Care of the Elderly
The next item of business is a statement by Susan Deacon, on the Scottish Executive's response to the report of the care development group.
I welcome this opportunity to set out to Parliament the Scottish Executive's response to the care development group's report and recommendations. As members will recall, I announced the setting up of the care development group in January, to undertake an examination of long-term care provision for Scotland's older people. We asked the group to produce recommendations to ensure that high-quality and sustainable services could be provided now and in the future, and we asked it to produce proposals, together with costs and implications, for the implementation of free personal care for Scotland's older people.
We should not underestimate the scale and complexity of that remit. Today, I and my ministerial colleagues wish to place on record our appreciation to members of the group for the substantial personal and professional commitment that they have given to the group's work over the past seven months. I pay particular tribute to Malcolm Chisholm for driving the work forward.
I can confirm to Parliament today that the Scottish Executive has agreed to accept all the group's recommendations, and that we are committed now to implementing them. In doing so, we are honouring our pledge to the people of Scotland to provide better, fairer care for our older people, now and in the future. From April 2002, free nursing and personal care will be provided for all Scotland's older people. From that date also, substantial additional investment will be provided for care services for older people.
As an Executive, we have made clear consistently our determination to ensure that the people of Scotland are provided with dignity, security and support in their old age. We have consistently backed that commitment with action, investment and, where necessary, legislation. The implementation of the care development group's recommendations represents a significant milestone in the fulfilment of our commitment. In addition, yesterday we published the Community Care and Health (Scotland) Bill, which is another crucial step forward in providing the necessary statutory underpinning of our work to improve care services and providing universal free nursing and personal care from April 2002.
The care development group's report stretches to 101 pages and contains 39 recommendations. I will highlight some of the main points in the report.
The group welcomed and endorsed the policy of providing free personal care. It endorsed the existing policy that the balance of care should continue to be shifted towards enabling people to stay in their own homes. It also stipulated that investment in and improvement of care services must accompany the introduction of free personal care to accommodate unmet need and increased demand.
The group made specific recommendations about the definition of personal care and the assessment of care. It adopted a definition of personal care that is in line with that which was recommended by the royal commission chaired by Sir Stewart Sutherland. The group also endorsed the royal commission's view that people should continue to pay for their accommodation and living costs. It recommended the removal of all charges for personal care in the community.
For those who are in a care home and are currently self-funding, the group recommended a flat-rate payment of £90 a week for personal care and a further £65 for those who are assessed as needing nursing care. Those sums reflect the current average costs for those in similar circumstances whose costs are currently paid from the public purse. The implementation of the measures will therefore benefit many thousands of people who currently pay for their care. Self-funders in care homes will see a reduction in their costs. Those living at home who currently pay towards their personal care costs will no longer be charged for those costs. Investment in services will build upon the £100 million that I announced last October. We will therefore see a further expansion in the care and support that is provided to older people across Scotland.
In accepting the recommendations of the care development group, we are not looking at free personal care in isolation. As the group's report makes clear, the provision of free personal care in itself will not solve some of the other issues that are facing the care sector, such as delayed discharge from hospital or the need for stability in the care homes sector. We are pleased that the care development group report strongly endorsed the work that is already under way to provide better services, more care at home, and better joint working between professionals and agencies. As the care development group has asked us to do, we commit to continuing that work.
The report highlights the good work that is going on throughout Scotland, and we want to build on that. However, it also identifies the gaps, deficiencies and duplication that still exist. Too many people are still not getting the care that they need when they need it or where they want it. That situation will not change overnight, but change is happening. I am pleased that the report identifies clear evidence that the actions and investment that the Executive put in place are bearing fruit. Rapid-response teams are providing quick, flexible support for people who fall ill and for whom a short period of help has avoided the need to go into hospital. Local authorities and the national health service are working together effectively to provide better, more responsive services and to deliver more care and support to people in their own homes. More long-term care is being provided at home for people who, for example, have suffered a stroke and might otherwise have had to go into residential care. More short-term help is being provided to support the recovery at home of people who come out of hospital—for example, after a hip replacement.
We applaud the efforts that are being made by local authorities, the NHS and the voluntary and independent sectors to improve the care of Scotland's older people. However, we believe that more needs to be done. We recognise that we have set a demanding agenda for local authorities in particular and that the introduction of free personal care from April next year is a further challenge.
The care development group recommended that an implementation group be established to take forward the report's recommendations. I am pleased to confirm that the Executive is acting on that recommendation and will bring together that group soon.
Delivering change on the required scale needs real partnership and teamwork. We will continue to work closely with the providers and the users of care to ensure that that change is achieved. However, change cannot be delivered successfully without proper resources being made available. That is why, last October, we committed substantial new investment to older people's services. We also made £25 million a year available for the introduction of free nursing care.
In July, the Minister for Finance and Local Government, Angus MacKay, set out how Executive budgets had been realigned to meet our priorities and to release a further £100 million next year and the year after to take forward the care development group's recommendations. By any measure, that is substantial additional investment. It is tangible evidence of the Executive's commitment to translating our promises into results.
We are aware, of course, that attention has focused in recent days on attendance allowance. I will set out clearly the position on that issue. As the care development group's report says, attendance allowance in care homes is a United Kingdom contribution towards personal care costs on which Scotland is choosing to build. Most of the 8,000 people who meet their care costs in nursing or residential care would be eligible for payment of attendance allowance at the rate of £55 per week, giving an annual amount of just under £23 million. In other words, the full free personal care entitlement would be £145 per week, made up of £55 UK entitlement plus £90 from the Executive. In addition, we are making available free nursing care of up to £65 per week.
The group said that it would be odd and contrary to equity if entitlement to attendance allowance stopped for those in care homes because of a policy of free personal care in Scotland. Put simply, the group's view is that the money is in the system. It is meant for personal care and should continue to be used for that purpose.
The Executive is engaging in constructive dialogue on that issue with the Department for Work and Pensions. The situation is not constitutional turf war. We are, together, as responsible Government, managing the practicalities of the complex interrelationship between the UK benefits system and Scotland's care arrangements. The discussion concerns payments to individuals and who should make them. It may take time to resolve the issue, but as the First Minister said on Monday, whatever the outcome of those discussions, the provision of free personal care for Scotland's older people is a pledge that will be fulfilled.
Throughout the chamber, members have a genuine commitment to improving the lot of Scotland's older people, but I say more in sorrow than in anger that some have attempted to reduce the debate to simple slogans or political point scoring. The coalition Executive believes that Scotland's older people deserve better than that. That is why, at every turn, in every statement, in every investment and in every policy development, we have addressed the issues. We have set about making a difference.
The Executive has delivered record investment in services for older people in their homes; the Regulation of Care (Scotland) Act 2001 to improve standards of care; radical changes to improve the way in which local authorities and the NHS work together, making care of older people a new priority for the NHS; and, more widely, cheap travel and free central heating for Scotland's older people. Those are real actions and real investments to deliver real improvements to people's lives. By its actions, the Executive has shown that it is rising to the challenge that the people of Scotland have set it.
I thank the Parliament for the opportunity to make the statement. I am, of course, pleased to answer members' questions. I hope that today will be considered a further significant step forward for the betterment of the care of older people throughout Scotland.
I invite those who would like to ask questions to press their request-to-speak buttons.
A debate is to be held on the issues tomorrow and I must protect the business that is scheduled for today, so I appeal for short questions and answers rather than long statements that could wait until tomorrow.
I pay tribute to the work of the care development group and warmly welcome today's statement from the minister. I am glad that, at last, the minister is now part of the consensus on this issue. I am sure that she will have noted that Westminster is watching.
The commitment to provide free personal care from next April is a victory for Scottish pensioners. Let us make no mistake, however, that it is also a victory for the independence and perseverance of the Scottish Parliament. Does the minister agree that the Parliament now has a duty to ensure that what has been promised is fully funded and deliverable?
The minister confirmed today that, without an agreement with Westminster on benefits payments, the Executive will require to find an additional £21.7 million. Will she now go further than simply stating the view of the care development group by making it clear that it is her view that the money that is currently paid by Westminster to Scottish pensioners in the form of attendance allowance—money that is derived from Scottish taxpayers—must, as a matter of principle, continue to be paid?
Does the minister agree that it would be a gross injustice if Westminster were to withdraw those benefits simply because Westminster does not agree with the policy of this Parliament? As the minister herself has said, that policy is designed to build on existing provision, not to replace it.
Finally, does the minister agree that her position in the on-going negotiations with Westminster will be strengthened if this Parliament agrees a motion tomorrow that makes it clear that we expect the Scottish Executive to win this battle?
Let me say sincerely that I am pleased that Nicola Sturgeon welcomes today's statement. I am genuinely pleased that she recognises that considerable work has been done to translate our promises into practice. I am bound to suggest to her that, if she is so welcoming of the progress that has been made, perhaps it is time for her to work constructively with that process.
From the outset, the SNP has attempted to confuse the debate and to undermine the commitments that were given by the Executive. First, we heard that the definition would be watered down. Then, when it was clear that SNP members could not criticise the definition that would be adopted, they moved on to something else. Last week, Nicola Sturgeon claimed that we were making only £8 million available for free nursing care, when the real figure was in fact £25 million. The SNP realised—not for the first time in recent weeks—that its sums did not add up, so it then moved on to something else again. Now, the SNP is attempting to change the debate into a constitutional turf war.
We work in partnership with our UK colleagues for the betterment of the people whom we are elected to represent. I recognise that partnership is something that the SNP finds difficult to understand, but we are committed to it. We are determined to continue to build upon that partnership for the betterment of the care of older people throughout Scotland. That has been our promise; our commitment is clear for all to see.
I thank the minister for allowing her statement to be made available earlier so that we could read it in advance.
At this stage, the Scottish Conservatives welcome the implementation of the majority of the care group's recommendations on personal care. I have to say that it has been a long time coming. This time last year, the minister stood in the chamber and said that free personal care would be wrong, so I hope that she remembers her U-turn. We question whether the minister is now able to implement a commitment that she did not, in the first place, believe in, but will she consider going further by implementing Sir Stewart Sutherland's recommendation that all community care funds be pooled?
Will the minister assure us that whatever comes out of her negotiations with the Secretary of State for Work and Pensions will be done in the interest of the UK and will not produce a separate benefits system, which the nationalists would very much like to create? Will she ensure that, between her and the UK secretary of state, we get a solution?
Let me first be clear about what has been achieved in a short period of time. It is only a year since we first set out in detail a demanding programme of investment and action to improve services for older people and to deliver greater equity in charging for those care services. In that time, we have translated into action much of the joint working that needs to be put in place to achieve that. We have introduced legislation and the care development group has completed its work. We should all applaud the work that has been done and what has been achieved in seven months.
As I said in the chamber in January, if the Executive promises change and improvements for older people in Scotland, we will deliver change and improvements for older people in Scotland. We will say when we will do it and how we can do it, we will explain the consequences of making changes and we will ensure that we deliver those changes. What members have seen from us in the past year is work—month in, month out and year in, year out—to ensure that those changes are delivered. Our on-going discussion with the Department for Work and Pensions is one strand of that much wider tapestry.
It is interesting that both Opposition parties desire to try to translate that discussion into a constitutional issue. We do not see it as a constitutional issue; we see it as providing the best care that we can for the people of Scotland and having an effective dialogue and partnership with our colleagues in the UK. That practical and pragmatic approach underpins our work in this area, as in many others.
What we are seeing today is Liberal Democrat policy being put into practice by the coalition Executive. Free personal care has long been a Liberal Democrat policy. On behalf of my colleagues, I am delighted to welcome today's statement. I thank Malcolm Chisholm and the care development group for their work, which builds on the work of the joint future group and the Health and Community Care Committee. I pay tribute to my colleagues on that committee for their work on the issue.
We all welcome the constructive dialogue with Westminster—I am glad to see that the minister of state is here, listening to the views of the Scottish Parliament that are being expressed clearly today. It is also important that the Executive continues to have constructive dialogue with local government, because our local councils will have an incredible role to play in taking forward this agenda from now on. How will the Executive implement the single assessment process and joint working policies between local authorities and the health boards, which should improve services and decrease delayed discharge?
Will the minister guarantee that the changes regarding local authorities that are envisaged in the care development group report will be fully funded, so that there will be no shortfall in actual expenditure on older people's services and so that other council services will not suffer?
As I have said, the Executive's approach is underpinned by partnership. That includes the partnership between Labour and the Liberal Democrats and a productive partnership between national and local government. I am pleased to give Margaret Smith the assurance that she seeks that we will work closely with local authorities in implementing the changes.
As I said in my statement, we recognise that the programme of work will be demanding, but there are solid foundations to build upon. There are tremendous examples throughout Scotland of effective joint working. The effect of investment is starting to kick in. With the bill that was published yesterday, we are underpinning the move towards joint working, pooled budgets and practical changes that the Health and Community Care Committee has taken a keen interest in and has promoted over the past year. We have much to build on and we will continue to do that.
I declare that I am the director of a nursing home company, albeit one that operates only in England.
I welcome the minister's statement. Will she indicate the numbers of long-stay NHS hospital beds in geriatrics, psychogeriatrics and learning disability that are still to close? In considering the care development group's recommendation for 100 per cent resource transfer of the funds realised by such closures from the NHS to the local authority community care budget, will the minister ensure that the community NHS medical and nursing services are funded to take over the health care?
Instead of ring-fencing the new money, will the minister consider requiring the local authority to publish its care of the elderly expenditure against grant-aided expenditure and resource transfer and consider, as part of a total settlement, making the local authority responsible for paying for nursing and personal care wherever the elderly person is situated, as that would remove the current perverse incentive? In Forth valley, that has led to the SNP-Conservative council in Falkirk increasing delayed discharges by unilaterally deciding not to take patients out of hospital because it saves the council money.
Richard Simpson's question serves to highlight how crucial and effective the working relationship between the NHS and local authorities is in ensuring that individuals receive genuinely responsive and seamless care that meets their needs. I will not repeat my earlier comments about the progress that has been made in that area. Long-stay NHS beds are touched on in the care development group's report, which recommends work that should flow from the group's consideration of the issue. We will be developing that work, and there are many areas in which we want to improve the data that are available, on the use of resources through the system and on the results that those resources deliver.
We are focused on results, and we want to strike a balance between monitoring and assessing how money is spent, in the NHS or by local authorities, and monitoring the results of that investment. The move towards outcome agreements between the Executive and local authorities on older people's care services signifies our determination to focus on results and improvement. It is a continuing debate, and I am sure that people in this Parliament and beyond will continue to consider how further improvements can be achieved.
As a socialist, I accept 100 per cent the positive aspects of the report. Does the minister recognise that, if free personal care is part of the overall universal provision that makes up a clear socialist principle, she must be prepared, in her constructive dialogue with the Westminster Government, to argue that the other side of the universal provision bargain now has to be met, and that we need progressive taxation—with higher taxes on the higher earners—to make universal provision available?
The balance between universal provision and targeted benefits, or targeting in other areas, has been a matter of debate for a century or longer, and I am sure that it will continue to be so. Here in Scotland, within the powers available to us, we have exercised judgments about how and where to draw that line in other areas. I am pleased that my colleague, the Minister for Social Justice, is with us in the chamber this afternoon. In areas for which she is responsible, we have focused on targeting resources to those who are in greatest need. There is often no right or wrong and no black-and-white answer in such areas, but we will concentrate our efforts, our powers and our resources on striking an appropriate and fair balance for the people of Scotland.
I pay tribute to the work of the care development group, and to the Deputy Minister for Health and Community Care, who seems to be ever the bridesmaid and never the bride at such big events.
The group's report sets the cost of free personal care at £145 per person per week. We know that the Executive has set aside £90 of that, and that there is continuing debate with Westminster about the remaining £55. Does Susan Deacon accept that not all people on attendance allowance receive the top rate of £55, and that some of them get the lower rate of £37? Even if Westminster agrees to allow people to retain attendance allowance, the Executive will still have an extra £18 to find for everyone on the lower rate. Has the minister calculated how many people are in that category, what the total additional bill will be and where the extra money will come from?
If there were time, I would take issue with one or two of the details of Shona Robison's question. However, the very nature of her question illustrates some of the complexities and technicalities that are involved. That is why we are not prepared to reduce the issue to simplistic terms. We want to hold constructive discussions with our colleagues in the Department for Work and Pensions to ensure that the arrangements that we put in place are effective and practical, and we will continue to do that.
Those members who know the Deputy Minister for Health and Community Care will know that he can rarely be said to hide his light under a bushel, and nor, today, can the Executive.
Will the minister reassure us that the press coverage suggesting that many elderly people in Scotland will, despite today's welcome announcement, be worse off than their counterparts in England is untrue?
We dismiss absolutely the claims that were made in the press report to which I think the member refers. If it is the same report, Malcolm Chisholm responded directly to it in the press. I therefore refer the member to Malcolm Chisholm's letter.
I, too, welcome the minister's statement and the Executive's achievement in full of its pledges.
I will return to the questions that were asked by Margaret Smith and Richard Simpson about the effective use of money and previously announced money. Will the minister give an assurance that measures will be put in place to ensure that the money adds value to local authorities' spending on care? There is an impression among some care groups that money is not producing much additional resource. Will the minister keep a close eye on that? Will she ensure that local authorities deliver in the sector in question?
I am happy to give the member the assurance that he seeks.
I declare an approaching chronological interest.
The Executive's intention is that people receive £145 per week for personal care; however, £145 is the average cost of personal care and 40 per cent of people who currently fund their own residential care pay more than the average. Does the minister accept that the Executive plans amount only to subsidised personal care for those people?
The care development group has carefully considered those matters. I commend the report to members who have not yet read it, because the group has considered not only how much people should be paid towards the cost of care, but how that system can be as fair, transparent and equitable as possible.
As I said in reply to previous questions, there are no absolute right or wrong answers, but the Executive and the care development group have set out the issues more transparently than they have been set out on previous occasions.
Colin Campbell mentioned a chronological interest, but not only those in the chamber with slightly greyer hair have an interest. A key part of the care development group's remit was to come up with recommendations for sustainable services. Many members are part of the baby boomer generation and will have needs further down the track. The care development group's approach is balanced and meets needs for the care of older people now and in the future.