Long-term Care
The next item of business is a Scottish Conservative and Unionist Party motion, S1M-1215, in the name of Mary Scanlon, on long-term care. There is an amendment to that motion. While members take their places for this debate, I would be grateful if those who wish to speak would press their request-to-speak buttons.
It gives me great pleasure to move the Conservative motion on long-term care for the elderly. This is the only opportunity that the Parliament will have to express its view on the recommendations of the Sutherland commission before next week's statement by the minister outlining the Scottish Executive's response.
Our motion is framed in such a way that it can be supported by every party in the chamber that is in favour of the implementation of the Sutherland recommendations. We should send a clarion call to the minister today that we can do much more for our older people than the Government has chosen to do for older people in England and Wales. At last, devolution can make a real difference.
As was highlighted in the public health debate last week, we have an aging population. Over the past 20 years, male life expectancy in Scotland has grown from 69 years to 72, and female life expectancy has grown from 75 to 78. The number of people who are aged between 75 and 84 has increased from 180,000 in 1970 to 260,000 in 1998, a 44 per cent increase. More strikingly, the number of people who are aged 85 or over has risen from 35,000 to 81,900 during the same period, a rise of 131 per cent.
The result is that new needs have come to the fore. Our population is healthier than ever before, as there is less ill health in earlier life. However, as people live longer, many more require care that relatively few needed in the past. That could be portrayed as a problem. In fact, it is a challenge to give older people the respect and care that they deserve and to bring health and social services together.
The Sutherland commission's well-researched report highlights the fact that, since the inception of the national health service, long-term care has always been provided in a mix of long-stay NHS beds and residential homes—the former have been provided free and the latter have been means-tested. However, change in the population resulted in a huge increase in demand for that care in the 1980s and 1990s. At the same time, there was a move from long-term hospital care to community care, which was based on nursing and residential homes and support services for people living in their own homes. Much of that was paid for through the social security system. Sutherland informs us that social security expenditure in this area grew from £350 million in 1985 to £2.5 billion in 1993-94.
Of course, many other changes took place in the 1980s. The sale of council houses led to 300,000 Scots becoming property owners for the first time, and personal savings were encouraged through tax-exempt special savings accounts and personal equity plans, and many people took out personal pensions. The net result is that many more people found themselves penalised for their prudence when they required care that was increasingly unavailable on the NHS.
The homes that people had purchased and the savings that they had put aside to provide security in their retirement and to pass on to their children were quickly being eaten up in care costs. Moreover, that care was for the illnesses and frailties of old age that they had fully expected would be the responsibility of the national health service to which they had contributed throughout their working lives.
Care in local authority and private residential or nursing homes had always been means-tested, but that was of no comfort to the many thousands who now required it, or to their families. In response to public pressure in 1996, the Conservative Government doubled the capital threshold in the means test to £16,000, which exempted many more people from charges. Although the clamour died down temporarily, it did not go away. Since 1997, the situation has worsened as the Labour Government has not uprated for inflation the capital disregard.
In fairness, when the Labour Government came to power it established the Royal Commission on Long Term Care to examine the problem and to attempt to resolve some of the inconsistency and unfairness in the system. I give the Labour Government credit for doing that. Many issues were to be resolved: the different charging regimes in different local authority areas; the apparently arbitrary retention of long-stay NHS beds in some areas but not in other areas, along with the seemingly arbitrary access to those beds; the lack of co-ordination between health and social work services; and the way in which long-term care has been treated differently from other health needs.
The resulting report from the Sutherland commission is comprehensive and well considered. It recommends a way forward, through provision that is based on need, which is free to the client and which is costed into the future. It resolves unfairnesses and proposes the unification of health and social work budgets for long-term care. That report is no wish list from a pressure group or political party that is eager to please the electorate; it is a considered, costed plan that has been put together after much consideration of the evidence.
One of the most compelling arguments is set out in paragraphs 6.33 and 6.34 of the document. It states:
"Whereas the state through the NHS pays for all the care needs of sufferers from, for example cancer and heart disease, people who suffer from Alzheimer's disease may get little or no help with the cost of comparable care needs. All these conditions are debilitating, but Alzheimer's disease cannot yet be cured by medical intervention. However, a mixture of all types of care, including personal care, will be needed. This is directly analogous to the kind of care provided for cancer sufferers. The latter get their care free. The former have to pay.
For this reason, the distinction between the way care is offered for different diseases has no justification. The situation must be put right. The proposal to exempt personal care costs from means-testing would do that."
I cannot make a better argument for fairness and equity than that, and I hope that the Parliament will agree with the commission.
The Minister for Health and Community Care, Susan Deacon, announced in her press release on Mr Blair's NHS national plan for England and Wales:
"I welcome the Prime Minister's statement today and his unequivocal commitment to the founding principle of the NHS: that health care should be given on the basis of a person's need not their wealth. That principle is as relevant today as it was fifty years ago at the birth of our NHS. And it is a commitment shared by this Scottish Executive."
Well, we will see. If the basis of the NHS is need and not wealth, why are the long-term care needs of the elderly and of Alzheimer's sufferers any different in principle from those of anyone else with health care needs? Those who reject the recommendations of Sutherland must answer that question.
If it is right in principle to implement the commission's recommendations, as I believe it is, how should they be financed? There is no bottomless money pit: choices must be made and priorities established. The report contains clear costings that, as Sir Stewart Sutherland confirmed to the Health and Community Care Committee, work out at approximately £110 million for Scotland. That price is worth paying and is a price that can be paid.
We know that that is affordable. Following the chancellor's budget, an extra £173 million was allocated to health in Scotland—enough to pay for the implementation of Sutherland's recommendations, with plenty left for other projects. Last year's NHS budget in Scotland was notoriously underspent by £134 million—more than the cost of implementing Sutherland's recommendations, the full cost of which would be only 2.1 per cent of this year's health budget.
Additional savings would be achieved by creating a unified health and social work budget for community care, and from the associated savings that would be created by reducing delayed discharge—bedblocking, as it is commonly known—in NHS acute hospitals. Currently, 2,400 beds are blocked—a scandalous figure that has risen by 40 per cent since the Minister for Health and Community Care took office—and are costing the NHS between £42 million and £96 million a year.
There are also the billions that Jack McConnell was bragging about in the Parliament last week. We can fund implementation of Sutherland's recommendations; the issue is whether the Parliament and the Scottish Executive will give it the priority that it deserves within the overall budget. SNP members have already indicated that they will support the motion. I thank them for that and acknowledge Christine Grahame's sterling work on this issue.
The Liberal Democrats' position should be equally clear. Their 1999 manifesto for the Scottish Parliament elections promised to
"Promote an early dialogue with all interested parties throughout the UK to establish a common way forward in achieving the recommendations contained in the Royal Commission on Long Term Care".
Of course, doubts about the Liberal Democrats' position stem—as always—from the partnership agreement that they signed with Labour to form the Executive coalition. In that agreement, the manifesto commitment is somewhat watered down to proposals to establish an independent Scottish inspectorate of health and social care and to promote joint working and effective co-operation between health and social work and their budgets. The agreement makes no mention of the royal commission and we will see in this debate whether Liberal Democrat members stand up for their manifesto commitment. If they do, a parliamentary majority can be secured for a policy that they have campaigned hard for in the past.
As for Labour, what is the position of the party that likes to claim the NHS as its own and says that it believes in free care from the cradle to the grave? In England, the Prime Minister's national plan for the NHS fails to accept the key Sutherland proposal that personal care should be financed from general taxation. That recommendation was rejected despite support from the House of Commons Health Select Committee, which has a Labour majority. So much for the listening Government—it does not even listen to its MPs.
The statement on the plan did nothing to resolve the vexed question of whether giving a person a bath constitutes a means-tested social bath or a free medical bath. When the Prime Minister was questioned on the practical problem of how to distinguish between nursing and personal care, he got into a lather and suggested that nurses should make such decisions. Unfortunately for him, the Royal College of Nursing has dismissed the Government's proposal as unworkable. Furthermore, Age Concern has said that older people would feel "bitterly let down" by the Government's response and the perpetuation of such artificial boundaries.
We must avoid a similar fudge in Scotland that leaves the core problem in the system—indeed, the very problem that the Sutherland commission was set up to resolve. Parliament has the power to provide a Scottish solution to the problem. On the day that the NHS plan was announced in England, Maureen O'Neill of Age Concern Scotland stated:
"It is time for the Scottish Executive to show that it is listening to the voice of older people, and make sure that they can look forward to a secure old age where their care needs will be taken care of. What is the point of having a Scottish Parliament if it doesn't listen to the views of people in Scotland?"
Hear, hear to that.
In the run-up to the previous election, Labour made great promises to the elderly and built up their expectations about what it would do in government. Sadly, the reality has been rather different. Today could be yet another in the series of Labour letdowns. It took the Sutherland commission 12 months to report its findings; however, the Scottish Executive has taken 18 months to respond, and the terms of Iain Gray's amendment are frankly a fudge.
With its talk of fulfilling Sutherland commission objectives "over time" and its silence on implementing recommendations, the amendment is a transparent attempt to confuse the issue and should fool no one. The issue is straightforward: should all personal care costs be borne by the taxpayer or not? Today is make-your-mind-up time for Parliament—not next week, not next month, not next year and not over time.
Our motion should be enthusiastically supported by the majority of MSPs. The costed proposals are available in the Sutherland recommendations and the funding is available in the NHS budget. I trust that the political will is here in the Parliament; the demand from doctors, nurses, care workers, social workers, older people and their families certainly exists. It is up to the Executive to heed their call. I urge the Parliament to support the motion and provide the people of Scotland with the care, dignity and security in later life that they seek and deserve.
I move,
That the Parliament calls upon the Scottish Executive to implement the key recommendations of the report "With Respect to Old Age: Long Term Care - Rights and Responsibilities" of the Royal Commission chaired by Sir Stewart Sutherland, including the funding of personal care on the basis of assessed need in order to alleviate the problems facing those who require long term care.
I know that the Tories think that they have picked a difficult debate for the Executive to respond to. But in many ways it is a real treat, because we will, quite properly, announce our intentions regarding care of the elderly to Parliament next Thursday. We will detail how we intend to use the significant resources for community care that were announced last week by the Minister for Finance. That will complement announcements that have already been made, such as the Minister for Communities' announcement that all Scotland's pensioners will have central heating within five years of 2001. Our plans will be subject to Parliament's scrutiny next week.
What is special about today is that we actually have a Tory policy to scrutinise. After months of health debates and community care debates in which the Tory contribution consisted of little but criticism, half-truths and personal abuse, we have a clear proposal—or do we?
David McLetchie says that the Scottish Tories are committed to the implementation of the Sutherland recommendations, but what does he mean? That is not a new commitment. Mary Scanlon made it at the Tory party conference back in June—or did she? What she said on 26 June was that health care for the elderly would be free. However, that is not what Sutherland recommended. Three days later, she announced that nursing care for the elderly would be free. That is not what most people would think of as full implementation of Sutherland. By last week, the Tories were agreeing that health-related personal care should be funded by the NHS. That is not what Sutherland recommended, either—or is it? It is extremely unclear. I do not know, and neither, it would appear, do the Tories.
Perhaps it is not surprising that the Tories have some difficulty with the Sutherland report. As David McLetchie quite rightly acknowledged, the royal commission was set up to consider how the system of funding long-term care that the Tory Government left behind could be improved. David McLetchie criticises us for taking 18 months to make it fairer, but, of course, the Conservative party took 18 years to make it unfair.
We have been making it fairer by implementing many of the royal commission's recommendations. The carers strategy has doubled resources for carers services. Direct payments have been opened up to the over-65s. Some £7.5 million this year has been devoted to funding better joint working between health and social work services and the joint future group is about to make recommendations to turn such working from the exception into the norm. We have developed national care standards for the first time. We have created space in this year's legislative programme for the creation of the commission for the regulation of care. We will respond to the remaining recommendations next week.
The Tory motion gives the game away. It is focused solely on the personal care recommendation. That does a disservice to what David McLetchie acknowledged is the carefully researched and argued work of the royal commission.
The minister might like to know that we lodged the motion in that form because we have no problem with acknowledging the recommendations that have been implemented—their implementation is a good thing. Will the minister respond to the fact that personal care lies at the core of the report? That is why we focused on it.
I have my own views on why the Tories focused on that recommendation. I repeat the point that all the other recommendations that Ben Wallace claims to have no problem with were not implemented during 18 years of the previous Tory Government. The recommendations address the unfairness of the system that the Labour Government inherited in 1997.
The motion focuses on the personal care recommendations, so it is that promise from the Tories that we should examine. Who would it benefit? What would it deliver for Scotland's older people? How would the Tories pay for it? The cost of the proposal, as David McLetchie said, would be about £110 million. That is well known. What is less well known is the fact that the majority of the resources would reduce the cost of care for around 7,000 people—those who pay all their costs in residential and nursing care. The remainder of the 34,000 Scots who are in residential or nursing care would see no change from that recommendation of the report, and no benefit from the investment of £100 million. Even those 7,000 people would not see their care improving and there would be no change at all in the quality of their care.
David Lipsey, a member of the royal commission, said:
"since seven in 10 of those in long term care are already fully funded by the state, the extra spending would go entirely to the remaining three in 10 who contribute to their care, and who are by definition the best off among them."
It is important to clarify what the Executive amendment actually says. Is the minister ruling out, even over a long time scale, any commitment to personal care? That is the crux of the Executive amendment, as opposed to the Conservative motion.
The point is that we have to address the situation in which we find ourselves. We have to recognise that what we do over the next two weeks or two years will not be the final word on long-term care of the elderly. It must continue to develop over time, and that is quite proper.
Some people might argue that the others can look forward to benefiting from the recommendation when they enter residential care, but they cannot. Four out of five Scots will never require residential care. Of the one in five who require it, more than 70 per cent will still not benefit from the proposal. That equates to 7,000 beneficiaries out of 34,000 people in residential care, out of 340,000 Scots over 75 and out of three quarters of a million Scots over 65.
Will the minister give way?
No. As we have made clear, we believe that resources that are devoted to older people must and will be increased. Where has the under-investment been? In the 10 years to 1999, spending on home care increased by £15 million, and spending on residential care increased by £125 million.
We believe that we must provide more care for more of our elderly people; that we must provide better care for our elderly people. That is entirely in line with the recommendations of the Royal Commission on Long Term Care. Would the Tories' promise provide more care? No. Would it provide care for more people? No. Would it provide better care? No.
We have to make choices about our priorities. I spend a great deal of time listening to older people, both individuals and their representative organisations.
No.
There is no doubt that many older people worry about what support they might need, but what comes over loud and clear is that they want to live independently for as long as possible. This is one of the great strengths of the Sutherland report: it majors on the importance of older people to our society.
The Tories must explain how their motion—this promise of theirs—helps older people who want to carry on living at home. While the Tories try to do that, Sarah Boyack is getting on with the business of announcing a concessionary travel scheme, which will help every pensioner in Scotland to maintain their independence.
David McLetchie, to his credit, talked about how the Tories' proposal would be funded. That is not new either: back in June, the Tories announced that the £110 million would come from two sources, the first being £70 million of unidentified savings in the NHS. What will they save that on? Fewer doctors? Fewer nurses? Linear accelerators? Alas, they do not tell us.
They will save the remaining £40 million by unblocking blocked beds. I puzzled over this one for a while, and then I remembered Mary Scanlon's parliamentary questions about the cost of a nursing home bed compared with the cost of an acute hospital bed. Use the back of an envelope, do a bit of subtraction and some multiplication and there is the £40 million. What the Tories do not say however, is that realising that saving from unblocking the beds and transferring the resource to long-term care would mean having to close the acute hospital beds. Here is the sting in the tail of the Tory promise: they will pay for it by closing thousands of hospital beds.
No.
That is just another old-style Tory promise, which concentrates on a relatively small number of people and which will be funded by £70 million of cuts in health services and £40 million of cuts in bed numbers. That is what the Tory press release on the announcement says.
The royal commission report is a welcome and important document. That is why we commissioned it, why we have begun to implement so much of it and why we will begin to implement more of it next week. However, it does not stand alone. Investment in older people has to mean investment in more care—more care at home, better-quality care, warmer houses and cheaper travel. Our guiding principle must be providing the maximum benefit to the maximum number of people. We have to tackle the greatest need first.
Next week, we will announce our plans for the care of the elderly. The plans will face up to the hard choices about the most immediate priorities, but they will invest significant additional resources to deliver significant improvements for a significant number of Scotland's older people. By focusing on one recommendation of the royal commission report for the sake of political expediency, the motion falls short of that. The motion is not about helping our older people, it is about helping the Tories; on that basis, it should be rejected.
I move amendment S1M-1215.1, to leave out from "calls" to end and insert:
"notes the report and recommendations of the Royal Commission on the Long Term Care of the Elderly; welcomes the Commission's emphasis on the importance of older people in our society; welcomes their concentration on issues related to the quality of care, the balance between residential care and care provided in the home, and the value of joint management and resourcing of services for older people; welcomes the additional resources announced in the spending review for the care of older people, and calls upon the Executive to ensure that these additional resources are used to deliver significant improvements in care for the largest possible number of older people, particularly those in greatest need and to continue, over time, to work towards fulfilling the Royal Commission's objectives of fairness and equity in the care of the elderly."
The minister may live to regret what he has just said. He said that the Executive welcomes the report, that it is important and that much of it is being implemented. He is not, however, implementing the crucial recommendation: that personal care should be free wherever it is delivered.
I remind the minister of just some of the organisations that contributed to the document. They include big hitters, such as Alzheimer Scotland—Action on Dementia, Age Concern, the Carers National Association and a whole range of others such as the Disablement Income Group, ENABLE, various elderly forums, the National Pensioners Convention and many individuals, the Association of Charity Officers, the Association of Hospice and Specialist Palliative Care Social Workers, the Association of Directors of Social Work (Scotland) and the Liberal Democrat party. The two-column list of contributors runs to almost 20 pages. That is roughly 8,000 contributors, starting with Abbeyfield Northern Ireland and ending with—whoever she is—Zlotnick, Annie.
That wealth of diverse experience has been distilled into a gem of a report, which is readable, comprehensive and costed. It was delivered on time—after one year—18 months ago. Apart from, apparently, the Deputy Minister for Community Care, no one in the chamber does not know the report's two key recommendations, one of which is that personal care should be free wherever it is delivered, whether at home or in a nursing or residential home.
For 18 months, the coalition Executive has been steadfastly silent on personal care, but we all know—the minister has just disclosed what was an open secret—that there is no intention to implement that recommendation. I quote from the minister's letter to me of 19 September:
"Ministers are conscious of the Royal Commission's recommendations on charging for personal care in residential and nursing homes and of the relatively small number of people"—
they will love that description—
"who would benefit from them. The Scottish Executive considers there are better ways to help people with the considerable additional resources required for long term care."
That is the Executive's position. We are back to that depersonalising buzzword—targeting.
The Executive is not listening to the royal commission, to those who gave evidence or to the older people who will continue to fight today, tomorrow and the day after for justice in old age, which is what the matter comes down to. People are compelled to sell their homes, or to wait stacked and depersonalised, like unwanted goods, in a hospital bed where they should not be, because social work has run out of funds to pay for their care.
Will the member give way?
No, I am not stopping. As the minister and I know, there is no fund of money in the settlement between central and local government that is ring-fenced for care of the elderly in the community.
Will the member give way?
No. Haud on and answer later.
There are no protected funds for those who need our protection. Older people who, perhaps through sheer frailty, require to stay in residential accommodation, watch the home in which they have lived for decades being put up for forced sale, not just to pay their living and housing costs, but so that they can have a daily bath and be helped from their chair to the garden. Families, already fraught with guilt for placing parents in residential accommodation, oversee the sale.
The deputy minister may wish to live in that kind of Scotland, but I do not. Even if he tells me that only three out of 10 people are affected, that is three out of 10 injustices too many. The Labour party once spoke up for the welfare state, for the underprivileged and dispossessed and all those who had no voice, but it does not seem to listen to those voices any more—or if it listens, it does not hear. A fine party that once thought big now seems to think small.
At the Labour party conference yesterday, the party failed to listen to the constituencies and trade unions and to that wonderful nonagenarian, Barbara Castle: it will not restore the link between pensions and average earnings. The Labour party will pay for that, one way or the other; its politicians fail to listen at their electoral peril and, I regret to say, their failure brings this Parliament into disrepute.
The Conservatives introduced care in the community 10 years ago and made mistakes, but I am not going to dwell on past frailties because they have seen the light. I am pleased when people see the light, and I thank David McLetchie for his gracious mention of my work on the issue. I hope that he will now sign up to my proposed bill on Alzheimer's and dementia care, if I have to proceed with it.
I know that honourable people in the Liberal Democrats are struggling with other members of their party on the issue and I exempt them from what I say next. The Liberal Democrats hold the balance—that is the privilege of coalition—but there is a price. They think they made a good deal over tuition fees without breaching their contract with the Scottish people. I beg to differ, but we will let that pass. The Executive amendment has "Lib-Dem get out clause" written all over it; small print for small ambitions, but with a big price tag: the integrity of the Scottish Liberal Democrats. The Liberal Democrats gave evidence to the royal commission and their election manifesto says about this Parliament:
"Our strategy therefore is to set our own distinctive policies before the electorate and point out that the more people who vote for us, the better the chance that those policies will be implemented after the election."
This morning is a key moment. The Sutherland report's recommendation on personal care for the elderly is a key Liberal Democrat commitment. Do not let older people in Scotland discover that that commitment was only political rhetoric. Sign up with the SNP, the Conservatives and, I have no doubt, Tommy Sheridan, Dennis Canavan, Robin Harper and some other good people from the Labour back benches. If need be, after today, sign up to my bill and let the Parliament deliver something far more worthwhile than a building at the foot of the Royal Mile—justice for Scotland's older people.
I finish with something that Hubert Humphrey said, quoted in Sir Stewart Sutherland's report:
"The moral test of Government is how that Government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadows of life—the sick, the needy, and the handicapped."
Let this Parliament meet that moral test.
I begin by outlining my party's policy. The Liberal Democrat policy paper "A Clean Bill of Health", published in February 2000, states:
"We accept the Majority Report of the Royal Commission on Long Term Care that personal care should be provided free at the point of use, and that people admitted into residential and nursing homes should have a three-month breathing space before they are subject to the means test. Thereafter, accommodation and living costs would be subject to means-tested charges."
Our view is that the recommendations of the Sutherland report should be implemented in full by the end of the next Westminster Parliament. The title of the Sutherland report, "With Respect to Old Age", reflects how the commission went about its work and how we, too, should proceed. The report talks about
"a lack of reliable and consistent data which has dogged our work from the very beginning."
Lack of data comes up frequently in a wide range of contexts. The answer to a parliamentary question is often "We do not have the information" or "The information is not collected centrally," or something like that. In the IT age, much more thinking is needed on how to collect, collate and make available useful and consistent information.
Some quotations from the report will illustrate my next point.
"Confusion and uncertainty exist as an intrinsic part of the current system."
"Simply describing the current system vividly demonstrates a number of complexities and confusion."
"Within it there are too many flows of funds which have been designed for different purposes and what the individual does or does not get out of it depends on a number of complex decisions".
Those quotations demonstrate what is at present amiss and how difficult it will be to meet the commission's suggestions that the system should be simpler and that the individual's entitlements should be clearer. The definitions used should also be clearer, tighter, and more consistent across Scotland. Redefining things to move them out of stretched budgets may be a temptation, but it is grossly unfair.
On budgets, I will quote again from the report:
"More generally the current system, with different budgets held in different places, is perhaps inclined to encourage cost shifting to someone else, without regard for what is best for the individual or indeed for the public purse overall."
The piecemeal way in which the system has developed has created perverse incentives that waste resources and do not provide appropriately for need.
I am confused. Is Nora Radcliffe saying that she will not support the implementation of the Sutherland report in the Scottish Parliament?
I said that my party's position is that the report should be implemented in full by the end of the next Westminster Parliament. We thought that that was a reasonable time frame in which to accomplish that. Because of the funding constraints on this Parliament, and because of the way that we are funded, we all know that to fund the report's full implementation in Scotland at this moment would mean having to cut funds from something else. We need time to implement the report in full.
I would like to move on. I was talking about perverse incentives. We need to recognise those perverse incentives and deal with them. We are beginning to eradicate them through pooled budgets and better joint working.
According to the report, the current system pushes people towards residential care, whereas most people would prefer to stay in their own homes for as long as possible. Measures that would help to level the playing field are: more emphasis on rehabilitation after hospitalisation; better support for carers; and more funding for aids and adaptations to homes—or, indeed, building homes that are barrier-free in the first place and do not require expensive adaptation later. Recent changes in building regulations are welcome, but there is scope to do much more.
In the chamber, we have talked a lot about carers. There are half a million carers in Scotland and the value of the care that they provide is estimated at £3.4 billion per annum. The nation owes those people more support; I cannot think of any public expenditure that is more cost-effective. The voluntary sector must come next—with £1.8 billion of funding per annum, it delivers services that are valued at £41 billion per annum. Smaller voluntary organisations, providing a wide and diverse range of services in their local communities, have been hard hit in recent years by the squeeze on local government funding. Many of those organisations were delivering the sort of practical help that enabled people to continue to live independently, in their own homes, for longer. Many of those organisations relied on grants—often very modest—from their local authority to enable them to keep going. They have not been able to step up fund raising to replace shrinking or vanishing grants, so the sector itself has been shrinking or vanishing as the grant aid has dried up.
As the increased funding that was recently announced for local government feeds through, the prospects for those small voluntary organisations look brighter, but much good service provision has been lost and will have to be built up again. That is one of the reasons that I must ask why we had to wait two or three years, while money accumulated in the Treasury's coffers, when that money could have been put to good use earlier. There is money in the coffers. We are a comparatively wealthy country. From society's pooled resources, we can afford, if we choose to do so, to look after those people in our community who require care.
Having begun by quoting the report, I will conclude on the report's final word:
"This Report is not about helping the well off—although some of the people who benefit may incidentally be considered ‘better-off'. It is about helping those in need of care. It is about a better and fairer split between costs met by the individual and the state. It is about allowing people to stay in their own homes for as long as they are able, and improving the lives of those older people who need care, and those who care for them."
That is not a bad ultimate goal.
I am delighted to have the opportunity to debate the Sutherland report and to expand on the excellent paper by Dr Richard Simpson on proposals for the implementation of the recommendations. I would also like to commend the work that has been done by Richard Simpson, Christine Grahame, Margaret Smith and many other members in progressing the Sutherland report.
In reference to the headline of Holyrood magazine, I put one question to the Parliament: "Do we dare to be different?" Now is the time to be bold and to dare to be different. We must use the Scottish Parliament to address the health needs of the people of Scotland. We do not need to wait for action by the Westminster Government or for an election at Westminster—devolution allows us to make decisions that are relevant to Scotland.
The Scottish Conservatives took time to sign up to the key recommendation of the Sutherland report—the funding of personal care. We supported that only after hearing the evidence that Sir Stewart Sutherland gave to the Health and Community Care Committee and after examining the exact difference between nursing and personal care.
It is worth outlining personal care as it is defined in the report. However, I must say that I regret the tone that was adopted by Iain Gray. Last week we had an excellent debate on public health, in which we showed that we could leave politics behind us and make health a priority, but I am saddened by the tone of today's debate.
As defined in the Sutherland report, personal care covers all direct care related to personal toilet; eating and drinking; managing urinary and bowel functions; managing problems associated with immobility; the management of prescribed treatment; behaviour management and ensuring personal safety. According to the report, all those elements fall within the internationally recognised definition of nursing, although many people who are not nurses may deliver them. We fail our elderly if we nit-pick definitions of nursing. Personal care is the care that is appropriate for people with dementia and frailty. The vast majority of frail elderly people do not need high-tech care; they need personal care—physical care—that incorporates issues of intimacy, personal dignity and confidentiality.
The defining condition of the Sutherland report is that unless the review addresses conditions such as Alzheimer's it will not be good enough. If the Scottish Parliament votes only for nursing care and not for personal care, we will have passed a level of care for our elderly that will not be good enough. Personal care is at the heart of today's debate.
The Health and Community Care Committee has taken hours of oral evidence and stacks of written evidence. I would like to quote the reply given by Dr Heath in response to a question from Margaret Smith, who asked:
"What would be the impact on the delivery of community care services in Scotland if the recommendations of the Sutherland commission were not implemented in full and we followed a similar line to England?
It would be a tragedy, for a number of reasons. For the first time, somebody's eligibility for free care would be based not on an assessment of their need, but on the job description of a specific health professional." —[Official Report, Health and Community Care Committee, 13 September 2000; c 1160.]
As Sir Stewart Sutherland pointed out in the evidence that he gave to the committee, if someone falls off a mountain and sustains injuries, or they fall ill because they drink or smoke too much, their treatment is free. However, if a person becomes old and frail or develops dementia or Alzheimer's, they are means-tested. The Parliament has the opportunity to end that discrimination.
Will the member give way?
I am sorry, but I am running over.
You have about a minute left.
All conditions, whether caused by smoking or other factors, are debilitating, but Alzheimer's cannot yet be cured by medical intervention. For that reason, the Scottish Conservatives ask members to work together and to support personal care for the elderly in Scotland. The principle is one of equal care for equal needs. The debate today is about equality in need and equality in care. I ask members of all parties to put their votes where their hearts are and support the motion.
I will begin with the point on which David McLetchie ended his speech. He talked about dignity and security in later life. Those matters are priorities for everyone in the chamber. The reality is that politics is about priorities; every Government faces choices about policy priorities and what it can spend its money on. It is interesting to look at the policy priorities of the Conservatives over the 18 years in which they were in office and see how far those priorities were followed through.
Will the member give way?
No, I will not.
The Sutherland report can be read as a significant indictment of the Conservatives' period in office. The Conservatives introduced charging for personal care. They set the agenda and the tone for the way in which it operated.
Will the member give way?
They introduced a system of community care that was consistently underfunded, and which led to the pauperisation of many elderly people. How do we remedy that? There are many things on which we could spend money to improve the plight of elderly people in Scotland. What are our choices? That is where we will define our political differences. We all claim to share the same broad goals, but our political differences are reflected by the way in which we set our priorities. The priority must be to support older people to maintain their independence and improve their quality of life. That is the axiomatic and central position that we must move towards.
We must provide a more effective mix of health and personal care that is appropriate to the needs of the individual and where relevant, the needs of carers. We must ensure that everybody who needs it gets a high standard of residential care and support. We can now realistically aim for that, but the questions are "How do we do it?" and "How do we fund it?" In conjunction with the Liberal Democrats, Labour has identified additional resources that we can spend on care for the elderly. How do we spend those resources? What are the priorities on which we must spend?
I have a quote from the minority part of the Sutherland report which sets out the debate on personal care:
"If the Croesian flood of expenditure required to support the free personal care recommendation went to purchase better care for elderly people, then the case for it would be stronger."
But of course the personal care recommendation will not improve the care that is available to elderly people. What it will do is shift the burden of who pays. That is the essence. In the Greater Glasgow Health Board area 86 per cent of people in residential care currently enjoy free personal care.
Will the member give way?
Will the member give way?
I will take Kay Ullrich's intervention.
Does Des McNulty think that it is right that someone diagnosed with Alzheimer's disease should have to pay for their care, while those with any other illness quite rightly get free care under the national health service?
We must look at the arrangements and the parameters for the provision of personal care in each category of need. But what are the overall priorities? Is our priority to provide basic care for elderly people on a broad basis, or is it to provide financial support for people who can afford to contribute to the cost of care?
We must consider the need for services alongside the contributions that people make. Our long-term goal is to move in the direction that Sutherland points us, but we must prioritise the action that we can take now. The action that we can most effectively take and that will benefit the greatest number of older people is to provide them with the health care and core support to sustain them in the way that they prefer.
We must do away with the bureaucratic barriers identified in both the majority and minority reports. We must take account of the service gaps and blockages, and the systems of informal rationing that force people into more intensive care environments when their needs could be better met through improved home support, day care, respite care and other means of support that allow people to lead full lives in the community. Such support for elderly people is the central priority. The personal care recommendation needs to be addressed and the mechanics of it must be examined. Elderly people require more from us. Our priority is to examine how we can best support the majority of the elderly quickly and effectively.
I do not know whether I should be angry, frustrated or sad—possibly all three—when I listen to Iain Gray and Des McNulty defending the indefensible. I was confused when I listened to the Liberal Democrats' contribution, as I think most members were. Nora Radcliffe said that our country is rich and that we should look after our old people, but that we must wait for Westminster to give us the green light to do that. That is unbelievable.
Part of the Lib-Lab amendment "calls upon the Executive". I remind members on the front bench that they are the Executive. Do they look in a mirror and decide what they will say to one another? Members of the Executive should not have to lodge an amendment to call on the Executive, because they are the Executive and should be doing something about the problem.
The amendment calls upon the Executive
"to continue, over time, to work towards fulfilling the Royal Commission's objectives".
If that is not a cop-out, I do not know what is. There is no mention of time scale and so on.
Perhaps the Executive thinks that people will be impressed by its announcements about central heating for the elderly, but I can assure it that those announcements will not wash with the elderly, who have much more intelligence than the Executive gives them credit for.
Eighteen months after the publication of the royal commission report, we are still waiting for the Lib-Lab Executive to move on implementation. The Executive's failure to take a bold and decent step to implement the report may be one of the reasons why the people I speak to in the streets are completely disillusioned with the Lib-Lab pact.
The Executive has the opportunity to change personal care provision and to help people make their lives real once again, but is failing miserably to use it. The SNP recognises that the present system is completely unfair and unsustainable. The Sutherland report makes that clear. I ask the Executive—and particularly its Liberal cohorts—to think again and to support the Conservatives' motion.
There are many cases of people caught in the savings trap, but I highlight one. An elderly woman, whose daughter wrote to me, is paying £290 a week for residential care. Her mental health has deteriorated and she has to move to a more suitable place, which will cost £350 a week. Had she broken her hip she would have been taken into hospital—that would have been paid for. However, because her problem, unfortunately, is a mental health one—dementia—she does not get any help.
Will the member acknowledge that her comparison is a false one? If the woman broke her hip and went into hospital, that would not be her home for the rest of her life. The most important thing would be to ensure that—rather than finding herself in residential care because she could not access services in the community—the services were there to enable her to continue to live independently. The motion does not address that.
Iain Gray tries spin once again. The lady would probably languish in hospital, because there would be no help for her once she was released. That is the big problem. The Executive does not seem to understand that local authorities do not have the moneys at the moment. The Executive could make the moneys available, implement the Sutherland report's recommendations and make life much better for elderly people, but it will not do so.
The lady to whom I referred is deemed unfit to live at home with her family. She needs trained staff to change her dressings, to take her to the toilet and to help dress her. The Executive may call it fair to charge for those services, but I do not, and nor do the public. The individual should not be left to bear such costs.
It is essential that the Executive takes measures to remove anomalies from the system and to help those who are trapped. It is a disgrace that in a modern, developed and wealthy society, pensioners who have contributed to that society throughout their working lives are forced to pay for long-term care.
The Presiding Officer is signalling me to wind up, so I will conclude by telling the Executive that the scandal must end. Ministers have the opportunity to do something about that.
I am sure that all members of the Parliament want to make care of and services for the elderly a priority. The disagreements of this morning will be about how to decide those priorities at this moment in time.
Margaret Smith said in the newspapers—I am sure that she will repeat her comments in her speech—that all the evidence submitted to the Health and Community Care Committee was that we should implement the recommendations of the Sutherland report in full, including the recommendation on free personal care. Equally, other evidence submitted to the committee was that we must expand home care services, that more respite care is required—which the Executive has started to take on board—and that resources must be put into the system in order to deal with what is unfortunately called bedblocking; delayed discharge is a better term. The committee was also told that there must be more money for our broad health policy of warm homes for people, so that they do not fall ill in the first instance. People who take an even broader view of health want more money for initiatives such as concessionary travel schemes, about which I hope to hear more this afternoon.
The question that faces us is what we should do now, given the priority that the elderly have, to help the largest number of older people in the most effective way.
As I considered my speech, I thought about the old truth voiced by Aneurin Bevin:
"The language of priorities is the religion of Socialism."
At this moment in time, if I had to choose between free central heating for all older people and free personal care, which would benefit only a minority of older people, I would have to choose the former. However, that is not to say that I do not support the latter, but, at this moment in time, we must put our priorities for the elderly in order and implement them step by step.
Malcolm Chisholm spoke about his preferences and about trying to balance central heating against long-term care for the elderly. Does he acknowledge the fact that the chancellor has a huge war chest? Why does he have to decide between one priority and the other, when both are important?
Politics is about choices. We can argue about public expenditure in macro-economic terms for ever, but we should accept that over the next three years we will have the most significant ever increase in public expenditure. The question that faces us is how we should spend that money.
My choice is to implement the recommendations of the Sutherland report over time, which would complete the unfinished business of the welfare state.
In response to Kay Ullrich's question to Des McNulty, I accept that there are issues of equity in relation to people who have Alzheimer's and that problems with joint working in the community would be eased by the implementation of the recommendation on free personal care. In the meantime, if we implement the recommendation on free nursing care, I hope that we will consider carefully the definition of such care, so that people with Alzheimer's can be helped and covered by its provision. I hope that we will also consider the charging regime, so that it becomes fairer across Scotland and loses the variations that exist at present.
The crux of the issue is whether the Executive's amendment can be judged as giving a long-term commitment to implementing the recommendation on personal care, which we have tried to get out of the minister. I quite understand and agree with the points made by Malcolm Chisholm about priorities, but we are asking for a long-term commitment, which we have not received.
I cannot speak for the Executive, but I support the implementation of the recommendation on personal care as a long-term commitment.
I would have to say that the implementation of the recommendation on free nursing care would also mean a significant expansion of the welfare state. Although I commend the speeches by Mary Scanlon and David McLetchie, I find it puzzling that the Conservatives in the Scottish Parliament argue for a massive expansion of the universal welfare state, while, at UK level, they argue for the exact opposite: a contraction of the welfare state and for people to pay for more of their health treatment.
That is a serious problem, and it is compounded for David McLetchie by the fact that all that he could come up with this morning to pay for a solution was fantasy savings from unified budgets, from the costs of bedblocking—although Sutherland would not reduce the costs of bedblocking—and from an underspend, all of which is at present being spent on the national health service.
I actually said that the primary source for paying for a solution would be the additional resources given to the Scottish Executive in March this year. That sum of £173 million for the health budget has not yet been allocated, but that would more than pay for the Sutherland recommendations. That is our priority; what is the Labour party's?
I accept the revision to what David McLetchie said, although he also said all those other things. He even had the brass neck to mention savings and bureaucracy in his press release—that from the party of health bureaucracy for 18 years. If he is now saying that he would be prepared to use the significant additional resources that this Parliament will have over the next four years, he must say in summing up from precisely which budget he would take the £110 million.
Looking into the future, I believe that Mr McLetchie's problems are further compounded by the fact that he is also a member of a party that, at UK level, is talking about reducing public expenditure by £16 billion. That would result in cuts of more than £1 billion in Scotland's budget. I commend his speech, but I must say that it is completely incompatible with all the other policies of the Conservative party.
I thank Mary Scanlon for lodging today's motion and pay tribute to Sir Stewart Sutherland and the royal commission for their work. It is essential that we listen to the depth of experience and the independent views that went into the royal commission from a range of sectors. I also pay tribute to the ministers and the Executive for the good work that the Executive has done and continues to do to take forward the Sutherland recommendations and develop the whole area of community care.
I believe that this is a listening Parliament that, through its committees particularly, will listen to, examine and act on the evidence presented by carers, users and professionals at the front line of care services. Over a number of months, probably too many to count, the Health and Community Care Committee has taken evidence from a broad range of people and organisations who deal every day with the problems that the present regime brings.
The Convention of Scottish Local Authorities, the National Health Service Confederation, the Carers National Association, Age Concern Scotland, the Royal College of General Practitioners, the Royal College of Nursing, the Royal College of Physicians, the British Geriatrics Society, the Scottish Federation of Housing Associations, the community care working group, the Church of Scotland, Scottish Care, the Scottish Health Boards Network and many other organisations agreed that we must implement Sutherland's recommendations on personal care. Of the 100 or so contributions the committee has received, only one group that expressed an opinion did not support that view. I would be failing in my duties on a number of fronts, including my duty to my party, if I did not listen to and act on those views.
The present charging system is an unfair muddle. Someone who receives care in an NHS ward or from NHS staff gets free care. If, however, they receive care at home from social services, including the personal care that Mary Scanlon described, they will be tested and charged for it. Furthermore, what people pay for and how much they pay depends not on their need but on where they live, as charging policies vary across Scotland's councils.
This is a question of fairness and dignity. Our society has decided to pool its resources through taxation and thereby to pool the risk. That is the principle that underpins our health service and our other public services. If someone has the misfortune to be mugged, the police do not march them off to the cash machine so that they can pay for the cost of the investigation if they earn too much money. In this country, when someone is wheeled into an accident and emergency ward, nobody will put a credit card payment slip in front of their nose. We have paid through taxation so that when disaster strikes us or our neighbours, the state is there for us. Long-term care should be no different. Instead of benefiting a wealthy few, funded long-term care would, through equity, bring peace of mind and benefit to everyone.
The Royal College of General Practitioners summed it up well when it said:
"the redistribution of wealth from rich to poor is the function not of a health care system, but of a taxation system. The function of a health care system is the redistribution of wealth from the well to the sick. What is being proposed is an underhand tax on frail older people." —[Official Report, Health and Community Care Committee, 13 September 2000; c 1162.]
Whatever the Executive chooses to do, it is essential that it tackles the treatment of the 60,000 Scots who suffer from dementia. I know that the minister has been wrestling with the issue. Dementia is a degenerative illness of the brain and the fourth biggest killer in Scotland, yet dementia sufferers, unlike cancer sufferers, are expected to pay for services that relate to their illness. That is an injustice and I hope that the minister will re-examine the issue.
Accepting the personal care recommendation would also take away some of the perverse incentives that currently exist in the system and encourage people to stay in institutions rather than move to their home. Right now we know about the problem of bedblocking. I have heard from professionals across the sectors that accepting the personal care recommendation would help to address that. What incentive is there at the moment for someone to return home when they may have to pay charges? I hope that the minister will reconsider ways of extending personal care payments to pensioners in that position, even if he does not feel able to extend it to those in residential care.
This is also an issue of service delivery. Councils from across Scotland echoed what Dundee City Council said—that the lack of a common charging regime between health and social work creates a major barrier to joint working and the fact that health services are free creates a disincentive towards community-based services that affects consumer choice and access. Witness after witness has told us that joint working would be made easier if there were a joint charging policy. That would also have a beneficial impact on the implementation of plans for the use of enhanced generic home care workers, who will combine elements of personal and nursing care services.
If the Scottish Executive adopts the Westminster model and decides to pay for nursing care wherever it is provided and to define nursing care as any treatment provided by a registered nurse, we are heading for disputes and for a situation that the RCN describes as unworkable. While hard-pressed councils try to have services defined as nursing care, hard-pressed health authorities will do the opposite. Only registered nurses' time would be provided free. Delegated duties would still be paid for. That would lead to dispute, which is exactly what we do not need in our community care services.
David McLetchie dealt with the some of the issues relating to cost. If we make the decision to implement the Sutherland recommendations in full, the burden of finding the extra money that is needed to pay for them will fall on the Parliament's committees, through their budgeting procedure. We must be prepared for that.
Parliament is now faced with a difficult choice. I hope that members from all parties will vote for the Conservative motion, which—unlike the amendment—is unambiguous and commits the Parliament to implementing the Sutherland recommendations in full. The motion would end an unfair system, encourage joint working in health and social work, give support to Scotland's pensioners and send out the clear message that this Parliament and this country dare to be different.
I salute Margaret Smith, the Liberal Democrat convener of our Health and Community Care Committee, for refusing to toe a line—a line that no decent human being should toe today. We must all stand together for the people of Scotland and do what we know to be right.
This is a defining moment in this Parliament's history. The eyes of the country are on us all, to see whether we are prepared to sell out the frail elderly. I hope that no member will do that. People are waiting to see whether we are prepared to sell the frail elderly out to the extent that we continue to impose on them what Sir Stewart Sutherland called "a tax on frailty". It is a very shameful day when we hear a Labour minister defend means testing of the frail elderly. Spirals cannot get more downward than the descent from Bevan to Blair.
Will the member give way?
The minister has had plenty of time already, and he will have time to wind up the debate as well. Some of us hold our principles extremely dear and remember when the minister's party actually was the Labour party. I do not know why it does not drop the word Labour nowadays, as it has ceased to mean anything.
Will the member give way?
The minister will get his chance; he gets plenty of time, whereas I do not.
Earlier, I was thinking about a poignant quotation from Dickens: "Please excuse aged parent". It is said by a son who is showing a visitor into his living room, where his old father is sitting in a corner. It is dreadful that such an attitude—of "excuse the elderly"—prevails today. They have nothing to be excused for. More than 1 million Scots are pensioners. They should be proud of themselves, because we owe everything we have to them.
Consider the fate of the elderly today. The number of local authority homes is decreasing by 2 per cent a year, while the number of private homes is increasing. Some of them are granny farms owned by vast, rich companies, which are so rich and making so much money out of frailty that some are registered in tax havens such as the Isle of Man.
I hear people talking of so-called primitive societies. I find that ironic. What is a primitive society? We are the primitive society; we cannot provide properly for our elderly and frail people.
We all know that the term care in the community is a mockery. Since the Labour Government came to power, 5,000 fewer Scottish clients have received a home care service through a local authority. That is the result of a spot check on one week between March 1998 and March 1999. There were 29,000 fewer hours of home care service.
Heaven help carers. Not only the younger and fitter care for the frail; about 85,000 carers in Scotland are pensioners. Some are aged well into their 80s and some are even in their 90s. I have met elderly people who crawl across the floors at night to turn an invalid who is only a little more frail than they are. All those people are looking to the Scottish Parliament to see whether we are really of value, or whether we are all willing to be party clones obeying some party line. That is not why I joined this Parliament.
Today, people like me will change the habit of a lifetime and vote for a Tory motion. Why? Because it happens to be the correct move for the Scottish people. Over many months of evidence taking in the Health and Community Care Committee, every major body in Scotland concerned with the elderly has urged us to ensure that the Sutherland report is implemented in full. How can we deny that? We cannot possibly do so.
Today will be a litmus test for Parliament. I hope that the Liberal Democrats will stand firm against pressure from Labour to obey. We are not here to obey anyone except the wishes of the people of Scotland. Support the motion.
During that speech, some members repeatedly turned their back on the member who was speaking. That practice is discourteous, so I hope that it will stop.
I too call on the Executive to implement the Sutherland report in full. For too long our pensioners have been treated by this naïve Labour Administration as if they come from another planet. That must stop, as the elderly are our flesh and blood. Des McNulty characterised that way of treating them today.
As I have said before in this chamber, agism has replaced racism as an evil in our society. In a fair and just society, this generation—our generation—must shoulder its responsibilities, get its jacket off and start taking proper care of the elderly.
Sutherland has shown us and the Scottish Executive the way forward. When it comes to decide on this issue, it must not be allowed to cherry-pick Sutherland as has happened in England and Wales.
Dr Richard Simpson's proposals are to be applauded. Margaret Smith's impassioned speech today was—as Dorothy-Grace Elder said—perhaps a defining moment in the life of this Parliament.
As Mary Scanlon said, the Scottish Conservatives have fully costed our commitment to full implementation of Sutherland at £110 million. That would be achieved by savings in other areas. By cutting bedblocking, integrating and unifying health and social work budgets and spending allocated budgets in full and not making a mess of it, we would free up funding to honour our commitments to the elderly.
Will the member give way?
No.
In Ayr, the need for action is particularly acute. As almost 30 per cent of households there are classed as pensioner households and more than 20 per cent of my constituents are of pensionable age, there is an urgent need to address these issues now.
Beds are blocked in Ayr hospital, yet nursing homes are closing down and lying empty or half full. Auchenbeg nursing home closed last week. Such mismanagement of our local resources cannot continue, as the number of elderly people in Ayrshire will rise over the next 20 years.
The debate is about forcing the Executive to do the decent, honourable thing by supporting pensioners. If it is not prepared to do that, it should step back and let those who are willing to do so get on with the job.
As Age Concern has pointed out, the burden of anxiety of old age could be lifted at a stroke by the introduction of free personal care. Currently, 2.2 per cent of all taxes, for all sectors, is spent on long-term care for people either at home or in a residential setting. Putting Sutherland into action would add 0.3 per cent to that. I believe that that is a price well worth paying.
As has been said, it is fundamental that personal care should not be means tested. Those who suffer from heart disease or cancer receive full medical care, yet those who suffer from Alzheimer's or Parkinson's disease do not. There must be no tax on illness or poor health. In changing and deteriorating circumstances, the fear of being unable to cope is for many people worse than the reality of coping.
The Executive has the opportunity to remove the burden of fear—the sword of Damocles that hangs over our elderly citizens. It also has the opportunity to relieve the pressure of having to cope in the most difficult, and sometimes degrading, circumstances. Both of those can be achieved at a stroke by implementing the Sutherland recommendations in full. As passionate, caring individuals, we cannot afford not to do that. As a country, we can afford to do it, and we must do it.
I am from that generation that benefited from the struggles of our elderly people in their lifetimes and from those of the generations that came before. They fought through the labour and trade union movement for a decent health service, and decent education and housing, to give opportunities in life to people who had been denied them. I firmly and fundamentally believe that we have a debt to repay to that generation.
I do not disagree with some of what Nora Radcliffe said: we should examine how we provide support, including nursing and personal care, for our elderly, but I also firmly believe that there are issues that need to be addressed immediately. I want there to be a health service that is based on need—not ability to pay—and free at the point of use. I want to hear the Executive telling us again and again that that is what will happen in Scotland, because I am alarmed by some Conservative proposals. No matter what the Conservatives say here, they would be hit by the consequences of their proposals at Westminster for cutting public expenditure and introducing private insurance.
As I came into the chamber, I was amused to see a Conservative member being interviewed for television along with pensioners who were holding a placard that said, "Free care for the elderly." I believe that the cameraman was experiencing technical problems because of the light coming off the brass neck of that Conservative.
David McLetchie's press release of 21 September said that
"a lot can be done to repair the damage that has been caused to date."
I agree—it is time to undo the damage that was done by 18 years of Conservative government, which drove many of our pensioners into abject poverty. I am glad that David McLetchie is admitting the consequences of the Tories being in power.
Will Hugh Henry give way?
No thanks.
We should give the Tories credit: they are at least consistent in wanting the process of undoing that damage to start with the better-off in society. That has always been a Tory aspiration.
Will Hugh Henry give way?
No thank you.
They would start with the 7,000 who, in the long term, need support.
On a point of order. Is Hugh Henry aware that this is the Scottish Parliament, not the Labour party conference?
That is not a point of order.
That pathetic comment is in keeping with some of the other comments that we have heard from the Conservatives.
We will have to start the process of undoing the damage somewhere. I agree with Nora Radcliffe that we should help those who are paying for care, but thousands of pensioners are living in poverty.
The Tories have told us what they would do. Sutherland made a contribution to the debate and most of the commission's reports are being implemented by the Scottish Executive, so it is unclear what the Tories are talking about. John Scott said that they would solve the problem by reducing bedblocking, but Mary Scanlon failed to reply to the question, put to her by Iain Gray, about bedblocking meaning the removal of beds. The Tories have still not come up with an answer to that.
Will Hugh Henry give way?
No thanks.
John Scott also failed to take up David McLetchie's point about the Tories taking the money from the funding that is allocated to the health service this year. Perhaps John Scott was singing slightly off key, as he spoke about savings coming from a reduction of the bureaucracy that was created by the Conservatives, whereas David McLetchie said that they would take it from the money that has been allocated—from the £173 million—including the £8.3 million for doctors and nurses; the £30 million for cancer treatment and medical equipment; the £60 million for shortening waiting times and tackling bedblocking; the £12 million for the implementation of Arbuthnott's recommendations and to help Scotland's poorest areas; and the £26 million for the biggest ever drive to implement public health initiatives. That is where the Tories say the money would come from.
I ask the minister for assurances that there will be free home care for pensioners on discharge from hospital, including those who do not pay for home care because they cannot afford it, and that there will be improved adaptations for those who need work to be done in their homes. I also want a rationalisation of services. I do not want Parliament to undermine the principle of subsidiarity by taking power away from local authorities, but we must enter the debate over different levels of charging across Scotland. We should engage with directors of social work, the Convention of Scottish Local Authorities and others to ensure that there is fairness and consistency throughout Scotland.
Let us start with the poorest pensioners and move on to repay the debt that we owe to their generation.
I remind members that when they do not take interventions they cannot expect to be given extra time.
Iain Gray's amendment talks about fairness and equity in the care of the elderly. I have not heard anything from Labour members about fairness or equity.
Where is the fairness in someone having to use their life savings or to sell their home to pay for their personal care? Where is the fairness in someone who is confused and diagnosed with dementia having to pay for their care when others do not? Iain Gray has made his position clear: there will be no funding of personal care. He has tried to justify that by minimising the number of people who are involved. Are our policies being dictated by numbers rather than by what is right?
Our policies are dictated by the need to ensure that we get the maximum benefit for the maximum number of people and use resources most effectively to improve the lives of Scotland's people. In what sense does the motion contribute to that?
Thousands of pensioners will hear Iain Gray's words and act accordingly in the months to come.
How can it be right that someone is compelled to sell their home or use their life savings to pay for personal care? Margaret Smith made it very clear that that fear permeates Scotland's elderly. Old people have told me of their fears that, in later years, their bank books will be checked or that they will be scrutinised to see whether they have any money under the bed. I have sometimes had to explain to elderly people that the money they have saved throughout their adult working lives is going to be taken away from them. Perhaps the minister would not have made his comments if he had had to sit in front of someone who had tears rolling down their face when they realised what was going to happen.
Will the member give way?
No—I do not have much time.
Labour members have tried to portray this section of the elderly population as rich pensioners.
Will the member give way?
No, I have given way to the minister once.
Those so-called rich pensioners have scrimped and saved all their lives, paid their taxes and probably bought their council homes. Are they the rich pensioners Hugh Henry was talking about? I think not. They have built a nest-egg, often for their funeral, and it is disgraceful that the Executive should want to take it away from them. Its arrogance knows no bounds.
Furthermore, I have been astounded by the Executive's arrogance in dismissing the clear view of all the organisations that have had an input into the Sutherland report and the Health and Community Care Committee. I take it that those organisations are all wrong and that the Executive is right. So much for the listening Government—which did not listen to its own party about pensions and is not listening to Scotland's elderly or the organisations that represent their interests.
Nora Radcliffe made the astounding suggestion that the SNP should renege on its responsibilities and wait to see what Westminster does. She should raise her sights; it is every MSP's responsibility to make this decision today. We cannot pass the buck. This is our opportunity to make a real difference. If we do not take it, we will never be forgiven.
This could be either the Parliament's finest hour or its most disgraceful. That choice rests with every MSP in the chamber. The Scottish Executive has made its position very clear and I have no doubt that it will not budge. It is time again for this Parliament to assert its authority and I implore members to look to their consciences and support the motion.
I am happy to support the amendment; I have two points to make. First, as Nora Radcliffe said, we are committed to implementing the full Sutherland report and, at a UK level, have set out a time scale of about five years to do so. However, her remarks have been misinterpreted in the normal style by other members. We have not said that we should not implement the full Sutherland recommendations; we have said that it would be more helpful to do so at UK level. If funds were disbursed at such a level, the Scottish Parliament could use its own limited funds in other ways. It is possible that, after the next election, there will be a Westminster Parliament with a different attitude to the issue.
Given that the Secretary of State for Health for England and Wales has introduced a plan that does not follow the Sutherland recommendations—which obviously shows Labour's intentions on the matter—and has therefore not provided a satisfactory UK-wide answer, should we not take our own direction?
The next Westminster Parliament can take a different direction if it wishes. Similarly, the Scottish Parliament can also take a different direction. I should point out that Scotland has a coalition—not a Labour—Government and it is up to us to ensure that that coalition reflects the views of the Parliament. The Liberal Democrats are committed to the fulfilment of the personal care aspect of the Sutherland report.
By when? The amendment does not say by when. It does not commit to personal care, which is the first problem; the second is that it does not have a time scale.
I would ask Christine Grahame where the time scale is in the motion that she supports. There is no date in the motion and there is no date in the amendment. There is no difference on that point.
Come on.
My point is that we are voting on a motion that uses English words in the English language and it is plain to see that the motion does not mention a date.
The Liberal Democrats are committed to delivering. However, as Malcolm Chisholm and others have said, there is a question of priorities. We feel that, at the moment, the money available can be used to benefit more pensioners in a better way if it is used on a range of priorities such as better housing, better transport arrangements and so on. I am sure that some of the priorities that Mrs Margaret Smith mentioned will be included in the minister's statement next week.
The question is one of priorities. We are not reneging in any way on our commitment—we are saying that the Sutherland report will be implemented.
Some members have cast aspersions on the amendment but, unfortunately, it is a fact of coalition government that amendments are not always felicitously phrased. However, if English means anything, the amendment's words:
"to continue, over time, to work towards fulfilling the Royal Commission's objectives of fairness and equity in the care of the elderly"
quite clearly include the personal care issue. That is the basis on which we support the amendment.
I understand that our group has not yet taken a decision to support the amendment. Does Donald Gorrie accept that, in answer to my intervention, the minister refused to confirm that the issue of personal care was included in the amendment?
The minister did not answer Mr Rumbles's question. Ministers have a regrettable habit of not answering questions, but that is how life is. The minister does not have a monopoly on knowledge of the English language.
We interpret the amendment as giving a commitment that—when funds permit and after the other priorities have been delivered—we will deliver on the personal care issue. Neither the motion nor the amendment says when that will be delivered. However, we will continue to press within the coalition to deliver on that issue as soon as resources permit.
If I may sabotage a well-known political quotation, Donald Gorrie's summing-up was the longest excuse in history.
I welcome today's debate and confirm the SNP's support for the Conservative motion. It is good to see that, at long last, the Tories have decided to campaign for full implementation of the Sutherland recommendations. To be honest, I am not sure why it has taken that party 18 months since the publication of the report to do so, but it is better late than never. I commend the Conservatives for getting it right, albeit belatedly.
On the evidence of Iain Gray's speech, it is not hard to see why the Government is in dire straits. He described today's debate as "a real treat". What utter arrogance. People will see today's debate not as a treat, but as a testament to his and the Government's failure to deliver on pledges for older people. On that subject, as on fuel tax, pensions and the exams crisis, ministers say that they are listening, but they refuse to hear. They refuse to hear Sir Stewart Sutherland, the British Medical Association, Age Concern Scotland, Help the Aged, the Carers National Association and Richard Simpson, who, in the latest edition of Holyrood magazine, calls for free personal and nursing care to be paid out of general taxation. They refuse to hear the vast majority of older people and their families, who want the central recommendation of the Sutherland report to be implemented as soon as possible.
Eighteen months on from the Sutherland report being published, the Executive will only next week respond. Back in 1997, when the royal commission was given a very tight time scale in which to report, it was stated that that was because
"the present unsatisfactory state of affairs should not be allowed to continue, and the government has a clear willingness to formulate policy and to act."
What has happened to that clear willingness to act for it to turn so quickly into desperation to dodge responsibility?
It seems that the real insult and the real slap in the face, if Iain Gray is to be believed this morning, will turn out not to be the delay, prevarication, ducking and diving, or even the refusal on the part of the Government to listen, which ministers are demonstrating as I speak, but next week's announcement that the Scottish Executive intends to follow meekly the Westminster example by refusing to make personal care free at the point of use.
It seems that that recommendation, which the minister tried ably to downplay this morning but upon which, according to the Carers National Association, the integrity of the royal commission's report depends, will be rejected out of hand by a Government that is woefully out of touch.
Des McNulty said that few people would benefit from implementation of that recommendation. He refused, however, to answer the point about the thousands of elderly people who are languishing in hospital because local authorities cannot afford to pay for their personal care.
No, just sit down and listen for once in your life, Mr Gray.
I agree with Shona Robison that Hugh Henry's comments, when he referred to better-off pensioners, were an insult. Those to whom he was referring are elderly people whose only asset might be their home, or elderly people who, belonging to a thrifty generation, might have managed to save a pound a week over the course of their lives. Those are the people whom Hugh Henry has insulted this morning.
The Executive's cry is, "We can't afford it;" the challenge for the Opposition is, "How would you pay for it?" Let us reflect, as David McLetchie and others have done, on the fact that the cost of implementing the Sutherland recommendation would be less than the underspend in the health budget last year. That is what the people of Scotland understand from the Executive's position, so let us have none of it. This is a question not of money, but of political will and priority—of whether Labour has that political will.
I conclude with a direct appeal to Liberal Democrat members. Their party has a long-standing, honourable commitment, reaffirmed in March, to support full implementation of Sutherland, and I respect that. Charles Kennedy rightly criticised Westminster's refusal to recommend the central recommendation of Sutherland. I ask the Liberal Democrats to withstand the pressure that I know they will be coming under; to do what they know is right; to do what their party and the public want them to do. They have heard Iain Gray rule out implementation of the personal care recommendation and refuse to confirm to Mike Rumbles that that was included in the amendment.
The Executive has no intention of implementing Sutherland's central recommendation, and we as the Scottish Parliament have a duty to force a change of mind. I ask the Liberal Democrats to support the motion. Let us secure a parliamentary majority for what people in Scotland know is right.
At the start of the debate, I posed some questions about the Tories' promise behind their motion—and we should remind ourselves that this is a Tory motion. The Tories therefore have to answer those questions—I have listened to all the speeches, and the questions remain unanswered.
Many Opposition members reiterated the arguments of the royal commission. The power of the commission, its analysis and its principles is not at issue. We commissioned that report, we have welcomed it and we have implemented many of its recommendations. Almost every Opposition member has used today's debate to lambast the Executive, to attack the partnership and then to hide behind a complaint that we brought politics into the debate. How dishonest is that?
When we announce our immediate plans for care of the elderly next week, they will demonstrate how we intend to invest resources in reducing delayed discharge—
Will the minister give way on that point?
No.
We intend to invest resources in allowing more people to access home care, in helping people to live longer at home, and in helping people to return home from hospital rather than entering residential care. We will invest in more respite for more people, and—yes—the plans will outline how we will address greater consistency and fairness in charging for services, which, as Hugh Henry and Margaret Smith rightly said, vary across Scotland.
Will the minister give way?
No.
Not one Tory member has addressed those issues. Not one of them has explained how their commitment on personal care will expand care or improve its quality. I appreciate that Nicola Sturgeon is new to her brief—I welcome her to it—but she should understand that the recommendation that we are discussing today would not unblock a single bed in Scotland.
Does the minister accept that blocked beds in hospitals arise because of the state of conflict between social services and health services about whether a patient should leave hospital to enter a residential home? That happens all over Scotland. That is what blocks beds. If the remedies are implemented, it will help to solve the problem.
Absolutely. Better working between health and social work services is one of the things that will contribute to unblocking beds. So is increasing resources to local authorities for community care. However, the recommendation in today's motion would not address those issues.
Will the minister give way?
No.
No one on the Tory benches has admitted to us how many acute sector beds they will close and what other cuts they will make in the health service to pay for their promise. Malcolm Chisholm was right. Not one of the Tories has had the nerve to set this in the bigger Tory picture.
Will the minister give way?
No.
The Tories have argued disingenuously all morning for an extension of state-funded care, while the bigger Tory picture is of a Tory party committed to privatising all but an emergency service NHS.
Will the minister give way?
No.
How can the Tories seriously argue that personal care will be provided free by the NHS, while William Hague and Liam Fox are saying that hip replacements and cataract operations will have to be paid for under the Tories?
That is the English Tories' position.
Let me come to that point. Are Tory members really saying that Westminster Tories will make £16 billion of cuts and leave public services in Scotland untouched? Are they saying that a Conservative Government at Westminster would allow tax breaks for private health insurance in Scotland and, at the same time, allow Scottish Tories to fully fund the NHS from taxation? That is not devolution; it is simply unbelievable.
Does Mr Gray understand that what we need to hear is that his amendment commits to the idea that, within a foreseeable time scale, personal care will be free at the point of use when it is needed? If not, we are in difficulty.
I will come to that later.
Both Tories and SNP members have raised important issues about care of the elderly, but the motion does not address them. Would it unblock beds? No. Dorothy-Grace Elder spoke about the principle of means testing; the royal commission recommendation would mean the continuation of means testing. Would the motion end means testing? Would it improve or extend care? No. The truth is that the motion is an empty promise, because it would not deliver what many believe it would.
Many members said that older people want to keep their houses. The royal commission makes a number of recommendations on that, and we will respond to them next week. The best way to keep one's house is to go on living in it; that is what people want to do. That has to be a priority, because recent research has shown that as many as 45 per cent of people in residential care could live independently with the proper support. They are in residential care because the care system has failed them, not because they want to be or need to be. That is the most urgent area of need, and the motion misses it altogether.
That is not the only urgent area of need. When we announce our plans for care of the elderly, we will acknowledge that, as our amendment does. I say to Ian Jenkins that we will keep on seeking ways to improve care of the elderly, with improved quality, greater innovation and greater equity over time. This is not the final word on any aspect of long-term residential care of the elderly—but government is about priorities.
Many members enjoined me to listen to older people, and I do. One thing older people say to me is that I will be old one day. I know that. Not so long ago, Christine Grahame recited a well-known poem about growing old disgracefully. I want to do that, too. I want to live my own life in my own way, in my own home, going to my own pub and sitting in my own seat at Easter Road on a Saturday. I want to turn up at my local Labour party branch and noise up the local MSP—especially if he or she is a minister. I want the services to let me do that—the motion would not help me. I want that for my parents, too. I want them to be at home. That has to be our priority now in the long-term care of the elderly.
I say to Christine Grahame that the motion would not help the woman in the poem to live how she wants to. The amendment holds out the hope of continuous improvement in the provision of long-term care for the elderly.
Those of us who are members of the Health and Community Care Committee know why we are here today. The Executive amendment, which is woolly, rambling and incoherent, illustrates the problems of the care sector. Both are confused and muddled by lack of common purpose and commitment.
Sir Stewart Sutherland chose Rubik's cube as a symbol for his report because it represented the interdependency of the different factors involved in long-term care and because "some of the squares" were already in position. I congratulate the Executive on the squares that are already in place. It has accepted nearly all the report's recommendations: the national care commission, the establishment of benchmarks and practical efforts to work jointly, such as are happening in Perth, which go a long way to solving the puzzle. However, there are no prizes for not completing the cube's riddle. I remember how frustrated I was when I tried to work out Rubik's cube, and the same colours with one out of place was all I could achieve. That is what we face today.
Although Iain Gray talked about growing old, his responses are juvenile. He has been saying that because the Tory party initiated the debate, it is not worth supporting. My grandfather and my great aunt are not Tories. Will he tell them that they will not get the support they need because the motion came from the Tories? Iain Gray said that four out of five people will not need long-term care—but four out of five people do not mind paying for the other person's long-term care to cover the risk of the lottery that long-term care has become.
The minister took many of his points from the "Note of Dissent" in the Sutherland report; it is a pity that in doing that he undermines a sterling report. He forgot to say that the "Note of Dissent" introduces the option of private insurance for care of the elderly. I suspect that although Des McNulty lectured us on private insurance, he had not read the "Note of Dissent". It is an old joke—what is the difference between Des McNulty and a shopping trolley? A shopping trolley has a mind of its own.
Has Malcolm Chisholm heard of devolution? That is what we are carrying out today. I suggest that Malcolm Chisholm read the Sutherland report too, and the report of the Audit Commission.
Has Mr Wallace heard of Mrs Thatcher?
I was eight when Mrs Thatcher came to power, and my generation has something to say. It is my generation's future that we are planning for.
When people ask where we will get the money from, perhaps they should read the Audit Commission's recommendations and the rest of the Sutherland report, which identify considerable savings in the United Kingdom budget, including the Scotland budget.
Does it really stick in Hugh Henry's throat that the Tories want to do something good about long-term care? It sticks in our throat when people such as Hugh Henry talk about issues such as the private finance initiative or privatisation—people from the old Militant Tendency but now in a party that has abandoned socialism, abandoned clause 4, and is going all out for privatisation. I hope that what we are doing sticks in Hugh Henry's throat. What he will be judged on is the way that he votes on the care of the elderly. It will not matter whether the motion came from the Tories or not.
Does Mr Wallace agree that we have heard a lot of spinning in the chamber today from the party of spin, but that the real spinning that is going on is that of socialists such as Aneurin Bevan, who are spinning in their graves because of what Labour members have said today?
That is a valid point. Labour members and trade union members did not believe the argument about wealthy pensioners when it was made by Tony Blair at his party's conference yesterday. Hugh Henry should look at the details.
If we accept the vital notion that personal care is about the care that a person receives, and not about whom he or she receives it from, we can remove from the process a splinter that for too long has meant that we endure the problems that dual funding streams and dual commissioning lead to. We will, at last, be able to complete the cube.
In England, "The NHS Plan" has opted to fund nursing care and ignored the alternatives. Sutherland states implicitly that personal care is at the core of the issue. In his recent paper, Dr Richard Simpson argues that the adoption of nursing care, as in "The NHS Plan", will only increase the lottery of care for those in need. I say to Iain Gray that, if he ignores what Richard Simpson says in his report, he will be a worse man for it. All of us on the Health and Community Care Committee know that Richard Simpson works hard, in a non-party political way, to ensure that we—who often do not have the medical expertise—can have balanced arguments. The minister does himself a disservice.
I urge the Parliament not to adopt nursing care, but to adopt what is at the heart of our motion—personal care. If we do not, I fear that we will need to commission another report in years to come. There have already been some trails to that effect, but I hope that they are not accurate. Those are not my words, but Malcolm Chisholm's.
Does Ben Wallace agree with me—as a representative of one of the other parties in the Parliament—that the question of personal care is so deeply embedded in the Sutherland report that if it were not accepted, it would be clear that the Sutherland report as a whole had not been accepted? Does he further agree that I should vote for a Tory motion for the first time in my life?
I thank the member for that comment—he has obviously taken the time to examine the full details of the Sutherland report and has identified one of the key issues. I wish some Labour MSPs had done the same.
I know that all parties want the report to be fully implemented—even Labour members. We have declared our intentions. The Liberal Democrats, I know, have been working towards a common way forward in the implementation of the report. The number of members who signed Christine Grahame's motion in February shows that the issue has all-party support. For once, this Tory can say that he is not in a minority.
Today, the Executive has focused on the aspects of the report that it has made a start on. We do not hold back from saying, "Well done," but we ask the minister to go that little bit further. He must understand that, without the correct recognition of appropriate definitions of care, and without a commitment to central, single funding, the report will not be able to tackle head on the issues that we desperately need it to tackle.
We hope that everyone will rally round the motion. Our health team fought to ensure that the debate was above party politics, and was for all who needed long-term care. In response to a point raised by Donald Gorrie, we chose not to put a time limit in our motion, so that policy would not be inappropriately railroaded into legislation. If the motion is backed, we hope that the coalition partners can take the time to work out a timetable for full implementation.
Unlike the Executive's amendment, our motion is a clear statement of commitment. The Executive's amendment is ambiguous, shifty and long-winded. It is full of intent, but has no commitment. Today, we have a chance to act for the good of Scotland and for the many who seek the reassurance of stability in their old age.
In his submission to the Health and Community Care Committee, Sir Stewart Sutherland says that the commission has done its job, to the best of its ability and on time, and that it is the Government's duty to respond. Sir Stewart finishes his introduction to the report with Hubert Humphrey's famous words, but as Christine Grahame has already reminded us of them, I will not repeat the quotation. However, I should point out that it was the Deputy Minister for Community Care who previously used them in a debate.
Will the member give way?
I am sorry, but I am winding up.
Sir Stewart concludes his introduction to the report by saying:
"It is this spirit which has informed our task, and it is in that spirit we hope our Report will be received."
However, the real question for Labour and Liberal Democrat MSPs is whether Iain Gray's amendment gives that commitment, or whether it wriggles to avoid the issue with fancy, flowery words. If the amendment satisfies members, so be it. I will simply disagree. However, if the amendment does not satisfy members and they feel that, come 5 October, we will lose personal care to the realms of nursing care for ever, I urge them to support the Conservative motion. Let us make a change from tomorrow.