Carers Strategy
The next item of business is a debate on motion S1M-317, in the name of Iain Gray, on the Executive's commitment to the introduction of a carers strategy, and an amendment to that motion.
I welcome to the public gallery carers who have travelled from all over Scotland to be here today. Given the caring responsibilities that they have, that represents a considerable effort.
In a sense, we are in the presence of 500,000 Scots who look after sick, disabled, vulnerable or frail relatives or friends. Some have done so for many years; others will have, suddenly and shockingly, found themselves in the situation as a result of accident or diagnosis.
The Scottish Executive's programme for government committed us to producing a strategy for carers in Scotland. The strategy document was issued by way of a parliamentary question yesterday, so that members of the Parliament would receive it before anyone else.
The first ministerial engagement that I undertook was a carers event. I promised then to bring their concerns to the chamber. I have met many carers and have learned from them something of what caring means. It has been a sometimes searing experience. Carers will speak passionately about the difference that services have made, but they will not mince their words about the struggle to provide care for loved ones, sometimes with little support and in isolation.
Before drawing up our proposals, we discussed priorities with carers organisations in Scotland, notably the Carers National Association, the coalition of carers in Scotland, Crossroads Scotland, the Princess Royal Trust for Carers and Shared Care Scotland. I want to put on record an acknowledgement of my gratitude for their help. Together, we identified four main areas for action.
The first priority of carers is that respite services should be of a better quality, more readily available and more flexible, as those services allow them to take a break with confidence and without guilt. We have therefore told the Convention of Scottish Local Authorities that we expect the resources spent on those services to double.
We are identifying £10 million of grant-aided expenditure for 2000-01 specifically for carers services and respite care. That doubles the £5 million that is already notionally allocated for such
services in the GAE system. We have already announced that the total GAE for social services will increase by £40 million next year, and it is from those resources that the additional £5 million will be found.
Every local authority on Scotland will receive its share of the £10 million, and local carers groups will be advised of the resources that are available to their authority for developing new services and enhancing existing ones.
Local authorities must consult local carers organisations on spending plans for those resources. We will encourage imaginative and innovative services that meet carers' needs. We expect authorities to take into account the needs of carers from ethnic minority and rural communities and those who care for someone with a learning disability.
Carers want a consistent standard of service across Scotland. We have already set up a national care standards committee to agree national standards for residential care, day care and home care services. National standards for residential respite care will be introduced in 2000 and for home-based care in 2001.
Carers are represented on the working groups already set up to discuss standards across the services and will be included in the groups that will discuss the proposals as they emerge.
It is widely believed that new carers legislation is required. I agree. I am determined to get it right and not to rush it. I have therefore decided to set up a carers legislation working group by the end of this year, on which representatives of the Scottish Executive, service users and carers, carers organisations and local authorities will work together to draw up legislative proposals for public consultation next year. Those proposals will consider the rights of carers—and users—to a direct assessment of their needs. In particular, we want and expect the legislation to enable carers under 16 to have, for the first time, a direct assessment of their needs.
All carers want more information. We can have as many services as we wish and services of the highest quality, but if carers do not know that they are there and how to access them, they are of no use. Too often, services are stumbled across almost by accident. It is no coincidence that the excellent carers centre in Perth is called Gateway. The handbook of the services that it helps carers to access includes many such services, but in the Gateway centre, carers will say that it is often an accidental meeting with someone from the centre that allows them to begin to access the services that already exist.
We must increase and open up such gateways to services. All agencies and professionals in the caring professions have a role to play. Working with the Carers National Association training unit that the Scottish Executive funds, we will take the needs of carers into account in future training of general practitioners, primary care teams and social workers. The next planning and priorities guidelines for the national health service will require health boards and trusts to recognise carers' needs.
In spring 2000, the Scottish NHS helpline will be extended to include information on services for carers. When NHS Direct is brought on stream in Scotland, it will be extended to include social care and carers advice, as well as medical advice. Early in the new year, we will launch a leaflet and local media campaign to publicise the carers strategy and services for carers.
Too many carers remain hidden completely—the 500,000 figure that I used is a notional one. We do not know how many carers there are. It is our intention that the census in 2001 should be the first one to include a question on carers, seeking information on the time that people spend on unpaid caring. We will consider extending the Princess Royal Trust for Carers pilot project to identify hidden carers and examine the potential use of GP databases to identify and include information on carers.
The four priorities are respite, standards, legislation and information. Priorities are all very well, but carers are concerned—and have expressed that concern to me—that the impact of the strategy should be monitored. Therefore, from April 2000, local authorities will be required to report in detail on the use of the resources allocated to them for carers and respite services through community care plans and annual updates. Further, in future we will require those plans to be accompanied by a letter from local carers groups, confirming that they have been consulted in the planning and development of services and that they are satisfied that their authority's share of the £10 million has been used appropriately.
In addition, we have tasked the Scottish Executive's community care implementation unit to review practice in involving carers in service planning and provision. The unit will identify and promote good practice, and—importantly—will report to me on any barriers to the development of good-quality services for carers.
Further, carers' needs will in future be included as part of the existing statutory performance indicators and assessments currently required of local authorities by the Accounts Commission. I have asked that the new, national data set that is being devised by the Scottish Executive, COSLA and the Accounts Commission to monitor social care on a national basis should include information
on carers assessments and respite care.
I mentioned young carers in the context of legislation, but they are a particularly disadvantaged group, whose specific needs we must address further. In Dundee, we are providing £210,000 over the next three years to a project aimed at identifying and supporting young carers. I have asked my officials to work up proposals for research on the support that is available to young carers in Scotland and the guidance that is needed for professionals in health education and social care. In the meantime, we will make available to directors of education a young carers pack, which I expect to inform the work that is currently undertaken by guidance teachers.
It would be wrong to conclude without acknowledging the contribution that carers make. We could not deliver community care without them. They care unpaid, unsung and unwaveringly. The package is a significant step towards addressing their needs, but it is only a step.
Some people will try to calculate how much the contribution of carers is worth in cash terms, but that misses the point. Carers care because they want to, and because they love the people for whom they care. We cannot put a price on something that is priceless, or a value on what is invaluable.
Caring is what holds our society together. It is the practical, most powerful, profoundest solidarity between husband and wife, parent and child, friend and neighbour. It touches us all. Like most people, when I think of carers, I think first of my mother caring for her father, my aunt and uncle for my cousin, and my friend for his son.
We all know carers. Today, we place them at the centre of our Parliament and at the heart of Scotland. They will never go away. Whoever stands here can never ignore their needs again. I move the motion on their behalf.
I move,
That the Parliament welcomes the Executive's commitment in its Programme for Government to introduce a Carers' Strategy for Scotland to assist unpaid carers, and approves the Executive's proposals for that strategy.
I can now give an interim answer to the point of order that was raised by Kay Ullrich. I understand that the parliamentary question was asked by Lewis Macdonald on Tuesday 23 November and was answered by Iain Gray yesterday. We are looking at ways and means of improving the flow of information in that area.
I call Kay Ullrich to speak to and move amendment S1M-317.1
welcome the sentiments that the minister has expressed. I am sure that carers across Scotland will join me in regarding this as a first step in the long-overdue recognition of the role played by carers in society.
For far too long, the needs of carers and those for whom they care have been largely ignored by the Government and given a low priority in terms of local authority support and services. Scotland's half a million carers provide by far the larger share of both health and community care services and save the national health service and local authorities more than £3.4 billion every year. Of course—and perhaps most important—most people prefer to be cared for by their family and in their own home.
As things stand, 60 per cent of carers get no practical help from any of the service providers. That may be due in part to the fact that many individuals and families do not recognise themselves as carers. Many, particularly women, simply see caring for disabled or elderly members of their family as their duty.
I was a carer until very recently. Women have rightly always been regarded as the main carers for children, but for too long there has been very little recognition of the fact that, for many women, the caring role does not stop when the children leave home. That is very often just the time when they have to start caring for elderly or disabled relatives.
Many have to give up their employment; many more have to juggle a career with their role as carer. That is why I ask the minister to address in his summing up the fact that the tax and benefits system penalises working carers. For example, if a carer's earnings are more than £50 a week, even though they spend every hour outside the working day caring for their relative, they are not entitled to invalid care allowance. If they give up their work to care for somebody on a 24-hour basis, they will be better off than if they were on income support by the grand sum of £13.95.
Will the minister address the fact that invalid care allowance is not paid to people over 65? As my colleague Dorothy-Grace Elder will point out, many carers are pensioners themselves. Of course, benefits are a reserved matter, but I would find it impossible to talk about support for carers without addressing the issue of benefits. Will the minister make representations to the Labour Government at Westminster regarding that problem?
I would also ask the minister to consider a national benefits take-up campaign to ensure that Scotland's carers receive the benefits to which
they are entitled. I welcome the announcement of the diversion of £5 million for Scotland's carers, which is to be added to the £5 million that is already earmarked from local authority funding. However, I must say that I am disappointed that this is not new, additional money, but money that will have to come from cash-strapped local authority budgets.
I will put the figures into perspective. Even if all the money reaches carers, £10 million works out at 38p per carer per week. When we consider that meals on wheels cost more than £1 per day, a home help costs £8 per hour, and a week's residential respite care costs £350, it is clear that Scotland's carers will still face huge problems. That is on top of the fact that the Labour Government has cut spending on community care by 12 per cent.
Until such time as the continued underfunding of local authorities is rectified, initiatives such as the one announced today—good though it is—will have, at best, limited success. Local authorities will continue to rob Peter to pay Paul. Unfortunately, that is often achieved by dipping into the community care budget.
I will take the current situation in Glasgow as an example. There are proposals to cut £3 million from services to elderly people, resulting in the loss of 150 home helps and the denial of that service to 219 people. That puts today's announcement into perspective.
"Caring for Carers", the national strategy for carers, refers to the need to take account of the recommendations made by the Royal Commission on Long-term Care chaired by Sir Stewart Sutherland. As we all know, it is fast becoming the report that dare not speak its name. Sutherland highlights the needs of carers and makes some simple recommendations that would go a long way to improve the situation, such as the application by local authorities of carer-blind assessments so that the existence of a carer is not the reason for services being withheld or, indeed, withdrawn.
Sutherland also highlighted the fact that a three- month disregard on the value of elderly people's homes and savings would not only have an impact on the so-called bedblocking crisis, but would allow time for rehabilitation and proper assessment of needs to allow many more of our elderly people to be cared for in their own homes, after a stay in hospital.
As we have already found, the Executive's rhetoric does not quite match the reality. Despite today's announcement, the reality is that local government funding in the first three years of the Labour Government is £2.4 billion less than it was in the last three years of the Tory Administration. It is essential that the Scottish Parliament ensures that support for carers is a key part of our social policy for Scotland in the new millennium.
As I said, I welcome today's announcement as a first step and as recognition of our debt to Scotland's carers. However, until such time as the tax and benefits system reflects carers' needs and local authorities are adequately funded to provide essential services, the needs of Scotland's carers will never be truly met.
I move amendment S1M-317.1, to leave out from "to assist" to end and insert:
"and calls upon it to provide local authorities with the necessary funding to deliver the services required by Scotland's unpaid carers."
We welcome today's motion. I congratulate the minister and Kay Ullrich on their contributions to an evocative and important matter.
The minister is also to be congratulated on being quite honest. He has not tried to claim that he is putting a great deal more money in. He is talking about £5 million. If we bear in mind my comments about hype over the past few days, the minister's speech made a refreshing change.
The Administration is to be congratulated on making constructive proposals. We shall await with interest—and perhaps increasing cynicism— the final proposals. However, at this stage, there seems to be consensus, which is to be encouraged.
I am grateful to have this opportunity to pay my own tribute, and the tributes of the Conservative party, to carers. They are an army of unsung heroes whose efforts go largely unrecognised— and certainly unrewarded. Parliament has a clear duty to do everything possible to recognise and reward—albeit in a detached but realistic way— the efforts that many people throughout the country make to assist those who are less fortunate.
What is the profile of a carer? As Kay Ullrich quite properly said, carers are usually women. Perhaps, Kay, it is because women live longer than men that, most of the time, they get the heavy end of the load. Women's contribution towards caring is certainly significant.
I note that the minister has undertaken to ask, in the next census, the appropriate questions to get a clearer profile of carers. The general household survey gives some interesting figures, and I commend it to him. In particular, it draws attention to the number of young people under the age of 16 who are actively involved in caring. Something like half a million people in Scotland are involved in caring, and 5,000 of them are under 16. To
them in particular we owe a real debt.
How can we make matters better? Ultimately, more resources are the answer, but—this is perhaps where I part company with Kay Ullrich and the amendment she moved—we have to recognise that local government's contribution over the past few years has not been especially significant. As I am sure Susan Deacon will accept, bedblocking is a problem. If local government had been providing appropriate community care services, we would not have arrived at the present situation—more than 1,700 patients confined in hospital who could be receiving care out in the community, where they would be very much happier and able to contribute to wider society.
How can we extend the body of carers? In most cases, carers are relatives; in other cases, they are—as Iain Gray said—close personal friends. But is a carer not also someone who works for charity, or who is a member of a church or voluntary organisation, and who gives of his or her time in order to assist? Should we not be examining—as Kay Ullrich suggests—our taxation system so that we can help people to make that contribution to caring, and perhaps encourage more people to do so?
It is not, of course, a question only of finance. Iain Gray dealt with that point. I would, however, like to mentions one statistic that I think is worth noting. If we paid the 500,000 people who contribute towards caring a nominal amount of £40 a week, the bill would work out at £1 billion a year, which measures up almost exactly to the social work budget for the current financial year. Perhaps that point should be recognised and accepted.
Thought should also be given to people who make their contribution in the more inaccessible rural parts of Scotland. Surely we should consider extending the rebate on fuel duty to community transport schemes. That would have a marked effect on people in those areas.
Mr Aitken says that the matter is not a question of finance and goes on to highlight the shortcomings in local government and the need to plough more money into rural and remote communities, with which we all agree. How is that anything but a question of finance?
Of course it is a question of finance, but it is also a question of enabling the people who might be on the periphery of making a contribution to do so.
I do not want to spoil the consensus on this matter. We recognise that there is a lot to do and that the Executive's proposals are worthy of support.
On behalf of the Liberal Democrats, I join in the plaudits to the deputy minister, who has produced a good paper and brought it before the chamber in an understated but effective fashion.
The extent and impact of caring in Scotland is one of our best-kept secrets. The dependency of wheelchair users is visible, as is the existence of a physically handicapped child in the family, but when I visit homes in various capacities and talk to people, I am constantly struck by how many families are touched by the presence of a dependent relative for whom the family members have some responsibility. My impression is that 20 per cent of families might be in that position, which is perhaps right as the estimated number of direct carers is about 13 per cent of adult Scots.
There is an immense burden on people who care. About half of them have provided care for more than five years. Many have to deal with administering medicine or injections and most receive no visit from professionals or volunteers. Even worse, only 6 per cent of known young carers have been assessed under the Children (Scotland) Act 1995, notwithstanding the fact that more than a third of young carers at secondary schools either miss lessons or have educational difficulties.
There is clearly—and rightly—no party divide in the chamber over the imperative need drastically to improve the support and help given to carers. I welcome both the commitment to properly developed legislation on the direct right of access to services and the careful consultation through the carers legislation working group.
The partnership Executive should be warmly congratulated on the extra £5 million that has been made available to carers services this year and its pledge to allocate more funding in the future if it is needed. However, no consideration of this area can avoid concern at the UK Government's long delay in responding to the Sutherland commission. The briefing document from the Carers National Association Scotland states:
"However, we believe that the lack of resolution on the issue of who pays for care will continue to undermine strategic effectiveness."
Members have already touched on the other area of concern, which is the continued loading of local authorities with new duties while there is a year-by-year failure even to fund pay rises. No wonder there are concerns that care money is not ring-fenced.
The answer to that problem is not a further restriction on local authority discretion. Nor is it the Scottish Executive's nannyish requirement to make councils supply community care plans with a
coupon from local carers groups confirming their satisfaction that the council has used its share of the £10 million appropriately. The answer is adequate funding of properly elected and accountable local authorities. To do that, we need to prise the Chancellor of the Exchequer's mitts off his multi-billion-pound war chest. Unless statutory duties are linked with appropriate funding, proper services to carers and other groups will remain a noble aspiration. Although the strategy outlined today is good and worth while, it must be backed by real new money if it is to succeed in the long term.
I also have concerns about young carers, to whom the deputy minister rightly gave considerable attention. They must be the priority in the general area of carers. Young people's life prospects have been severely damaged by early and heavy responsibilities of this kind. There is a need to assess young carers and for information, but this major problem needs to be addressed urgently. I am happy with the deputy minister's assurances that he will develop further research in this area.
There are many good things in the strategy, not least the involvement of carers in its development. It is a healthy skeleton. I hope that the minister will be able to tell us whether his discussions with UK ministers give us hope of putting flesh on the bones, not least through implementation of the Sutherland report.
Scotland prides itself on being a caring society. The document is excellent, but it is a beginning, not an end. I look forward, therefore, to further development of the strategy by the minister.
A number of members want to speak in this afternoon's debate. I ask members to keep their speeches as close as possible to four minutes.
I welcome today's debate. It is essential that our discussion of this issue is informed and constructive. We must move the carers agenda forward.
The Scottish Executive has placed carers high on the political agenda, as is evidenced by their inclusion in the programme for government and by the commitment to provide an additional £5 million for carers.
Does the member for Airdrie and Shotts agree that the doubled allocation of resources for the provision of carers services, including respite care, displays the Executive's commitment to carers issues? Will she further acknowledge that the announcement of the requirement to consult carers groups in developing local service plans and to seek confirmation from those groups that resources have been spent appropriately will ensure that the Executive's strategy is delivered at local level?
Yes, I agree.
It is especially important that priority has been given to young carers. It is estimated that there are around 5,000 young carers in Scotland, a third of whom care for an adult with a mental illness. Young carers face many pressures and problems, including poor physical health and injury, lack of time for recreational and peer-centred activities and conflicts between caring responsibilities and schooling. Schools must be one of the key points of contact between young carers and support services. With that in mind, I encourage all Scottish schools to use the young carers pack produced by the Carers National Association.
I recently had the pleasure of hosting a briefing session presented by young carers from across Scotland. The briefing, which was co-ordinated by some of the major Scottish carers organisations, was well attended by members from all parties. All those who attended were touched by the stories that the young carers had to tell. It is important that young carers have a voice; only by listening to them can we provide the support structures that are needed.
One young carer, Jamie from Edinburgh, told her story. She said:
"I have been a young carer since I was six years old, I am now seventeen. Because of all the time I spent caring for my mum I didn't have much time to myself. I didn't go outtoplay ...I felt like I had to be with my mum all the time.
When I was at primary School I found it very difficult to mix with other children . . . I didn't think they would talk to me, all I could think about was being bullied . . . Nobody at school ever asked if I had any problems at home.
Just before my exams I got involved with the Edinburgh Young Carers Project . . . When I started talking about things I felt great . . . I think that it is important for every young carer to receive some kind of support."
I, too, believe that it is important for every young carer to receive support. Current Scottish legislation is flawed. Young carers under the age of 16 do not have a statutory right to request assessment. I welcome the Executive's recognition of that problem and its commitment to draw up legislative proposals as soon as possible to extend the Carers (Recognition and Services) Act 1995.
Carers organisations recognise the need to proceed carefully and methodically. The carers legislation working group will include representatives of service users and carers groups and will ensure the production of well-drafted
legislation.
It is important that we acknowledge the valuable services that young carers provide and highlight the range of issues that impact on them. I welcome the measures detailed in the strategy for carers in Scotland. We have a long way to go, but thanks to the Scottish Executive we have at last embarked on that journey.
I, too, welcome the fact that we have highlighted young carers today and I wish to confine my remarks to that subject.
I am glad that young carers are being recognised, but I am sad that we have to recognise their existence. Many of them are not carers through choice, but because the burden lands on them. That said, we have to examine some specific areas of the strategy for young carers.
We have to consider the right to assessment. A commitment to a working group, which includes public consultation in 2000 but which does not rush into legislation, will not help current young carers with their problems. The right to assessment for young carers could be brought forward now, with an interim change to the guidance issued by the Scottish Executive.
The Age of Legal Capacity (Scotland) Act 1991 contains a general understanding about children aged 12 and over. We could issue guidance under that general understanding rule so that, from the age of 12, young carers could ask for an immediate assessment. I ask the Executive to examine that possibility in the interim.
We also have to consider local authorities' children's service plans and ensure that, at every stage, the needs of the young carers are taken into account. That includes their education and, for those in employment, the right to take time off. We have to examine how young carers go through their education—they are taking time off it now because of their caring duties. We cannot tolerate instances such as one that I heard about recently, in which a young carer attended a carers meeting and returned home to find that the truancy officer had been to find out why she was not at school. That is an unacceptable burden to put on young carers.
Training for guidance teachers has already been mentioned. We need to provide it now, not to the directors of education, but to the guidance teachers. We have to consider the support that we give young carers. They need training in how to get advice, how to get information and in the physical work they do, including lifting techniques.
It is sad that we have to talk about this, but we do. We must not put physical burdens on young carers by not training them correctly.
I notice that the carers strategy mentions conducting training through GPs, but I do not think that general practices provide the correct forum for training young carers in lifting techniques. The strategy also mentions respite for young carers. That is a particular issue, and it does not mean a fortnight off once a year. Carers do not want that; they want time off with the family they care for. A young carer needs regular breaks, almost every day. If a young carer goes to a homework club, they should be assured that there is respite care: that someone else will care for their parent or sibling while they are at the club.
We are talking about coherent, integrated services for young people. We cannot ask them to go on their own to social work, health, community education and leisure departments—we should be addressing leisure and transport issues too—they need someone to go to; an advocate to help them through. We cannot, unfortunately, get away from money, which is necessary to provide the services. East Dunbartonshire young carers project has a £5,000 grant for a one-year project. Young carers do not, however, have one-year care burdens—their burdens go on for longer.
I remind the Executive again that we have to ask young carers what they need. We have to listen to what they want and support them. Ultimately, we have to give them back their childhood.
I must begin by declaring that I still act as a medical adviser to foster carers in the former Central Region, now Falkirk, Stirling and Clackmannanshire.
There is little doubt that much caring in families and among neighbours goes unacknowledged. The way families, neighbours and friends step in quietly and without any fuss when a crisis occurs never ceases to amaze me. We should all acknowledge that help.
I remember one of my patients, a stroke victim, whose friend came in every morning before going to work to shave him and to have a chat with him. That was almost worth more than many of the therapeutic efforts that the team was undertaking. I also remember the families in my practice who, in the 1970s, volunteered to provide respite care at short notice for families with profoundly disabled children. That scheme is now incorporated within statutory provision, moving from a voluntary capacity to a statutory capacity, which is excellent.
I welcome the Scottish Executive's strategy for
carers and wish to address three points that are raised in the document.
First, the inclusion in the 2001 census of a question on carers will undoubtedly help us to understand the wealth of caring in society—and make us proud of it. I welcome the minister's statement that the new G-Pass GP data system can be employed in that respect—I think that it is flexible enough to do that.
Secondly, I emphasise the need for patient consent to the provision of information to carers by the primary care team. Only after careful consideration should information be divulged without that consent. The one exception to that rule is when the medical information about the family of a looked-after child would be crucial to the care of that child. While current General Medical Council regulations prevent doctors from releasing that information to carers, I am discussing with interested parties the possibility of a bill to ensure that the rights of the child are paramount in this area.
The need for information about the help that is available from the NHS is also important. I welcome the patients project, which is developing a strategy for effective communication. The extension of the NHS Helpline, to which the minister referred, should be linked closely to the development of the NHS Direct service and the proposals for NHS Direct must be linked to the continuing development of out-of-hours services. The services must be linked up to provide a comprehensive service to carers.
Thirdly, the provision of aids and adaptations remains a vexed problem at the interface of health and social services, which must be streamlined with the rapid implementation of best practice, both for joint assessment and for joint provision. The care and repair provision also has problems: the different pots of money for different categories of housing must be combined to ensure one-stop provision. It is, quite frankly, obscene that money can remain in one agency's budget while an unmet demand remains with another agency in the same area. I can give the minister detailed examples from my constituency, if that would be helpful.
We must also address the vital issues that face foster carers. The UK standards have been published. We must value and support our foster carers if we are to create the best parenting for looked-after children—previously known as children in care. Research from John Trisiliotis shows that too many foster carers are leaving the system. I believe that we must move rapidly to a salaried service.
In the meantime, in keeping with the new proposals for pensions for carers in general, we should apply immediately pension rights to the fees and expenses of foster carers. Ten per cent of foster carers who left the service did so because of a lack of respite—one returns repeatedly to this issue—and the minister has recognised that by providing new money, which is fundamental to the provision of respite care.
Finally, we must recognise that family structures are changing. The homophobic regulation that prevents households with two adults of the same gender from offering foster care is, frankly, no longer appropriate and should be removed. We know that good outcomes for children's mental health depends on the quality of the relationship between the adults who care for them— irrespective of gender—and not on the structure of the household.
I welcome the Executive's caring strategy as an excellent first step.
I welcome the opportunity to debate this extremely important issue in Parliament. I will use my time to draw attention to the needs of the valuable people who care for those with mental illness.
I would like to make three points. First, I wish to flag up the difficulties that exist in identifying carers of the mentally ill. Secondly, I wish to highlight the different needs of carers of people with mental illness from other carers. Thirdly, I wish to draw attention to the fact that the special needs for this group of carers are not met and not properly addressed in the strategy document.
One in four people in Scotland will suffer from mental illness at some point in their lives and 14 per cent of the adult population have significant mental health problems, yet many people who suffer from mental health problems never have contact with the health service and many are cared for in their own homes by carers, family members or friends. The extent to which that happens is difficult to estimate. Mental illness is a taboo subject; many will admit neither to being cared for, nor to being the carer.
Many carers suffer alone or in silence. Margaret Paton, of Trust: a Carers Connection, which operates in Ayrshire, has experience of just that situation. Her adult daughter was diagnosed as a paranoid schizophrenic at the age of 21. That is when Margaret's nightmare began. She went to hell and back in an attempt to get her daughter the help she needed, in a community where her daughter's condition was misunderstood and stigmatised. So horrific was her experience that she has gone to extraordinary lengths to ensure that no one else has to go through it. Singlehandedly, she set up a support group at Ailsa
hospital in Ayrshire, which meets once a month. That has now extended to six support groups throughout Ayrshire. An office in Ailsa hospital has been set aside for Margaret, in which she deals with carers' problems. She does all that entirely voluntarily, providing a support service and advocacy for people who receive no support from elsewhere, least of all from the public agencies.
Carers of mentally ill patients save the Government £280 million every year through the services they provide, yet local authorities provide only £54 million for people who are recovering from mental illness; that is less than 20 per cent of the estimated need. Unofficial carers provide the rest of the care.
Nowhere in the national carers strategy are carers of the mentally ill, and their special needs, referred to specifically. Carers of mentally ill people have different needs and different priorities. Those to whom I have spoken are not looking for benefits or respite care. They want information and support, recognition of their loved ones' illnesses and medical care to address them. They want their loved ones to see the same psychiatrist and to have continuity of care; they want the chance for relations to build up between patient and psychiatrist. They want information to flow freely between patient, carer, psychiatrist and GP. In short, they want rights and they want their opinions to be considered.
The national carers strategy, like many of the Executive's announcements, is a step in the right direction, but there is not enough money to fund it and there are important omissions from it.
Mental illness can affect one in four of us. Many of those who are affected are cared for at home. Carers of the mentally ill have different needs from other carers, and people such as Margaret Paton deserve our recognition and support.
There is time for one more speaker. I call Kate MacLean; you have three minutes.
Thank you, Presiding Officer. I will try to be brief.
Iain Gray said that one of the first events he attended as a minister was a carers event. I wonder whether it was the event that I attended with him, at the Marryat Hall in Dundee. He made a commitment at that time to introduce the strategy. I made a more modest commitment to hold a special surgery for carers in Dundee and I did so recently at the Princess Royal Trust Carers Centre.
Many people came along, some of them giving up precious respite time to do so. People came with specific problems, but a general theme emerged. The first thing that struck me was that carers were asking for very little. I thought that people would make many more demands, but often they wanted a couple of hours off just to do shopping, to visit a friend or go to the cinema, or to have some breathing space.
The other thing that came through quite strongly was that although carers' needs are sometimes met in terms of time off, there is a lack of appropriate respite from day care. That is particularly so in cases involving young adults with learning difficulties and people with early onset dementia. Many of the facilities that are provided are for the elderly and infirm and are not suitable for younger and more active people.
At a meeting with Dundee City Council's social work office, it became clear to me that there is a commitment to improving the lot of carers. The office had just published a report called "Breaking New Ground", which was the result of the work of a short-term working group. It identified lack of funding as a problem, so I welcome the minister's announcement about the grant-aided expenditure allocation being doubled to £10 million— notwithstanding the fact that it comes within the £40 million increase for social work that has already been announced. I hope that if there are to be increases in GAE in the future, it might be possible to find new money for them.
I would be grateful if Mr Gray could say in his summing-up how the additional GAE will be allocated and what the criteria for allocation will be. I am not clear about the mechanism that will ensure that the additional GAE is spent where it is intended to be spent. The carers strategy document suggests that there might be a possibility of conflict between local authorities and carers groups.
I welcome the fact that there will be wide consultation, but I hope that in addition to consulting carers organisations, the Executive will take on board the fact that because of their particular problems, carers will need assistance with participating in consultation and discussion.
My final point—on which I do not expect an answer now from the minister—is important and I hope that the Executive will take it on board. I welcome the strong emphasis on the need to support young carers. That area has been overlooked in the past. Young people with caring responsibilities have been neglected in terms of their social and educational needs. I plead that the minister will extend the definition of young carers to those aged 16 to 18. I hope that that can be examined closely. The youth care group in Dundee, which Iain Gray mentioned, supports young carers up to 18 years of age.
I welcome the report. I think that it sends out a good message to carers—that their views and opinions are at last being considered.
On a point of order. Might it be noted when we have important debates such as this in future that ministers should not make statements prior to the debate? People who wanted to be included in this debate have not been. The elderly have not been mentioned and neither have various other aspects of community care.
Thank you. I understand the point of order.
I welcome the minister's comprehensive speech and, like all the other members who have spoken today, the strategy for carers.
It is good that we have moved the hidden army of 500,000 carers to centre stage today. I welcome Mr Gray's comments that that is where they will remain—certainly throughout the life of this Administration. That hidden army allows us to have a semblance of community care in this country.
Some have attempted to quantify care in terms of money—that is a crude way of doing it. However, Bill Aitken's comments, which related the issue to the social care budget, showed starkly how much we rely on carers and where we would be without them. People throughout Scotland are struggling to care for their relatives, friends and— as Richard Simpson said—their neighbours. Those people have their own lives to live. They have livings to earn. Children who are carers have rights as children—the right to education and the right to be able to go out to play.
People have the right to leisure. That is why respite care is fundamental; I am pleased that the Executive is finding extra money, particularly for respite care. Other members have said that respite is not about having one week or two weeks off. Respite means having regular time away. That will make all the difference, so I am pleased about what has been announced today.
Many carers are struggling on their own with little or no assistance from public services. We must identify carers much earlier in the process, support them and learn from them what their needs are and how we can assist them.
Through personal experience as a representative, and through speaking to people at surgeries, I know that caring has an impact on the health of many carers. That is why assessment of them, as well as assessment of the people for whom they are caring, is essential. That is particularly the case for those who are caring for people with degenerative illnesses such as Alzheimer's disease or mental health problems. I know from constituents that such factors have a real impact on the health of carers. If they try to take respite care, they often feel guilty, which we should do something about.
It is crucial that carers' involvement in the services has been moved to centre stage, that the minister has met carers groups and representatives before today's debate, that carers will have a say in the services that are delivered by local authorities with the extra money that has been announced today, and that, in the coming months, carers will be involved in the working group that will produce draft legislation. I welcome those elements of best practice; I hope that they will be seen in action.
Carers tell me that they want to have a say in the services that are available to them and to the people for whom they care. Of course they want access to greater resources, but some of the things that they want are very simple. They want their voices to be heard and they want access to information. As Iain Gray said, they do not want to have to stumble on the best information and care only when they are lucky enough to bump into somebody.
Like other members, I welcome the fact that we are highlighting the role of young carers. As an Edinburgh councillor for several years, I came into contact with the Edinburgh Young Carers Project. We should be doing everything that we can to support projects such as that throughout Scotland. There is no point in tackling the problems that an individual has if we are allowing their carer to slip into a lifetime of difficulties with education and the ability to hold down employment in later life.
It is important to remember that the support that carers need can be simple. Many carers have to give medication, lift people or give some other form of health care, as the chief medical officer's bulletin in July rightly highlighted. That may be where primary care people can play their part.
Like other members, I welcome the strategy. It is only a first step, but it is a good first step. Many of the things that the minister and others have said today, and the way in which they have been said, are to be applauded and supported.
On a point of order. It has been the practice for the Presiding Officer to indicate the number of members who wanted to speak in the debate but were unsuccessful. Will you say how many members were not allowed to speak in this debate?
I am not aware that that is a practice, Mr Sheridan. For your information, I believe that the number is three.
Thank you.
Much of what I wanted to say has been said. I am delighted that there is such consensus on this issue. I would like to think that, whether in a small or in a more committed way, all of us in and outside this chamber are carers who have a commitment to care for people, be they family members or others.
I welcome the Executive's commitment in its programme for government to introduce a carers strategy. Conservative members will certainly support the motion. We welcome the consultation with local carers organisations, the monitoring of services, the carers legislation working group, community care plans, the census question, the national standards and the commitment to better- targeted information.
It is difficult to put those elements in any sort of order, but perhaps the most important is the question on carers in the 2001 census, as we do not have the information on which to base and target our support and advice for carers. I welcome the fact that we will gain more information in the 2001 census.
I read the document that Iain Gray issued yesterday. I found the last sentence the most exciting. It promised:
"A second pension for carers . . . and the protection of pension entitlements of carers who have given up paid work to care."
Yes, I really liked that and got quite excited about it, until I read the date—2050. If my relative Dennis Canavan thought it rather odd that it should take 20 years to eradicate child poverty, I wonder how he would feel about the fact that it will take 50 years to fulfil that commitment of a second pension. That commitment was outlined in the Queen's speech last week and is in the Carers National Association Scotland strategy. I would like to hear the thoughts of the carers in the gallery today, who proposed the second pension to this listening Executive, on the 50-year phasing-in period.
Although we welcome the commitment, I thought that it warranted a reality check, so I looked up the Highland carers strategy, "Working Together to Make a Difference"—I shall briefly mention some of the points that it made. In Lochaber, there is no specialised nursing care for people with dementia and there is a crying need for more family-based carers for children. In Easter Ross, it has been suggested that there should be care managers in general practitioners' surgeries and that GPs and district nurses should play a greater role in caring. In Nairn, people feel frustrated by the fact that they have repeatedly expressed their needs but no action has resulted.
I know that this has already been mentioned, but the working partnership between social work departments and the national health service is nothing short of a national scandal. In reply to Kay Ullrich's question last week, we were told that more than 2,000 patients were blocking beds in Scotland, receiving inappropriate treatment and preventing others who were in need of treatment from gaining access to hospitals. I ask the minister to consider putting some of this money towards the services in the NHS that people really need.
Adam Ingram's point about mental illness is one that I have been made aware of by carers. They say that, because of the lack of information, they cannot adequately understand, support and give the appropriate care to the mentally ill. I appreciate that there must be patient confidentiality, but the issue must be re-examined to take account of the needs and problems of carers.
Finally, I want to mention a submission from one of my constituents, who said of a local day centre that
"the staff are not trained and are often on a ‘New Deal' job opportunity or even Community Service! This does not inspire confidence in the system—particularly where vulnerable, mentally-handicapped adults are in their care without supervision."
I welcome the tone and substance of this debate. Members from all parts of the chamber have made good speeches. I am sure that the Minister for Health and Community Care will have much to say in response to Robert Brown's point about local authorities, to Adam Ingram's point about mental health and to some of the points that Mary Scanlon has just raised. It will also be interesting to hear her response to Kay Ullrich's question about the representations that have been made to the UK Government to put the subject in the wider context of the Sutherland report and the invalid care allowance.
Let me knock on the head the suggestion that the funding announced today is extra money. We welcome what has been announced and we welcome the shuffling of resources, as targeting is very useful. Let us not pretend, however, that this money has not already been announced or that it is not part of the underspend from the previous year.
Will Mr Hamilton give way?
I will not give way.
The £5 million is a relaunch of money that has already been allocated. Welcome though that
money is, let us not go down the track of suggesting that it is either new or extra money.
I would like the minister to address three general financial points. The first concerns the Government's long-term commitment to the strategy, as everyone appreciates that the more money that we can put behind support for carers the better. Robert Brown mentioned the Government's pledge of a long-term commitment. I wish that that there was one. The Government's document says:
"If, to ensure real improvements, it is necessary to increase that sum, we will consider doing so".
There is no long-term pledge, merely a pledge to consider the matter. Instead of the three-year pledge in England, this is a one-year pledge only. I want to know what the Minister for Health and Community Care means by long term and what categorical assurances she can give us today.
I also want to ask her about monitoring the strategy. The document says:
"Community care plans will be submitted to the Scottish Executive for scrutiny. From now on we will require them to be accompanied by a letter from local carers' groups confirming that they have been consulted in the planning and development of new services and that they are satisfied that each authority's share of the £10 million has been used appropriately."
What will happen if that money is not used appropriately and if the local carers groups feel that the local authority has not acted in their best interest and not met the requirements? Will that mean a reduction in amount of money for that local authority and, if so, will that not risk reducing the amount of money going to the people who need it? I look forward to a clear enunciation of the policy on long-term monitoring.
On the division of funds, Mr Gray highlighted three priorities for the Government: learning disabilities, ethnic minorities and rural costs. He rightly said that in rural communities—which Mr Aitken also spoke about—there is an additional burden. Is that to say that the funding disbursed from the two lots of £5 million will follow those priorities? Will that mean that local authorities that have a greater emphasis on one of them—the Highlands and Islands, for example—will receive greater resources than local authorities elsewhere in Scotland? If not—which would mean an additional burden on those local authorities without adequate resources to implement the plans—why not?
I hope that we will have support from our Liberal Democrat colleagues, as I am in the perhaps unique position of supporting an SNP amendment without having heard one argument against more money going to local authorities. Mr Brown made the case clearly for more money. Kay Ullrich told us that £2.4 billion less will have been spent in the first three years of this Administration than in the last three years of the Tory Government. That is the context of any announcement today or yesterday, in the press or in Parliament. It equates to a 12 per cent real-terms cut. If the 19p a week—which is, of course, welcome—is the summit of the minister's ambition, that is not good enough. We need proper investment in local authorities, proper back-up for the priorities that have rightly been identified and a step further than has been made today. On a report card, the Executive's efforts might merit a C plus—pass marks, but must do better.
In supporting the amendment, I emphasise that the priorities identified are wise but that the resources must be made available to allow local authorities and national Government to achieve those objectives.
Let me say at the outset how genuinely pleased and proud I am to be standing here today shoulder to shoulder with Iain Gray and other members of the Executive to put the strategy for carers before the Scottish Parliament and to place the needs and the voices of carers at the centre of our consideration.
Until a few moments ago, I thought that I would be able to welcome whole-heartedly and unequivocally the consensus and constructive comments that had emerged during the debate. That spirit was maintained until the last speech, which, sadly, was grudging, patronising and insulting—not to me or to the Executive, but to the carers and the people on whom the debate has focused and whose needs we care about.
I will, gladly, deal with the SNP amendment in my comments. I welcome many of the comments that members of the Opposition have made today but, as various members said yesterday, SNP members would do well to decide once and for all whether they welcome particular measures. If they welcome them, a single transferable amendment for every debate and for every motion is not appropriate. I suggest respectfully to the SNP that its amendment is not appropriate.
Speaker after speaker talked about the contribution that unpaid, informal carers make; I will not reiterate those points. However, I concur with the view that, for too long, carers have been taken for granted. Today, as Iain Gray and Margaret Smith said, we want to start—yes, start—to redress that situation. We have signalled our determination to ensure that the needs of carers are addressed and, as important, that their voices are heard.
I am conscious that when I say "their voices", that feels slightly wrong because, as evidenced in the debate, this matter is not just about them—in many ways, it is about us. It is about our families, our relatives, our loved ones and our communities. It is about what we value and whom we value as a Parliament and as a country. Many members have made heartfelt speeches based on personal experience. That perspective is important and enhances our capacity to be effective policy makers and legislators.
I will deal with some of the points that were raised. I am conscious of the fact that I will be able to address only a few of them, but we have listened carefully to the comments that have been made—many of them will be taken up in the consultations and discussions that we will be having in the weeks and months ahead. For example, some of the points that Kate MacLean and Fiona McLeod made might appropriately be considered by the legislation working group.
Reference was made to reserved matters. Of course we recognise that there are policy areas that are reserved and dealt with at a UK level but that impact upon carers and users of services. In our work, we will embrace many of those areas. For example, in the information for carers, we do not draw a line between what is reserved and what is devolved; we ensure that all the information is brought together. We will concentrate our efforts and energies on making changes in the areas in which we have powers to do so. That is right and proper and it is the correct use of our time. Of course we will continue to co-operate and liaise with our colleagues south of the border to ensure that we make the maximum impact and deliver the maximum benefit to the people of Scotland. I give an assurance that we will continue to do that in relation to the royal commission and to many of the matters that have been mentioned today.
There have rightly been a considerable number of references to local government. We want to work with local government to make a difference. We want to ensure that we work together so that we come up with solutions that are right for the people of Scotland and that deliver services as effectively as possible.
Many members have mentioned the need for effective communication and joined-up working. We are putting that into practice and translating rhetoric into reality. Iain Gray and I met representatives of every local authority and every NHS trust just a couple of weeks ago to discuss how we could take forward our community care agenda. At that meeting, we were addressed by a carer—directly and vociferously—and we will be taking forward the points that were raised.
When the minister met representatives of local authorities, did they assure her that they were receiving adequate funding to provide community care services?
Perhaps this is the appropriate point at which to address the SNP amendment. Amendments such as the one that has been moved today are dishonest and disingenuous. In every debate, we hear the cry for more money. We hear it for roads, for schools, for students, for buses, for farmers, for agriculture and for the countryside.
Will Susan Deacon give way?
No, I will not take another intervention.
It is not possible to give money to everything. To suggest that we can is a false promise. We are doubling the money to local authorities for carers. That is a doubling of real resources to £10 million a year—not once, but every year. That is real money and resources year after year. I am not interested in false promises; I am interested in real results, which is exactly what we are delivering.
I recognise that, as many members have said, the needs of individual carers vary. When we talk about carers, it is important that we realise that they are not a homogeneous group. Carers are a diverse range of people with diverse needs, which vary over time and according to circumstances. It is important that, to meet those needs, our policies and services are flexible and responsive. That means that we must listen to carers when they tell us what their needs are. We must hear what they say and act on it. That approach—of listening to the people who use the services—is a theme that runs across our community care agenda and our health agenda. We will make progress in that way in the years ahead.
Usually, people do not ask for the moon; as many members have said, they want practical measures. They are not listened to, however, so that does not happen. The work that Iain Gray will do in the months and years ahead, working closely with carers associations, will aim to change that.
I will now put our proposals in a wider context. It was not so long ago that a British Prime Minister said that there was no such thing as society— [Interruption.] This Executive is serious—we will say this again and again—in its belief not just that there is such a thing as society, but that we must cultivate and nurture that society and build on our strong collective traditions.
Will Susan Deacon give way?
I do not have time.
I could accept the Conservative spokesperson's lectures about the time that it takes to deliver if that party had not failed miserably to deliver on this agenda in its 18 years in government. We
want to build on the strong collective traditions that survived those 18 years and on which so much that is good about Scotland has been built.
We live in a modern era. We need modern government and modern politics. Therefore, our debates have to be rooted in statistics and strategy. Of course we have to set targets and timetables, but we must remember that politics is not just about numbers; it is about people. I hope that in the Scotland of the future, the defining characteristic of government, of public services and of our communities will be our capacity to care for all our people.
Compassion and concern must rank alongside enterprise and achievement as the hallmarks of our new Scotland. A successful Scotland will be a caring Scotland. I ask all members to join me today in sending a clear message that Scotland's Parliament cares and that it cares about carers.