected by yet another postcode lottery. Local authorities must get together on all those issues and move towards implementing a system in which everyone in the country, no matter where they live, receives the same free personal care.
The withdrawal of the attendance allowance from Scottish pensioners, which Christine Grahame went into in great detail, is scandalous and, indeed, discriminatory. My mother and father, others’ mothers and fathers, relatives and so on worked and paid their taxes all their lives, but these pensioners are now being told that because they have benefited from the Scottish Parliament’s progressiveness—and we all agree that free personal and nursing care has proved to be a fantastic way forward and that it is wonderful that people can now stay in their own homes, be more comfortable, be nearer their relatives and so on—they will not be able to access that money. People can call that whatever they like, but I believe that it is discriminatory and that those older people are being penalised just because they are Scottish pensioners. If it had happened in any other country in the world, the Government would be taken to court, and I sincerely hope that the issue will be raised in the new partnership—I think that that is what we are calling it; it is not yet a concordat—between the Scottish Government and the new Government in Westminster. The issue desperately needs to be clarified. The money has been taken away from Scottish pensioners just because they are Scottish and because the Scottish Government is progressive in its approach to health, and we need to get it back.
A tenth of our older people rely on free personal and nursing care. Although, as members have pointed out, certain areas need to be reviewed, clarified or simplified, under no circumstances should such provision be reduced.
11:07
I am pleased to take part in this debate on free personal care for the elderly. The policy, which was begun under the previous Labour-led Scottish Executive, is highly valued by elderly people and their carers, and Labour wishes to see it continue. Indeed, we stand by our belief that we should never forget the most vulnerable in our society, and free personal care was at the vanguard of turning our values into law. As we consider the policy’s future, it is important that we strongly recommit to it.
The Scottish Government says that it is
“urging Scots to consider future care for older people alongside climate change and the economy as one of the country’s top priorities”
and that
“If current models of care are sustained, the present care budget of £4.5 billion will need to rise by £1.1 billion by 2016 and £3.5 billion by 2031.”
As the minister has also talked about working
“In partnership with Scotland’s local authorities”
I asked Dundee City Council, which is run by an SNP minority administration, whether it had made any estimates of the cost of maintaining the current level of provision of free personal and nursing care over, say, the next five or six years based on population projections. It replied:
“Not as yet. They are currently being developed as part of an estimate of demographic pressures.”
It appears that so far the partnership with local authorities does not extend to the Scottish Government’s ability to ensure that it has information such as that for its reshaping care for older people consultation.
Will the member—
Perhaps the minister will let me continue.
Of course, Dundee, with its ageing population, faces the same demographic pressures as all other Scottish councils. Dundee’s population is projected to be 142,000 in 2013, with almost 27,000 aged 65 or over. Although the population is forecast to decrease to 137,000 by 2028, the number aged over 65 is predicted to rise to almost 32,000, an increase of about 5,000. Unfortunately, there is no corresponding increase in healthy life expectancy, or the number of years that a person might expect to enjoy good health. In fact, for men and women in Dundee, the disparity is above the Scottish average. Although, as we have heard, the majority of older people will never have contact with the care system, we must get it right for those who do, and the Scottish Government must engage constructively with the UK Government through the review of social care in England to secure the long-term sustainability of free personal care in Scotland.
Despite the fact that free personal care is a highly important issue in its own right—according to the Scottish Government, it is on a par with climate change—the online material for the reshaping care for older people consultation compares unfavourably with that for other consultations on the Government’s website. At the moment, there is only one 12-page leaflet. In comparison, the Scottish Government’s consultation documents on proposed public records legislation run to 26 pages—
Will the member give way?
I ask the minister to let me finish my point.
The Scottish ferries review runs to 76 pages and the consultation on the proposed tobacco display and sale regulations runs to 64 pages. As I say, despite its obvious—and agreed—importance, the reshaping care for older people consultation can muster only 12 pages; clearly there is room for much greater detail. The programme’s thrust is to shift the emphasis from acute provision to a preventive re-enabling model.
Will the member give way?
No, thanks.
Although that seems like the right direction, the consultation must be fair and thorough.
It is interesting to view the contents of the short booklet available on the website in the light of comments from the Royal College of Nursing Scotland, which has referred to the
“lack of publicly available evidence”,
the fact that
“little coherent information is ... available both at national and board level”
and the need for
“access to accurate, up-to-date and transparent evidence on the current situation”.
If we are to redesign services in the best way possible and continue this flagship policy of free personal care, there must be clear and full information to allow proper engagement.
11:12
I, too, thank our friends the Lib Dems for using their time to debate free personal care and acknowledge the cross-party commitment to the policy.
During the passage of Community Care and Health (Scotland) Bill, the Conservatives stated that a long-term approach to funding free personal care was essential. Indeed, that has been highlighted in the briefing that we have all received from Age Scotland. With the new coalition Government at Westminster, we have an opportunity to engage constructively in finding ways of funding long-term care for the elderly.
In preparation for the debate, I looked back at my speech in the stage 3 debate on the Community Care and Health (Scotland) Bill, which had been taken through the committee stages under Margaret Smith’s able convenership of the Health and Community Care Committee. I noted then that, instead of the
“single body for budget holding and planning and commissioning community care services”—[Official Report, 6 February 2002; c 6099.]
that the committee had recommended, we got “aligned and pooled budgets”. I also remember that all witnesses bar one were in favour of a single budget, although there was no agreement on which organisation would hold it. That confirms the basis of Murdo Fraser’s amendment in this debate.
The Community Care and Health (Scotland) Act 2002 also introduced direct payments for the elderly, which were welcomed as bringing more accountability, freedom and choice into the provision of care. However, many carers have found councils less than willing to assist them with this service. As a result, the council becomes the monopoly provider of home care services, with no alternative available to people who feel that the service is not what has been promised.
Secondly, the act promised that elderly people cared for at home or in care homes would receive regular six-monthly assessments, which are essential in ensuring that the care package is updated to address the individual’s on-going needs. I know from many constituency cases that some people have been on the same care package for years, whether it is home care or residential care, with no further assessments being carried out, despite the fact that their general condition and mobility have deteriorated considerably.
During committee proceedings at the time, we constantly discussed the issue of having one type of care home for the elderly, and were assured that that would be the case. There were to be integrated care homes that would take care of people’s residential and nursing needs, with no need to move elderly people to another place for nursing care. However, that has not happened. Instead, we have three types of care homes for the elderly: residential, nursing and integrated. The result is that elderly people remain in residential care homes when they really need nursing care, and the appropriate level of care is not given at the time of need. Further, many care homes provide nursing care but are paid for providing a lower level of care. In Inverness recently, a woman who is a nurse visited her mother in a residential care home and had to point out to staff that her mother had had a stroke. That was because there were no nursing staff there. That highlights the situation, which was not what the Parliament intended. I trust that the minister will examine that.
As I said earlier in an intervention, in the current financial situation we must surely consider the cost of placements in care homes. From a freedom of information inquiry last year, I learned that Highland Council—which today will vote on care homes, as I am sure Jamie Stone will point out—pays 80 per cent more for a person in a council home than it does for someone in a home in the voluntary or the independent sector.
Will the member give way?
Let me finish.
Argyll and Bute Council pays £357 for someone in the independent or the voluntary sector compared with £817 for a person in a council home. In Dundee, the figure is £454 for the independent sector and £826 for council homes. The fact is that all care homes must meet identical quality standards. Under the current funding arrangements, for every five people who are funded in the independent sector, only three can be cared for in council homes from the same budget. Given the demographics that we face, we must be honest and fair and consider that issue.
Then we have the self-funders. Given that every person who is in a care service receives an identical level of care, should not the payments for their care be identical? Those who are self-funding can pay twice the amount that the council pays for care of another resident, which surely is not fair or reasonable. That has resulted in many families of people who are self-funding complaining that they are subsidising the care of others.
As Jackie Baillie said, given the rising number of people who are in need of free personal care, more emphasis must be put on preventive care. That is a good point that we should not lose sight of. Access to chiropody services, shorter waiting lists for assessment and access to aids are all essential.
I seek clarity from the minister, either in her winding-up speech or in a letter, on the issue of notional capital. What is the time period for disposing of the family home and the use of that financial asset to pay for care?
I support the motion and the amendment in the name of Murdo Fraser.
11:19
The debate has been largely consensual. As Ross Finnie said, the starting point is that older people are an asset, not a liability. That is a fundamental point of which we must not lose sight. The demographics mean that we are faced with increasing longevity and substantial increases in the number of the very old, although it is interesting that those who are over 85 tend to have fewer long-term conditions and can be fairly fit—if we get to 85, we have a chance of living well beyond that. One problem is that healthy living has not increased in the same way that longevity has. We are faced with the major challenge of an elderly population with significant long-term conditions. Many members have referred to the need for effective prevention of emergency admissions, which are expensive and not good for the patient or individual.
The figures are clear: 9,500 people receive free personal and nursing care in a care home and 45,000 receive care at home. The budget figures are also clear and show that all that accounts for only 8 per cent of the total care budget, which is a point that is not recognised in England. Although the cost will rise, it is not likely to rise as a percentage of the total care budget. In England, the latest discussion document, which came out last year, indicated that the average cost of care for those over 65 is about £30,000 a year. There is a debate on the issue in England, and a consensus on at least two points. First, there is consensus that there is a problem and that the current situation is not equitable, sustainable or fair. Secondly, there is consensus in the opposition to the uniformity and consensus in Scotland, where all parties support free care. We have a clear dividing line between the Scottish Parliament and the English parties.
As those parties debate the way forward, there should be an opportunity to revisit the issue of the attendance allowance, to which Christine Grahame and Sandra White referred. Taking the totality of care, it is clear that including that funding to us would be helpful.
Under the Liberal Democrat and Labour Administration that drove forward the free personal care policy—Henry McLeish was the First Minister who was committed to it—we endeavoured to introduce the joint future programme. That was an attempt at the grass roots to introduce unified budgets for health and social care. However, the programme has gone very slowly. The minister might advise us as to whether the joint future programme is continuing, as I have no idea. In Perth and Kinross, which was the pilot area, it took 18 months even to agree the salaries of two individuals—one from health and one from social work—to do the same job. The willingness to make progress on that has been very poor.
When change is driven hard from the centre, as happened with delayed discharges, a particular problem with that interface can be eliminated. Local authorities did not gain from taking people out of hospital—it was a cost on the local authority, so why would they ever do so? However, by driving change from the centre, we have been able almost to eliminate delayed discharges, although it is regrettable that the Government’s promise to keep the rate at zero has not been kept. The figure rises to about 100 at the worst times every year.
As Helen Eadie said, the history of free personal care started with Bevan’s introduction of the NHS. We should not forget that the NHS included long-term care until the 1980s, when almost all long-stay wards were closed and the nursing element was devolved to local authority and private nursing homes. That is when the enormous discrimination began to arise. Someone who was dying of cancer went into a hospice or hospital, but someone who had dementia, for example, had to meet their own costs. We can do without that sort of discrimination, which Irene Oldfather has referred to repeatedly in debates on the issue.
In Scotland, all parties are in favour of free personal care. We need to develop that partnership. Government, local authorities, the voluntary sector, users, carers and the wider public must all be involved in the debate as we proceed. We certainly need to squeeze out inefficiencies and shift the care from the acute to the preventive. However, in reality, the threshold for care in the community is rising. People need to have more and more severe conditions to get care, which is the exact opposite of what we need to do.
We do not need unilateral action of the sort taken by SNP-led Stirling Council, which tried to close fairly modern care homes, although that was stopped by a public campaign. The council has cancelled support for the Independent Living Association Forth Valley and instead looked at direct payments, but without consulting the two other local authorities that are involved. It failed to repay the meal preparation charges and was one of the last councils to abolish them. I congratulate the Government on correcting that important measure, and I am sorry that it took so long for us to do it.
The elderly are a substantial and largely untapped resource and must be engaged positively on the issue of free personal care. We have consensus, we have had a largely reasonable debate and we need to keep our joint resolve. The Labour Party is committed to continuing free personal and nursing care.
11:25
This has been a stimulating and mainly consensual debate, with one or two notable exceptions—the usual suspects. It has served the purpose of giving the Parliament a further opportunity to have a continuing, long-term and comprehensive discussion. It does not end here; there will be other opportunities to continue the discussion and, to reassure Jackie Baillie, I tell her that we will return to Parliament with more detailed and specific proposals in an overall package of transformation for future discussion.
I will address some of the points that have been made in the debate. Ross Finnie talked about clear national priorities and outcomes. We have gone a long way to achieving those through the clear eligibility framework, for the first time with minimum standards. That was required because different local authorities were interpreting the legislation in differing ways. Murdo Fraser talked about the single budget in commissioning. I gave a clear steer in my opening speech that all those things are being considered actively as we think about how to take forward the interface between health and social care.
Christine Grahame and Sandra White made some forceful points about the attendance allowance. What is important here is not just the fact that it is not fair and we should get our money back—although that is obviously the case—but how we could then integrate and use that attendance allowance resource as part of the financial backdrop to how social care services are delivered. As we saw during the previous UK Government’s debate on the future of social care and its interrelation with the benefits system, not having direct control over that is frustrating and a real impediment because, whatever action the UK Government takes and whatever changes it makes to the benefits system, or indeed the pensions system, that will impact directly on social care in Scotland. We need to ensure that the two parts of the system are joined up and that we take the opportunities to join them up in Scotland. We do not yet know the direction of travel of the new coalition Government in that arena but, under the respect agenda, we expect as a minimum that the needs of the Scottish population and Scotland’s older people will be taken into account at an early stage.
I am not sure what point Marlyn Glen was trying to make. We have good national and local statistics about the demographic changes. She seemed critical of the size of the consultation document, which is a bit like spinning on the head of a pin. We are holding meetings on reshaping older people’s care the length and breadth of Scotland. If we had laid out clearly that we had already made our decision about what we wanted to do, no doubt the criticism would have been, “What’s the point of a consultation when you’ve already made your mind up?” We are having a good consultation and the number of people turning up at the meetings speaks for itself. There has been really good engagement with older people, which I am pleased about.
To clarify the point that I was making, it was RCN Scotland that called for more information. I was concerned about the lack of information that Dundee City Council seemed to have when forward planning is clearly needed.
I have had numerous discussions with Dundee City Council and I do not share the member’s perspective. The council knows well what the local demographic challenges are. We have engaged closely with Age Scotland, which has been one of the key voluntary sector bodies involved in the consultation. It signed up to the direction of travel, which I am sure remains the case.
I hope that I have been able to reassure Mary Scanlon that we are looking at the whole system, but I will write to her about the notional capital issue. I welcome Richard Simpson’s sudden conversion to supporting the return of the attendance allowance; it is just a pity that he did not support it in the past eight years of the policy’s delivery when he had the opportunity to do that at UK Government level, but we welcome support from whichever part of the chamber it comes.
We have made genuine progress on delayed discharge. We returned to the zero standard in April and there has been a huge improvement since the end of 2006, when 650-plus people were caught up in a hospital environment that they did not need to be in. I hope that Richard Simpson recognises the huge progress that we have made.
Free personal care was born out of a strong sense of social justice aligned with cross-party support and consensus that we have seen again today. I am keen that we do not lose sight of the principles that are enshrined in the act and the great successes that we have achieved so far with that cross-party consensus. However, each and every member in the chamber has a responsibility to embrace the reshaping and modernising of care services locally and not to stand in the way of essential service redesign, whether that is establishing a reablement home care service or a shift in the balance of care from acute sector beds to community-based services. We cannot support the theory of the policy but not the practical effect in the community. On that basis, I hope that we can all stand together and ensure that we can really and truly deliver for the older people of Scotland.
11:31
In making the final speech in the debate, I thank everyone who has contributed to it, including my good friend Helen Eadie, whose contribution I enjoyed.
I am proud that the Parliament and all the parties are able to coalesce around what Ross Finnie referred to as a “landmark social reform”. In the early days of the discussion about free personal care between the Labour and Liberal Democrat parties, I remember going to a reception in Parliament hall and meeting Henry McLeish, who said to me in an up-front way, “Yes, we will deliver this policy.” Indeed he did and credit should be given to him. As to the arguments that might or might not have taken place in the Labour Party, that is for another day.
Ross Finnie said and Richard Simpson quoted him, as I will too, that
“older people in our society are an asset, not a liability”.
That is exactly the right view to take when delivering the policy. It is no accident that this policy, and our doing something different from what happens south of the border, is one of the reasons why devolution is as liked and accepted as it is among the older people in our country.
Ross Finnie and many others referred to the unevenness in distribution of free personal care and that remains a key issue for us to tackle. Almost 10,000 people are in receipt of free personal care and a much greater number—45,000 people or thereabouts—receive care at home. Lord Sutherland challenged us to put in place clear national priorities and outcomes and, as Ross Finnie said, it is arguable whether they are in place. Again, that is work that we must complete. Ross Finnie concluded his speech by asking how we can drive cost out of delivery. That is another question for us all.
The member will be aware that Lib Dem-led Highland Council is today proposing to privatise five of its care homes. As Mary Scanlon pointed out, that will save money. However, it will be at the expense of the lowest-paid care workers, whose wages, pensions and sick pay will be cut by 30 per cent. Is he happy about that?
I anticipated that intervention from Dave Thompson. I believe two things. First, we have to trust local authorities to do their best and, in the case of Highland Council, I have no reason to think that it is not trying to do its best in an extremely difficult financial situation. Secondly, it does not always behove MSPs to wag their finger at another democratically elected body that is trying to do its best in a tricky situation, not just for councils and the Scottish Parliament, but for the whole country.
Murdo Fraser made the point, which Mary Scanlon echoed, that functions could be transferred from social work services to the NHS or another body. The Liberal Democrats support the Conservative amendment—we are not against it—but something similar to the furore that surrounded the removal of water and sewerage services from local authority control would occur if hands were laid on the social work aspect. Moving the function to A N Other body but not the NHS would surely just duplicate the costs that are incurred at present.
In her intervention on Shona Robison, Mary Scanlon referred for the first time in the debate to the fact that a council placement costs more than a placement in the private sector. I suppose that that is connected with the intervention that David Thompson just made.
Jackie Baillie’s most important point was that costs vary between local authorities. Ross Finnie referred to that difference in costs, which has been called a postcode lottery. Jackie Baillie asked the minister to agree to a debate—probably later this year—on the possible funding mechanisms, which goes back to Murdo Fraser’s point.
In the important debate on funding, can I take it that—under the respect agenda—the Liberal Democrats support our negotiations with the UK Government about the return of the attendance allowance moneys?
Christine Grahame put her point eloquently at the meeting between committee conveners and the Secretary of State for Scotland, Michael Moore. From his answer, I have no reason to think that he will not consider the matter and do what he can. However, we must bear it in mind—as I said in response to David Thompson’s intervention—that money is not available in large quantities. I think that Christine Grahame would agree that Michael Moore’s response was helpful.
Christine Grahame gave us an accurate potted history, but I must take issue with the notion that she was ever a green back bencher. When she first appeared in 1999, she was a fully formed battleship firing—
Members: Oh!
I am so sorry. I withdraw my outrageous remark.
In the same tone, I point out to my good friend Helen Eadie that Nye Bevan introduced what Mr Beveridge had designed in his report and, of course, we all know which party Mr Beveridge belonged to—he was a good Liberal.
Helen Eadie referred to elderly people staying in their own homes, which set me thinking. I will digress and make a new point in the debate. In all my time as an MSP, I have tracked the voluntary sector’s involvement and its contribution to our society in Scotland. That sector could make a further contribution. In looking after elderly people in their own homes or in whatever form of amalgamated home we eventually agree on—that relates to Mary Scanlon’s speech—the voluntary sector has a role to play. When we debate the subject again, I hope that the minister will consider carefully the potential of releasing and using the voluntary sector, which gains a great sense of achievement from its work. Building in a form of recognition would be extremely useful.
Finally, from Helen Eadie’s many years of worthwhile service on the Subordinate Legislation Committee, I should have thought that she had learned to trust me, of all Liberal Democrats, at any rate.
Members: Oh?
I hear doubt expressed from a sedentary position.
Marlyn Glen’s speech was the last in the open debate. From what she said, I make the point—which has been made—that the rest of the UK, where the political parties cannot agree what to do, has much to learn from what we in Scotland have done. We should transmit that message loud and clear across the border. Murdo Fraser is probably correct—the English Conservatives have much to learn from the Scottish Conservatives in how to go about things.
I will draw attention to two closing speeches.
Very quickly, please.
Mary Scanlon’s points about nursing and residential homes and about the lady with a stroke were well made. We need to sort that out. Finally, Richard Simpson made the point that elderly people may be living longer but they have long-term conditions, which has cost consequences. That is all meat to the debate that lies before us.