Elder Care
The next item of business is a debate on the reshaping of the future care of older people.
I am pleased to open today's subject debate on the reshaping of care services for older people in Scotland. Ensuring the provision of good support for older members of society is a marker of a strong and just democracy, and it is fitting that the Parliament should come together to consider the challenges that that responsibility brings. Before exploring what some of those challenges are, I say that I am grateful to colleagues for agreeing to a subject debate at this stage in our thinking.
How we go about ensuring that older people have access to appropriate services is a matter of enormous strategic importance to this nation as a whole—indeed, to all of us as individuals, too. It is a challenge whose implications will span many generations and many Administrations of whatever political colour. We, as parliamentarians, must work together to put down a marker of the Scottish Parliament's will on how best to provide care for older people that is sustainable, deliverable, appropriate and fair. I feel certain that we would all agree to the basic premise of that commitment.
All members have had access to some background material on the subject from the Scottish Parliament information centre to inform the debate. Let me set the scene with a few statistics that I am sure leap out at other members as much as they leapt out at me. Between 2006 and 2016, the number of people in Scotland who are aged over 65 is projected to rise by 21 per cent, and by 2031 the number is projected to rise by 62 per cent. The rise in the number of people aged over 75 during those periods is projected to be 21 per cent and 81 per cent, respectively.
We estimate that, in 2007-08, slightly over 40 per cent of total expenditure by the national health service and social work services in Scotland was on older people. Of that expenditure, we estimate that nearly two thirds took place in institutional settings. Indeed, unplanned admissions to hospital accounted for almost one third of the total. Taken together, all of that means that the way in which we currently deliver services for older people is simply not sustainable in the longer term. Often, though, those services provide vital support to people. Day in and day out, our health and care professionals provide services that make a positive impact on the quality of life of thousands of older people. We must also acknowledge and support the important contribution of the voluntary sector and of the many unpaid carers who support people across the country.
Nonetheless, we also know that there are many instances in which we could be doing things differently and, often, with a better outcome.
On the demographics, does the minister agree that there might be additional pressures in rural areas, where figures show that the elderly population is growing the fastest? Will she work proactively to restore rural weighting to the funding formula that is used by the NHS Scotland resource allocation committee?
During the work on the reshaping of older people's services, we are very much taking into account the needs of older people wherever they live. I accept that there are particular pressures around sustaining services in rural areas.
On a positive note, I point out that the enhanced care service that is being worked on in the Borders, I think, is interesting and provides a model that other areas of the country could learn from. I am happy to share details of that service with the member.
We have to ask ourselves whether our current patterns of service delivery for older people are delivering what people need or want. We must also ask whether we can use the money that is already in the system to better effect. The answer that I and most other people would give to that question is yes.
We need to start thinking in terms of a different fundamental philosophy about care of older people, one that begins and ends with the principle of supporting people, whenever possible, to look after themselves, rather than disempowering people by doing things for them, which can sometimes happen. Many unplanned admissions to acute hospitals could be avoided through, for example, greater support for self-care, more programmes of anticipatory care and easier access to health and social care services in the community at any time of the day or night.
Let us be clear that this is not Government looking for alternatives to increasing investment in older people's services. We already know that simply spending more does not guarantee better results. The multi-agency inspection report on older people's services showed that the significant levels of variation in elderly spend per capita had no obvious relationship to outcomes.
Constituents have raised with me the fact that Highland Council's budget for aids and adaptations ran out months ago, which means, for example, that it will be next April before those aged over 90 get a shower instead of a bath. How can that help or empower people to live at home?
Within this debate, we will no doubt hear of individual instances in which things are not as good as we would want them to be. However, the debate must be about how we can plot and plan services that can deliver a better deal for people in Scotland no matter where they live. We need to think about how, in doing that, we can overcome issues such as the one that Mary Scanlon has raised. However, we must concern ourselves with the bigger picture and with the direction of travel.
As a matter of priority, we need to design services that support moves away from overdependence on institutional forms of care. We also need to get to grips with the cost—in terms of results for people and value for the public pound—of the variation in clinical and care practitioner decision making.
Many of those working in health and social services would say that they could improve outcomes if only resources could follow the patient or service user to where they could be used most effectively. I am, therefore, pleased to note the work that is now under way in four test sites to implement an integrated resource framework that will enable partners to realign existing health and adult social care resources to support shifts in the balance of care. We can use the evidence from those test sites to consider better ways of managing resources across our health and social care systems, which we have been talking about in Parliament for as long as I have been here. However, those challenges raise questions for us all that go well beyond how much money we spend on individual health or social care services, or what those services look like.
A few key observations should guide us. First, older people get much of their care and support from someone who is close to them. Secondly, it is more likely to be a person's social support network rather than their health alone that affects where they receive care. Thirdly, many specialist services run counter to our policy goal of optimising independence because they fail to recognise the value of self-care.
We need a shift in our thinking so that older people are never viewed as a problem or a liability but are recognised as our biggest asset and as contributing far more than they consume. We need to ensure that unpaid carers are supported effectively and that our systems do not work against the vital contribution that they make. We must, of course, do everything that we can to enable greater protection for those adults who are most at risk of harm, primarily through the Adult Support and Protection (Scotland) Act 2007.
The 2007 act puts in place modern and strengthened measures to enable greater protection for adults in Scotland who are most at risk of harm. It sends a clear message that the harm or neglect of such adults is simply not acceptable. Members will be aware, as I am, of the recent press coverage of elder abuse. Elder and other forms of harm should never be tolerated by society. Adult protection is a sensitive issue and we should continue to address it sensitively, while endeavouring to strike an appropriate balance between protecting people and enabling them to live fulfilling lives. I will make a formal statement to Parliament tomorrow morning on elder abuse, in which I will cover the issue in more detail.
Does the member share my concerns about the use of sedation for older members of society? Does she agree that inappropriate use of sedation constitutes a form of elder abuse?
Rhona Brankin raises a very important issue. When the "Remember, I'm still me" report was published, I met the Mental Welfare Commission, the Scottish Commission for the Regulation of Care and officials to consider how we can act quickly on some of the very serious issues that were raised in the report, such as the issue of sedation. I assure the member that work is continuing on the issue to ensure the appropriate use of any medication that is required, and that we are acting on her concerns.
The Scottish Government is actively working with local government and the NHS to agree on what we need to do now to shape the future of health and social care. At a local level, much is happening throughout Scotland to reshape and modernise care services to make them more outcome-focused, more personalised and more responsive. In 2010, we will embark on a process of public engagement to consider how best to address those challenges. That engagement exercise has been commissioned by the ministerial strategic group for health and community care, which I chair and which has NHS chairs and senior local authority councillors among its members. It will begin in early 2010 when the first stages of analytical and preparatory work are complete.
Has the minister included the voluntary sector in the eight very important work streams?
We are involving the voluntary sector, and we have discussed with it how we should take that work forward. However, it was important for us to be clear about the general direction of travel, because it would be dishonest for us to go out with a blank sheet of paper and say to people, "What do you think?" We need to be able to put down some ideas to gauge and guide that discussion, and that is the stage that we have reached. We have by no means ruled anything out, but we need to give some direction to the discussion, and we have been undertaking work on that. I will give members an indication of the priorities that have emerged early on from that preparatory work, on which the discussion will centre. I do not think that any of the themes will come as a surprise, but the fact that they are familiar in no way diminishes the challenges ahead.
In broad terms, we will focus on better integration across services and the workforce in health and social care; more anticipatory and preventive care; more supported self-care and better personalised care; better crisis care; more complex care at home; the use of care homes to provide more specialised care; better care pathways, particularly in and out of hospital; and last but by no means least, serious consideration of how best to promote and encourage healthy living so that our older population is as healthy as possible.
We need to keep it in mind that the work is not just an exercise in improving services for today's older population and that we must also keep an eye on the horizon. Today's younger people, whom we must support to be tomorrow's healthy, independent generation of older people, will have very different expectations and desires. I will be looking for engagement to take place as much locally as nationally. I am pleased that the members of the ministerial strategic group have agreed to be key players in taking the discussion forward locally. The points and ideas that members raise in today's debate will also form an important part of the process and will be included in our deliberations.
We are, of course, also working with the United Kingdom Government in the light of its green paper "Shaping the future of care together". Given that any changes to the benefits system, particularly attendance allowance, will have profound implications for the way in which social care is delivered in Scotland, that dialogue is important. I am clear, however, that here in Scotland we need a free and open debate about the implications of an ageing demographic as well as discussion of specific ideas for change. We cannot develop individual proposals until we have all agreed, at the least, that marginal changes to current services will not be enough to bring about the required conditions for system-wide innovation.
I look forward to a lively and stimulating debate. We need to grasp the challenges and I hope that we can agree today on a common purpose and direction of travel. I am happy to engage with parliamentarians either formally or informally as we take the work forward, and I hope that members will also get involved in local discussions. The issue is probably one of the most important areas that we can take forward at present and I hope that we can reach a political consensus as we do so.
I welcome the minister's contribution on this important issue. I also pay tribute to my colleague Irene Oldfather, who has, along with the cross-party group on older people, age and ageing, driven a lot of the work on the issue. Unfortunately, because of her own caring responsibilities, she is unable to contribute today.
In debating services for older people, we must recognise that many older people are active and positive contributors, even though—inevitably—the discussion then begins to focus on care issues. When Malcolm Chisholm and Rhona Brankin, as ministers, drove our older people's strategy, they were keen to ensure that there was an emphasis on the former aspect as well as on care. I hope that colleagues will forgive me if I concentrate on care issues in my speech.
Journalists do not often find themselves being praised in the Parliament, but I begin by offering a vote of thanks to the BBC and The Herald for what was investigative journalism at its best. They made an important contribution to opening up a more rigorous debate on the nature of care of older people in our communities by confronting us all with the reality of neglect and abuse of vulnerable older people. The "Panorama" exposé on home care and the more recent Herald investigation have had a powerful impact, but I regret that there has been insufficient evidence of urgency on the part of the Scottish Government in its response to their findings.
The investigations revealed the misery and inadequate support of real men and women. Those findings are in tune with the reports of some of my constituents and, I am sure, of constituents of members throughout the chamber. Few of us will be untouched by the realities and frustrations of securing proper care for older people. Too many people—and their carers—describe their search for consistency and continuity of care as a battle or a struggle that is shaped by fear for the future rather than by confidence. When we think of carers' battles for their loved ones, how much more fearful should we be for those without family or those for whom family members, as The Herald identified, are the problem because they are the perpetrators of abuse?
In the face of that situation, the Scottish Government's approach as indicated by the concordat—although certainly not by the broader contribution from the minister today, which was welcome—focuses simply on respite places and funding issues around free personal care. That approach is inadequate and it misses the point. We know all too well of cases in which people are offered inappropriate respite and that, as a consequence, much-needed support is not taken up. It is also evident that we need to go beyond simple repetition of a commitment to free personal care, to addressing the quality of care and, indeed, what we mean by care.
The journalistic investigations have highlighted the gap between the reality in communities and the debate that the Parliament has been having over time. We face a massive challenge: if the voices describing physical abuse, sexual abuse, financial abuse, neglect and exploitation of vulnerable people and those who are unable to defend themselves are to be heard properly and understood, we should not—indeed, we cannot—be defensive. Our response must be brutally honest and urgent. This is no time to explain away or defend the situation, or to marshal statistics to prove that everything is better than it has ever been—or, if it is not, to claim that the blame lies elsewhere. I agree with the minister that the huge challenges that face us go beyond our usual politicking: this is the time for members of this Parliament to ask what we can do to address the challenges, and to examine what we need to change in order to respond to this scandal at the heart of our communities.
The challenge for ministers, the Scottish Government and the Parliament is to acknowledge that everything that they do must be tested against whether it makes people safer or makes things worse. One example is the Scottish National Party's commitment to a centrally imposed council tax freeze. Although the move has given some older people £1 or so a week extra in their pockets, it has also resulted in cuts to their day care services at a time when the Scottish budget has increased by £600 million. If we are to interrogate the options seriously, we cannot simply leave to one side the reality of the impact of the imposed council tax freeze, with only assertion to defend it.
In response to the "Panorama" programme, the minister has said that she will issue guidance on home care that will be "very robust indeed". I would welcome more information on whether that work has been done, on the dialogue that she has had with local authorities on the matter and on concerns that have been expressed about contracts.
As I say, the nature and scale of the challenge demand creative thinking and the acknowledgement that, as far as our society's priorities are concerned, we are in very-big-question territory. Although much of the debate about older people has focused on pensions and funding, and despite our recognition that for many people the fourth age is a time for learning new skills and facing new challenges, the fact is that surveys of older people have repeatedly identified as key concerns loneliness, isolation and safety issues. How should the Scottish Government be protecting those often very low-level but nonetheless lifeline services that are provided by lunch clubs, projects that take people to the library or to church and community transport schemes that allow people to visit hospital—in other words, the services that provide the kind of experiences that sustain people in their own homes, as opposed to care regimes that contain them there?
How is the Scottish Government going to support the community initiatives—such as the reminiscence groups run by the Village Storytelling Centre in my area—that seek to intervene early in respect of the impact of dementia, or the services that support elderly carers who wish to keep their loved ones with them as long as possible? The fear is that, despite this debate and discussion, those very services, which provide people with real quality of life, are seen as luxuries when funding decisions are made.
We must be concerned by Audit Scotland's finding that local authority spending on care is being retrenched towards high-level needs, so I would welcome the minister's saying what discussions she has had with local authorities on that shift. We have to fear for localised services when the efficiencies that the Scottish Government is demanding might be resulting in the stripping out of the key bits of care that make a difference. We must acknowledge that if such services, which are driven by a compassionate understanding of need, are proving to be vulnerable, and if contracts are being squeezed to the extent that care providers are experiencing high staff turnover, the result can be the unbearable image from the "Panorama" programme—which is, I am sure, seared on all our minds—of an elderly man being washed while his carer was talking on her mobile phone. Such an image will drive everyone in the chamber to tackle these issues.
I am interested to find out what the Scottish Government is doing to address staff turnover and the lack of regular contact with the same person, which are particular concerns in relation to quality of care. I cannot be the only member with constituents who still, with all the stress that it involves, go home at lunch time to check whether the support for their elderly parents has been delivered in the right way.
I am glad that the minister has acknowledged the critical role that the voluntary sector can play in understanding and meeting needs. However, what is the sector's real role in the Government's work streams? I understand that we cannot start with a blank sheet of paper, but liberating those who best understand need to tell us what has to be done has informed policy in the past and can do so again. For example, we know that older volunteers have played a key role in supporting people and that an active interest in volunteering can keep people healthy and involved for longer. It is therefore a matter of regret that the retired and senior volunteer programme had to close through lack of funding.
I am sure that the minister will recognise the anxiety of many that the shift in the balance of care will lead to increased pressure on carers, including voluntary carers. I seek from the minister assurances on sustained funding, particularly for carer centres, which advocate for carers and offer a proper understanding of their experience as well as a support and help group for them through very challenging times. Such centres provide proper and meaningful support so that carers can do what they want to do as well as possible. Although I understand that spending alone does not solve problems, stopping spending often creates problems or compounds them. That is my concern about what is seen as the bonus issue.
There is an important debate to be had about the limit of technology as a means of supporting people in their homes. Although technology can buttress support in practical ways, it cannot be a substitute for it. Technology cannot hold a person's hand when they are sad. I am interested in what work the minister has done to shape the current approach of the Minister for Housing and Communities, at a time when sheltered housing is reducing—the number of wardens is reducing—and when organisations such as Inclusion Scotland are highlighting the need for local authorities to do more to provide housing to meet disabled people's needs.
Another issue is the effectiveness of the Scottish Commission for the Regulation of Care in monitoring and in dealing with those who abuse the trust that we place in them to care for people. We must ask how a dementia strategy can be supported and funded so that we transform the nature of care and provide proper processes in relation to personalised care and who is in control.
The future care of older people is a care issue, but it is also a justice issue. We must hear from the minister about the discussions that she has had with justice officials and the care commission about prosecuting those who are guilty of stealing time from care packages or of abusing older people who are in their care. That is not just in the interests of the identified victims; it will also deter those who might be tempted to prey on the elderly, which we will revisit tomorrow. It is a scandal that the only action by the police as a consequence of the "Panorama" programme was to arrest the journalist who exposed the neglect rather than the perpetrators of it. We should all condemn the treatment of the undercover journalist Arifa Farooq. We must know that the justice system recognises its role in protecting the elderly.
If ever there was a need for a national conversation and a big debate, it is for one on future services to support older people. People need consistency, continuity and confidence. The work of The Herald and the BBC opened up a set of circumstances. It is a test for the Parliament to rise to the challenge. I assure the minister that, on the big questions, she will have the Opposition with her in ensuring that we have a proper strategy to protect our older people.
I welcome the debate on future services for the elderly. We recently had an excellent debate on the charter of rights for people with dementia, which was led by Irene Oldfather, whom Johann Lamont mentioned. It is the responsibility of each and every one of us to do as much as we can to get that charter out to older people and their carers.
The debate is on future care, but I make no apology for repeating some points that I have raised previously. Currently, more than 800,000 people in Scotland are aged 65 or over, and 66,000 of them have dementia. Throughout the UK, one in four people over 65 has depression that impairs their quality of life. The over-65 population in Scotland is set to rise by 21 per cent by 2016 and the over-85 population is set to rise by 38 per cent in the same period. It is clear that the UK and Scottish Governments need to prepare for that.
As the minister said, last year health and social care expenditure for over-65s was £4.5 billion. A third of that expenditure went on emergency admissions. Surely, the first thing for a future policy is to provide support and care that will empower older people to be as mobile and independent as possible and to live in their homes for as long as possible. We should not assume that everyone over 65 needs care. Of that population, 89.5 per cent are not in the care system at all. As I said in a previous debate, the over-65s represent more than 20 per cent of the population, but receive only 5 per cent of the input from national health service psychology services and the psychology profession in Scotland. That cannot be right. As well as their direct input, psychologists can train and support staff who work specifically with older people. That is very much needed.
If we wish to enhance independence and the quality of life of elderly people, we could stop rationing chiropody—or podiatry as it is now called. We could consider having a system in which elderly people can self-refer when their mobility is threatened, and we could stop the stupid argument about whether podiatrists should cut toenails. Podiatrists are highly qualified and provide high-quality foot care. If there is to be investment in any service to keep people mobile, it should be in podiatry.
The same applies to physiotherapy. It is a nonsense that a person can wait 18 weeks between general practitioner referral and surgery and yet can wait months or even years to see a physiotherapist. After such a long wait, the damage for an older person is probably much more difficult to repair—if it is possible to repair it—and it is almost impossible to restore the person to good health.
I thank the Royal National Institute for Deaf People in Scotland for providing an excellent briefing on hearing issues among older people. According to the RNID, 17 per cent of its respondents waited months to receive equipment, and it estimates that about 350,000 people in Scotland who could benefit from hearing aids are not using them. It can take 15 years before people seek help after first noticing that their hearing is deteriorating. In Inverness last week, I was delighted to get a little leaflet through the door—when the posties were not on strike—to say that Specsavers is now doing hearing checks. One can just walk in and get one's eyes and ears tested at the same time and, within a week, one can get a digital hearing aid for around £400. I hope that the Government will be as supportive of high street hearing tests as it is of optometrists and opticians, and that it does not allow its anti-private-sector bias to affect patient care.
More use of telehealth could greatly assist independence at home. Let us not assume that everyone who is over 65 does not know how to switch on a CardioPod. Let us not treat them all as if they did not live in the age of technology.
It is time to reconsider the Community Care and Health (Scotland) Act 2002. When it was passed, the intention was that every care home for the elderly would be an integrated care home, so that when nursing care was needed it would be provided. Somewhere between passage of the bill and implementation of the act, something happened, and instead of one type of care home we have three: residential care homes, nursing homes and some integrated care homes. The result is that people who need nursing care in a residential care home do not get it. In fact, quite often the carers and managers of the home do not diagnose the problems.
Still on care homes—and bearing in mind the current budget scrutiny—I ask the Scottish National Party to consider another issue. I use the example of Dundee, given that it is the minister's constituency. Why does the SNP allow councils, for example Dundee City Council, to pay £454 a week for care of a person in an independent care home but £826 a week for people in council homes? We have a tight budget, and a growing elderly population, and twice as many elderly people can be cared for in the independent sector, with the same quality and standards as the council sector.
Finally, we need to consider the removal of ring fencing and what that has done for care of the elderly. Dr McKee is familiar with Kilchoan in the Highlands. Those who go to the lunch club there to be cared for are now serving soup and caring for themselves because there is no money in Highland Council's budget for their care. People in the Highlands are being told that the budget is spent and that they must wait until next year. The removal of ring fencing was to allow councils to ensure that all single outcome agreements were achieved, and that what was assessed as a need was provided for. If the budget to promote mobility, health and independence at home runs out in a few months, either care of the elderly is not a priority in the councils in Scotland or the single outcome agreements are not robust enough to ensure that the money is invested for older people. If we are serious about this issue, we must consider that.
As always, the difficulty in being the last of the front-bench spokespeople to speak in a subject debate is that all the useful statistics that have been provided by the various organisations have been copiously articulated by all the previous speakers.
It is given and accepted that Scotland's ageing population is graphically illustrated by recent population statistics. We know that. As Mary Scanlon said, we are talking about a valuable section of our community, which is a point that I want to share. In general, we should regard the fact that we are able to live longer as an achievement—something to be proud of, not as a great challenge; we should not think, "Oh dear, what a pity." Of course, the purpose of the debate is to acknowledge that sections of that community need our special care and attention. Since last we debated this subject, the only real difference—other than the exponential growth of that population—is that difficulties that are largely a consequence of the financial crisis have arisen.
On individuals' ability to look after themselves—which we wish to encourage—real problems are arising with pension arrangements. That is not a matter for this Parliament, but it is a vital component of our attention to care for the elderly. It is clear that those problems will cause elderly people real concern, because their pension provision may not meet—and is not meeting—their expectations. My colleague Robert Brown will expand on that point in his speech.
Another issue is the impact on carers. Johann Lamont and Mary Scanlon made much of those who care. Recently, a lot of care in Scotland has been provided through, and funded by, charitable organisations. How tragic it is, therefore, for us to read some of the material that has emerged recently from the Princess Royal Trust that shows that not only have those smart bankers fraudulently obtained their bonuses, but those who worked for Lloyds TSB have brought an eminently great charitable organisation to a shuddering halt. I hope that, as they live on their inflated pensions, they might have some conscience about what they have done to hundreds of thousands of people in our community. The carers who, with charitable support, were able to offer such vital care to our elderly people are now in danger of being unable to do so. The tragedy of our banking crisis and the rapacious prosecution of self-interest by those who ran those banks is now being seen by those of us who operate in the community. That is one of the major differences since we last debated the subject.
Johann Lamont and Mary Scanlon majored on the issue of our being able to get care out of the institutional setting and into the community setting. I make no apology for getting into the same territory. As we look forward, we have to do so very carefully indeed. I think that there is unanimity in the chamber about the need to get care out of the institutional setting and into the community, but we have to be honest and admit that real difficulties are emerging not just in that transfer but in the way in which care homes and less-than-institutionalised arrangements are operating, how firms and other organisations are being employed and how they are deploying that service.
The "Panorama" investigation and the Herald article are not lone examples. There are problems about the nature of care that should not be described as institutional for individuals whose preferred option might be to live in their own homes but for whom that is not an option. The model that has been designed throughout local authorities cannot be said to be in any way providing a satisfactory alternative. Mary Scanlon is right: we need to look very carefully at that in taking this whole issue forward. In addition to the "Panorama" programme, there is the issue that Rhona Brankin raised earlier about inappropriate prescription of drugs. Regardless of whether that constitutes elder abuse, it still has to be roundly condemned.
The minister should also be aware that, as local authorities struggle with the mantra of getting people out of institutions and into communities, clear examples throughout the country—I know of an example close by in the West of Scotland, in Renfrewshire—show that the bedblocking statistics focus almost exclusively on the local authority's inability to be satisfied that the provision that it can make is suitable. Sadly, that means that we return to increased bedblocking and the consequent incurring of unnecessary costs and cost burdens for social care budgets in the local authorities that are affected.
I do not want to make a big issue of the matter, but does Ross Finnie acknowledge where we are with delayed discharge, which is the preferred term? We have a small number of delayed discharges—one is too many for me; I want none—but we are a million miles away from the days when hundreds of people were in beds but who should not have been. The latest figure is 55: it was 627 in 2006-07. Does he acknowledge that we have made progress? There is a way to go, but we are a long way from where we were.
Mr Finnie should finish now.
I am happy to accept the more refined term "delayed discharge".
What the minister says might be right. My point is not about the total numbers; my point is that it is clear in some local authority areas that any increase relates singularly to elderly people for whom appropriate care is not available in their communities. Renfrewshire Council's budget this year shows that the council expects an increase in its social care spending as a result.
The debate is about a huge, vital and multifaceted subject. It concerns a section of our community who demand and deserve the best care. Elderly people are a vital component and they should not only be cared for, but be in a condition to make a much-valued contribution to society. They should not find themselves a blight or a burden on our society.
A debate on the future care of older people is of great importance to the future of not only the country, but of us all personally, because we will all be older people one day—indeed, several of us have been accorded that status already. In case one is inclined to laugh at this point, it is my duty to point out as sensitively as possible that most members are—on account of their great age—eligible to book Saga holidays. The name "Saga" stands for sex and games for the aged, as my children continually tell me. That might raise the occasional smile, but there are serious points to make in connection with what I just said.
I am certain that most of the 70 MSP colleagues who are over 50—including you and me, Presiding Officer—do not regard themselves as elderly. However, many young people have a different idea. At a meeting on the right to die that I attended some time ago, a determined young lady said that she was totally against euthanasia, but she was 24; she might take an entirely different view when she is 50. Many people who are 50, 60, 70 and 80 still enjoy sex and games, yet young people regard them as being totally past it. My mother-in-law is in her 90th year, yet she country dances in winter—[Interruption.]
Be very careful, Mr McKee.
When my mother-in-law was 82, she swam in the Sound of Mull—all right, that was because I accidentally dropped her in from a boat, but she managed 100yd to the shore without mishap and helped herself to the warm soup from the Kilchoan community centre. She would be horrified to be lumped into a catch-all category.
Older people are individuals, with individual capacities, needs and aspirations. It is wrong to treat them all as victims. It is with that in mind that I welcome the minister's commitment to keeping people at home wherever possible. Of course there will, sadly, be people who require long-term residential care—people who might need treatment and care that cannot be provided in the home—but modern methods of treatment, which in the past often required hospital or institutional care of some sort, can now in many instances be delivered effectively in the home. The establishment of Macmillan nurses working in the community means that elderly people who have malignant diseases and who wish to end their days in their own homes may do so in dignity, with the highest standards of palliative care. Mild to moderate dementia is best treated in the home environment, as are many other illnesses. Transferring an older person from home to hospital or residential care might solve some physical problems, but it might equally replace them with something much worse.
I do not think that anyone is arguing for older people to be institutionalised, but the difficulty lies in making the care at home real, so that people are not contained in their homes, but are, rather, sustained in them. Does Ian McKee agree that the support that is given to older people is important—not just medical care, but the sort of care that is offered by voluntary organisations?
I agree with that, and I will go on to make that point.
As I was saying, transferring an older person from home risks taking away their sense of independence. To substitute an entirely different environment for that with which they are familiar could make their pre-existing confusion worse, or could even induce confusion in someone who had never exhibited it before.
These days, we are continually fighting the curse of this modern era: the utterly foolhardy and doomed quest for an absolutely risk-free existence. People are stopped from doing all sorts of things because of the risks involved, even if more damage is done to them as a result. That is not confined to care of the elderly: we stop teachers from cuddling a child who has hurt herself in case the teacher is a paedophile, or we ban home cooking at office parties because someone somewhere once got food poisoning. However, the elderly receive more than their share of unnecessary cotton-woolling. The plain fact is that many older folk should live dangerously, especially if they live on their own. It is verging on being criminal to remove a person from his or her home to an unfamiliar institution either to avoid some very remote risk to that individual or, even more inexcusably, simply to protect the people responsible from any criticism should things go wrong.
That does not mean that we should actively court unnecessary risk. I am all for alarm systems, especially if they work. Telecare can provide an extremely reliable system for monitoring how someone is coping in their own home. I am delighted that the Government is sensitive to that, and that it has provided funds so that such schemes can be rolled out. Home helps should be trained and encouraged to report any signs that a person is getting into difficulties at a stage when action is likely to be beneficial.
Relatives, neighbours, voluntary workers and other older people all have potential roles in keeping people at home and in good health, but they need training, co-ordination and support if maximum benefit is to be derived. Above all, anyone who can play a vital part in such an endeavour should have their work recognised and valued. There is enormous good will in the community, but we need to know how to tap into it.
We in Scotland have a lot to be proud of concerning care of older people, not just in terms of telecare developments but in free personal care and a variety of initiatives all over the country. My main message, however, is that with which I started: all older people are individuals. Some need personal care; others require help setting up new businesses. Some are very reliant on others; others want to keep working well after the age of retirement. We must recognise all those varying needs, and we must seek to meet them. Older people still have much to contribute to our society, and we must allow them to make that contribution.
Like Ian McKee, I declare an interest. None of us is getting any younger, and we all have parents who are getting older. Just when we think we are escaping the responsibilities of child care, we sometimes meet the reality of the increased responsibility of elderly care. I am sure that there are many members with personal experience of care services represented in the chamber today. Inevitably, there will also be plenty of personal experience of failures in those services when we have needed them.
Members encounter a steady stream of problems and issues that are brought to them by constituents. Inverclyde, in my constituency, has suffered from a decline in population but will experience 16 per cent growth by 2031 in the number of people who are over 65. In such a community, elderly people are dependent for care on other elderly people, who will soon get to a stage at which they themselves need to access care. By 2031 it could cost £3.5 billion—more than treble the current level of spend—to provide the health and social care services for older people in Scotland that we currently provide. The minister talked about that, and we can all agree that it is an issue.
There will be varying degrees of need, as Ian McKee pointed out—I look forward to taking him for a long walk off a short plank at Leith waterfront some time—but the issue will not go away. It will grow, and we will be presented with a huge challenge—and I repeat, "we". Of course there will be arguments about our big brother in London and where we can get £30 million to plug a gap, but the overall responsibility is ours. We are talking about our parents and our older people, in our communities. Rather than row about all that, we should concentrate on things that we can affect.
Free personal care is rightly viewed as one of the Parliament's achievements. The minister will remember working on the issue in health committees in previous parliamentary sessions. Our focus was pretty narrow at the outset—it was on the cost to families of residential care—but now, after all those years, we are starting to think about the 69,000 people who receive care at home. Many of those people cannot get out of the house to go for a swim. Sometimes they are forced to leave not just their family home but their community to get the appropriate care, because the Parliament has not connected up with local government and all the agencies to provide the services, aids and adaptations that would enable them to stay at home. Such matters are our responsibility and no one else's, and we should consider them, rather than fight over who should be paying for what and dropping problems on other people's budgets, as we all do. It sometimes seems that the health service and local government get involved not to consider people's needs but to argue about whose budget a service will come out of.
Similar issues arise in the debate on child protection. All sorts of people are responsible for child protection, but until we get someone in the Cabinet who has their hands on significant budget streams we will never pull everything together.
We need to realise that if we are to protect the health service, as we are doing, there will be consequential cuts in the local government budget and every last penny will be squeezed out of services. Care workers who deliver services will face greater demands and workloads and will have less time, less training and fewer opportunities to develop skills. The people who ultimately suffer will be the older people who need the services.
I understand that the balance between value and quality is difficult to strike, but there are issues that we need to confront. Evidence that the Local Government and Communities Committee heard showed that there is sometimes no correlation between what is paid out and the quality of the outcome.
The "Panorama" programme, which has been mentioned many times, was shocking. Secret cameras uncovered serious neglect as overworked and low-paid carers struggled to provide standards of care that we could be proud of. Leaving aside the question of whether it is appropriate to care for an elderly man while using a mobile phone, the programme raised serious questions about how we procure care services. Until that point, such services were procured by a reverse e-auction, going to the cheapest price, like Bid TV for cheap jewellery—that was how we procured our services for the elderly.
You should be finishing now, Mr McNeil.
Those issues are our responsibility. The questions of regulation and inspection are our responsibilities. They do not necessarily come with a big price tag but we must recognise them as big issues. That is why we wanted this Parliament—so that we could accept such responsibilities. We cannot dodge them. There are major issues that need to be addressed quickly.
I concur with some of Duncan McNeil's remarks, but I do not know if we should beat ourselves about the head too much as parliamentarians. In the 10 years of the Parliament, we have made some substantial achievements for the elderly in Scotland. The central heating programme has made a huge difference to people's lives. Free personal care—even with all the issues that have arisen from it, which were trailed when we considered the issue—has nevertheless been a major step forward on equity for our elderly people.
Concessionary travel has been an extraordinary success and led to better health for our elderly people through giving them mobility, reducing their isolation and often putting fun back into their lives. I say that as I use my pass regularly. We are keeping the bus services running, and I assure members that the buses that run between Edinburgh and Glasgow are full of pensioners and students. The Parliament, across all political parties, has taken some excellent steps.
All the aforementioned services have succeeded, and I applaud that because they are not means tested. It might be controversial to say this, but means testing elsewhere has proved to be administratively cumbersome, costly, ineffective and often unfair for individuals on the borderline. A prime example is the low uptake of pension credit, which pensioners who are on the borderline do not apply for or are just missed by. My preference is for taxation of those who have the money, but not to means test, and it is good news that means testing has been removed from services to older people.
Unfortunately, I disagree with Duncan McNeil on other points because we cannot change the basic rate of the state pension. If we were to ask pensioners what their top priority would be, most pensioners would say a decent basic state pension. As I say, the pension credit has failed because many who were entitled to it simply did not apply. The application form is lengthy and difficult; one would need a PhD in applying for a pension credit.
The minister referred to Scottish Borders Council, which recently conducted a review on transforming older peoples' services. I applaud the council for that; it has been a step ahead of the game and it has come up with some important ideas. When someone is discharged from hospital to home, there is an intermediate care package to try to prevent the falls and readmissions that are, for the most part, avoidable.
The council is turning its attention to day services and day hospitals, many of which are provided by the voluntary sector as referred to by Johann Lamont. We must cherish that sector and ensure that its funding is sustained where appropriate. I am thinking particularly of the social centres that were piloted in Innerleithen and West Linton with the Red Cross providing neighbourhood services to them.
Many of those who work in the voluntary sector are pensioners themselves. We must remember that the pension age now runs from 60 to well over 90, which covers two generations and those who served in the second world war as well as those, like myself, who were born after it. That is a huge range of people and abilities. Ian McKee was quite right to say that everyone in that category is an individual with individual talents, abilities and needs. However, notwithstanding Ian McKee's attempt to shorten the lifespan of his robust mother-in-law, there is indeed a lack of appropriate assistance in various areas. That issue comes up in the cases that we get.
We do not have enough sheltered housing. The warden system, which was terribly important in much sheltered housing, is being reduced or taken away entirely. That is ironic when there are places such as Heinsberg House in Penicuik, where people went in at 65 and now find, 20 years later when they are 85, that they have lost the warden service. They now have a token round their neck to press or a buzzer to call if they are in difficulty, and what actually happens is that the lady who has the flat next to the door opens it and lets people in. The warden did so much else, such as arrange Christmas and birthday parties, and was a bit of a social worker for the 30-odd residents, but they are now gone, which is a great loss. The warden system represents something that we cannot always measure in monetary terms but can measure in terms of residents' wellbeing.
As we know, there is a shortfall in the provision of aids and adaptations. That may mean that, although somebody is assessed in hospital for discharge, while they wait for social work to kick in they have to be reassessed because they become worse or become institutionalised and lose some of their independence. None of that is rocket science, and we all know that funding it is not a bottomless pit. Parliament must address those issues.
I want to focus on medical care in care homes, which was referred to in the context of the documentary on it. However, I will refer to the "Remember, I'm still me" report of May 2009 by the Mental Welfare Commission for Scotland and the care commission. If members have not read that report, they should do so, because what it shows is absolutely shocking—I do not use that word lightly.
The report has a list of things that are wrong in care homes. For example, of the 67,000 people in Scotland who have dementia, 40 per cent are in care homes. They are the most vulnerable, but it was found that such individuals are rarely involved in any review of their care. It is as if they are an "it" and not a person. It was found that around half of people in care homes never leave them; it is as if the care home is a padded prison for them. It was also found that, although more than half of care homes have accessible gardens, there is little evidence that they are ever used. Those are not big problems to cure. It was also found that there is little creative use of a person's funds to support them.
One problem is that our care workers are undervalued. Care work is a poorly paid job, and it is often young people who do it. It is not their fault, but they may not relate in the best way to a very elderly, frail person. There are great differences in the way that the generations behave towards each other, but it is often young people who work in care homes with very vulnerable people.
Away back, we had talk about the pill in the sandwich, when people were given medication without their knowledge. That still happens, but all such problems are curable, and the Parliament should address them before the end of this session.
It is good that we are considering today and again tomorrow the care of older people, but it is important to set it within the broader framework of the wider agenda about the contribution of older people, the opportunities for them and attacking all forms of ageism. It would be good to hear from the Government before too long about progress on that agenda.
Sticking with care, we should remember that only a minority of older people require care services: 3 per cent of those between 65 and 74, and 40 per cent of those who are 85 plus. Of course, in relation to care, the welcome explosion in the number of over-85s in the next 20 years will be important.
The key issue for care is of course quality, and central to quality is personalisation. In many ways, we seem to be going in the wrong direction when it comes to that. Of course, we should acknowledge today the great deal of progress that there has been, from the setting up of the care commission a few years ago to the welcome initiatives that the minister described earlier. However, it is right that we should focus in this debate, as Johann Lamont did, on issues such as the "Panorama" programme, the articles in The Herald, the rising number of complaints to the care commission, the "Remember, I'm still me" report, and what is actually happening on the ground, which is often contrary to the stated policies and objectives.
The "Remember, I'm still me" report has been referred to by several speakers. Sticking with the theme of personalisation, I refer members to a couple of examples in the report of an absence of personal plans that meet the individual needs and preferences of people, and an absence of activities that are tailored to people's individual needs. Those examples and others send out a very important message to care homes, the providers of home care services and councils involved in the commissioning process.
That leads me on to an example of what is happening on the ground in my constituency. City of Edinburgh Council will soon introduce changes to home care services that I will come on to describe, but the council has already changed the tendering process for care-at-home services for people with learning disabilities, mental health problems and physical disabilities. In that process over the past few months, the views and wishes of those who receive the services have been ignored.
A central feature of personalisation is putting the person at the centre as a participant in shaping the services that they receive, but the views of service users in Edinburgh have been ignored. Many service users have said that they will take out direct payments rather than accept the new providers, so what has City of Edinburgh Council done over the past few days? The council has frozen direct payments, which are an important dimension of the personalisation agenda. I believe that the minister should look closely at what is happening in Edinburgh, which seems to me to be contrary to legislation.
On home care services, City of Edinburgh Council intends to move 75 per cent of provision into the private sector. Before the Conservatives leap to their feet to intervene, let me clarify that I am not saying that the private sector is necessarily worse. We need to look carefully at quality. In service reviews, the views of users of independent sector services contrast with those who use council services. On the basis of that evidence, it seems that the users seem to prefer council services, although that is not necessarily the case. It is certainly wrong to award contracts solely on the basis of lowest cost—as appeared to happen in the evidence shown in the "Panorama" programme—but the changes in Edinburgh seem to be driven by the desire to make the services cost as little as possible. We should all be concerned about the implications of that for the quality of service.
Will the member give way?
I have only two minutes remaining. I shall give way if I have time, but I will first highlight two other issues.
On the important subject of abuse, which we will also consider tomorrow morning, we should acknowledge the progress that has been made through the requirement for enhanced checks and through the Adult Support and Protection (Scotland) Act 2007. However, following a concerning incident in a council care home in my constituency—someone was convicted of sexual assault of the patient a few weeks ago—I wrote more than once to the minister about how the case raises serious issues about the effectiveness of checks when, as in this case, the member of staff comes from abroad. I know that the Government will try to deal with the issue to some extent in the Criminal Justice and Licensing (Scotland) Bill, but there is still a wider issue about checks on agency staff. In the case in question, the member of staff was employed by an employment agency, which cannot be inspected by the care commission. More generally, I think that we need to look carefully at who is employed in care homes. As Johann Lamont said, continuity of staffing is important and part of the problem is that agency staff come and go.
My last point is about the wider agenda. There has been a lot of progress on personal care, but some of the wider agenda is being ignored. Last week, I had a meeting with Care and Repair Edinburgh. I know that the Government supports such services in principle, but I must pass on the organisation's concerns about the loss of ring fencing, which obviously creates worries about funding. Another project in my constituency is the Pilton equalities project, which is trying to fill some of those gaps by using volunteers to provide a handyperson service.
I will take Mary Scanlon's intervention.
Given the tight budgets, does the member think that it is wrong that councils pay twice as much for care in a council home as in an independent home?
We need to look at the reasons—wages, pension rights and so on—for those differentials.
I am glad to accept that intervention from Mary Scanlon, given that she hosted a recent meeting with clinical psychologists that I attended in the Parliament. Like her, I want to make a point that was raised at that meeting. Clinical psychologists have recommended the development of a national education programme that would target general practitioners and practice nurses to support better identification and management of depression in older people. They also propose more posts for psychologists with specialist skills in supporting older people. That is an important aspect of the care agenda for older people that we should remember.
We have heard some excellent speeches both by the opening speakers and by the subsequent contributors to the debate from the body of the chamber. One point that we should perhaps keep in front of us is Malcolm Chisholm's comment that what happens on the ground is sometimes contrary to the policy. That has perhaps been a lesson of the implementation process of free personal care from the beginning. The theory behind the policy was supported by all parties in the Parliament, but the practice has sometimes been rather different.
It is common ground that we face considerable challenges because of changing demographics, but let me put that in perspective. Although our ageing population poses growing policy and financial challenges for us, it is possible to overstate the matter. I will give a couple of illustrations of that.
Just over 100 years ago, in 1908, the Government—a Liberal Government, as it happens—introduced the first old-age pensions at the rate of 5/- a week for a single person and 7/6 for a couple. There were dire predictions—mostly, it must be said, from the forebears of the Conservative members—of the end of civilisation as we knew it. It was said that the national finances, which were running an empire that straddled a quarter of the globe, would never stand the strain and that the pension was an encouragement to sloth and idleness among the lower classes. The bureaucrats of the day predicted that demographic changes, including an increase in how long people lived, would destroy the scheme. In fact, the old-age pension gave innumerable older people dignity and security in retirement for the first time, and the demographic time bomb somehow failed to explode in quite the way that was predicted.
In recent years, the value of the pension has eroded to the point where, under the current Government, it is worth less in real terms than it was in the 1950s. That is my second illustration. Britain was on its uppers in the 1950s, crippled by the cost of the second world war and the underinvestment of the depression and the war years. For that matter, it was deprived of 1 million male members of the workforce by deaths in the first world war and another 500,000 working-age adults by deaths in the second world war. However, it could afford a reasonably decent pension for its older citizens, whereas now the basic state pension is 25 per cent below the poverty line and some pensioners are thrown on to reliance on benefits for the first time in their lives.
That is not a matter for this Parliament, but we must, as Liberal Democrats have argued, relink the pension to average earnings and move it upwards to pension credit level—which is one of the current Government's achievements, albeit one with many faults—as soon as possible.
My comments are also directed at the empowering policy of free personal care for the elderly, which is one of the Parliament's signal achievements. Many people—Sam Galbraith springs to mind—crop up periodically to claim in doom-laden terms that the policy is not affordable. It is undoubtedly subject to upward pressures, but it is a gross exaggeration to suggest that expenditure of the order of £300 million or £400 million a year—less than half a new Forth bridge, for example—is not possible to fund. In any event, it is also a vital underpinning to everything that we try to do in this policy area.
Various members have touched on social contact, which is vital. I said in an earlier debate that the "Remember, I'm still me" report on the provision of care in residential homes for people with dementia was
"one of the few, stark, totemic reports that are immediately and obviously definitive."—[Official Report, 9 September 2009; c 19395.]
I hope that that proves to be the case and that the report proves to be a wake-up call.
We look forward to the Scottish Government's dementia strategy in the spring, but I hope that it and other initiatives will have at their heart a commitment to ensure that older people are treated as unique individuals, are not left without social contact or stimulus and—particularly, but not only, in residential homes—are enabled to live as full lives as possible.
That is the guiding phrase that goes right through the debate. It will mean providing specific and accessible opportunities for older people—sometimes not independently ambulant—to take part in cultural, social and recreational activities. It will mean, for example, that a local authority such as Glasgow City Council will not in future be able, under the pretext of financial pressures, to regard social work transport to local groups as an optional extra—discretionary and not part of its core duties—rather than the vital conduit to flexible, loneliness-busting and life-enhancing social contacts that it is. That is an important aspect of the expansion that we get from the voluntary service.
I will give members another statistic of relevance on psychologists, an issue on which Mary Scanlon and Malcolm Chisholm touched. Although one person in four over 65 in the United Kingdom has depression that impairs their quality of life, there are eight psychologists per 1,000 people for those aged under 20 and 0.6 per 1,000 for those over 65. Only 32 psychologists work in specialist services for older people in Scotland. That is a gross scandal on which I hope the minister can give us some comfort. Depression in older age is understated, under-reported and undertreated. In some primary care trust areas, there are no mental health services specifically for older people. There is a huge task to educate GPs, practice nurses and other health professionals; to better identify and manage and support depression in later life; and to build a system that has wellbeing at its core.
Carers and people with caring responsibilities have to be central to our thinking. The network of carers centres works with up to 50,000 unpaid carers and 3,000 young carers a year, supported until recently by the Lloyds TSB Foundation for Scotland, which Ross Finnie mentioned, and the Laidlaw Youth Project, among others. Lloyds TSB Foundation, with its vital voluntary sector input, is the newest victim of the banking crisis and of an attempt by the bank to slash the future funding agreed at the time of privatisation. The Laidlaw Youth Project is also stopping its funding.
We are facing a major challenge in voluntary sector funding, and we must look at whether the Government might convene a national forum of leading funders to consider what can be done to replace or stabilise funding in these difficult circumstances.
You must close please, Mr Brown.
My concluding point, Presiding Officer, is that how we treat our old people, whether we make full use of their talents and enable them to overcome loneliness and depression, and how well we support them are central to our future as a society. We cannot ignore the demographic trends, but they need not be our masters either.
I must point out that we have no spare time at all left in the debate, so members should please keep to the times given.
A month ago, I turned 65. I got letters of congratulation from my German member of Parliament and from the university rector, for I still put in several weekends' unpaid teaching—which is great; I will come back to that point—and examining during our recesses. I seem to be working harder than I have ever done as, besides my MSP duties, in the morning or evening most days I have to care for my parents, who are 91 and 92 and are still in a house that would be rather big for them if I was not around. I enjoy that work and I appreciate the different perspective that caring has given me, although at times it can be a crazy egg dance.
Home care of the elderly in Scotland costs local authorities, gross, about £1.5 billion per annum. That is roughly the size of the share—proportionate to population—that Scottish bankers got of the £21 billion that was divvied up into bonuses in the glorious year 2006 to spend on multiple houses, yachts, huge watches, four-wheel drives and so on. In Germany, we always got the Financial Times of a Saturday, including a magazine called How to Spend It, which my wife used to brandish at me, saying, "Aren't you lucky that you're married to me and that I don't want one of these?" I notice that the publication is still as healthy as it was before the crisis. I mention that because, in my four years looking after the old folk in Melrose, I have never met socially any of the numerous four-wheel drivers who set out through the village looking as if they are going to cross the Gobi desert, whereas my parents are dependent on plenty of women carers who have rather small cars, if they drive at all.
As I have implied, caring has a lot to do with housing. A good point about the council housing system is that it created the possibility of our having a policy that caters for people at all stages of life, particularly those who are widowed or less mobile. Throughout Scotland, there are groups of houses—compact, convenient for shops and well insulated—that were built in the 1950s or 1960s for the elderly. I have my doubts whether our owner-occupied free-for-all has provided anything better.
There are societies in which care happened in an in-built, rough-and-ready way, such as India, Russia or Ireland, where old folk lived in great houses as part of extended families. That sort of family clan was actually closer to the historical Scottish clan than the English nuclear family. We learn that from a valuable book, "The Causes of Progress," by the French-Scots social anthropologist Emmanuel Todd. That type of organisation could provide a model for the present day.
The space and income of the elderly in our society is under unrelenting attack. There is also the pension funds crisis, the collapse of what had once been reliable shares, the closure of local shops, bus routes, churches and pubs, not to mention the deterioration of daytime TV—anyone for Jeremy Kyle or, mysteriously, "Postman Pat" in Gaelic in the morning?
Lloyds Banking Group's desire—I am not the first to refer to this—to curb the charitable foundation that it inherited from the Trustee Savings Bank shows exactly what we should not be doing. The effect on Scottish charitable organisations, including those aiding the elderly, would be extremely harmful, especially as their clients are already suffering from the recession.
That leads me to the notion that we ought to try to revive the mutual and civic forms of saving and insurance, since aggressive, profit-driven finance has shown itself unfit for purpose. Its decay shows how little integrated our society has become. If anything, our ageing society needs more funding of charitable organisations, but charity is not enough. As Shona Robison pointed out, those who move into retirement now and in the future will have different expectations and requirements, with the emphasis above all on independence.
I stress—as I have done in previous debates—that European countries gain a lot from the commitment of young people to undertaking a year of social service between school and university. One of the delights of teaching in continental universities is the fact that the young people are more mature by the time that they reach the university system.
We must make it a priority that home carers—especially relatives—receive assistance, information and respite time to protect those for whom they care and their own physical and mental health. We must ensure that councils choose care providers that provide good-quality care and that instruments and effective feedback exist for the customer as well as for the council.
However, things cannot stop there. Scotland's elderly also require a society that is fit for their purpose and simple improvements to be made in public transport, such as regular clock-face timetables. The timetables in the Scottish Borders have changed six times this year. Imagine how difficult it must be for elderly people to find out when their bus is going to arrive to take them to the post office or the Co-op. Strengthening local communities and making post offices, shops and community centres more accessible will benefit the elderly and maintain their participation in society. That will benefit not just them, but all of us.
It appears that the minister will be the youngest member to contribute to the debate this afternoon. I wonder whether she will consider the speeches of other members as wisdom derived from her older peers or the expression of vested interests by MSPs who are closer to the end of their careers than she is.
Christine Grahame was right to point out that the Parliament has done a good deal to take forward the agenda on behalf of older people. Concessionary travel, care in the community, the establishment of the care commission, free central heating and the introduction of free personal care are a series of milestones and achievements that have undoubtedly made a significant difference to older people. However, one of the problems that I have with the debate—and perhaps with its title of reshaping the future care of older people—is that, in the context of the financial situation that we face, we have not engaged with the real issues in discussing the future care of the elderly. It is reasonable for us to consider the principles of what services ought to be available in an ideal world, but the reality that we face is that difficult choices will have to be made by the Scottish Government and by local government concerning competing priorities, not all of which can be pursued.
In the debate that we ought to have about reshaping the future care of older people, we must first be clear about what we can and cannot do financially. Secondly, we must address the demographic pattern of growth in the number of older people with care needs. Thirdly, we must recognise that the needs of elderly people are not static but fluid and that they change as people get older and require different kinds of care at different points in their lives.
Jeremy Purvis made his usual plea for more money for rural areas and talked about the increasing number of older people in the Borders. In fact, the statistics show that Bearsden and Milngavie, in my constituency, have the highest number of elderly people of any district in Scotland. Interestingly, there is a larger population of elderly people in Bearsden and Milngavie than in Clydebank because of the significantly higher mortality rate in Clydebank. There are more elderly people in Bearsden and Milngavie than in Clydebank because people live longer there.
Of course, we know that the issue with the costs of care—if, as I think we should, we take into account hospital care—is that the biggest cost to the state in relation to the provision of care to older people occurs in the last 18 months of their lives, and largely within the last six months of their lives. We need to find ways of keeping people out of hospitals and residential nursing care institutions and ensuring that they can stay in their own homes. That is not simply an issue to do with services that are deemed to be care services; it is an issue to do with how we provide housing services. We should think about making it easier for relatives and friends to provide support services for elderly people that do not cost the state anything and which provide a cost-effective way of dealing with some of the problems around health, care and loneliness that affect elderly people and might otherwise induce them into more expensive—for them and the state—institutional settings.
As well as providing support for care, we also need to deal with the quality of care in residential nursing care and palliative care settings; we must ensure that such care is of the best quality.
Robert Brown made the point that the Princess Royal Trust for Carers found out today that another major source of funding for its network of carer centres, the Laidlaw Youth Project, is shutting down. That will have a significant effect on the work with young carers that the trust does through that national network of carers centres and young carers projects that is part of the Scottish young carers alliance. If we are not able to support young people in providing care, the chances are that they will be less likely to do it or that they will not do it as effectively as they otherwise would.
Of course, it is not only the Laidlaw Youth Project that is under financial pressure; we have heard about the Lloyds TSB Foundation, and there are also pressures on the Big Lottery Fund. We need to find a mechanism that ensures that younger people can support older people effectively, in a way that does not necessarily place a burden on the taxation system. We need to find policies on housing and issues such as transport that ensure that people are not totally dependent on state-provided care and can stay in a community setting. To an extent, we have done that.
Will the member give way?
No, the member is closing.
That is not only good for the state but absolutely good for older people. We hear time and time again that that is what they want.
Now, I—
I am sorry, Mr McNulty, but we must move to the closing speeches.
It is clear that we have all returned refreshed from our short recess, because around a core—perhaps I should say a nugget—of a very worthy debate, in which every speaker has displayed an impressive knowledge of and care for the elderly, there has been a wide-ranging discussion on the periphery, from the Deutschland of Christopher Harvie, on which he is a great expert, to Robert Brown's history lesson about the golden days of H H Asquith, which we Liberal Democrats remember happily as we drop off to sleep at night.
Like Christopher Harvie, I have an interest to declare, in that my mother, who is 85 going on 86, lives with me and my wife. She shows no sign of leaving home or going into a care home, which is quite understandable, because she is, amazingly, still helping out with the over-60s Christmas party and the meals on wheels service. Although she is my mother, I say that she is an example of an individual who is contributing to society. People such as her are to be supported.
As Ross Finnie quite correctly noted, the opening speakers outlined the statistical background to the problem that lies before us. I will touch on some of those issues from the point of view of my constituency.
Shona Robison referred to the issue of unpaid carers and, although I will not get into the details of that matter tonight, I have at other times spoken about care organisations in my constituency, and young carers in particular.
Johann Lamont correctly reminded us of what the BBC and the Herald said. They did a great service: as appalling as those revelations were, it can only be a good thing when journalism shocks us and makes us collectively sit up and think. Mary Scanlon, in her speech and in an intervention, made the point about public care homes versus private care homes. Any MSP knows that that is an issue, and, to be fair to the private and public sectors, we must get to the nub of the matter. We should ask about the facts and the expenditure patterns that lie behind the apparent imbalance, for which there may or may not be good reasons.
My colleague Ross Finnie outlined what the huge change—the financial crisis—that has occurred since our previous debate on the subject has meant for charitable organisations. He said that he hopes that the executives who headed up the banks and took large bonuses have that on their conscience. I think every single one of us would say amen to that.
Dr Ian McKee gave a most amusing speech, in which he mentioned his mother-in-law and touched on the issue of home helps. Every one of us knows that paid home helps—both those who work in the public sector and those who work privately—are becoming harder to find. It is becoming harder to get young people to go into that profession, and many of the home helps who are on the Highland Council payroll in my constituency are reaching retirement age. We heard from Des McNulty about the huge importance of getting young people to join in with caring for, helping and working with older people in a way that does not alter the tax situation, which was an extremely sensible point that we would do well to bear in mind.
We all want home carers to be paid as much as necessary, and according to the value of the job, which is huge. However, it is a concern that the wages for Highland Council home carers are not the same as the wages that organisations such as the Crossroads Association pay. The council loses very good staff because it is unable to match those wages.
I accept Mary Scanlon's point. It leads me to an issue that I have just thought of. I am aware of an incident that I have mentioned before in the chamber, in which a home help on the council payroll went to help a man in his 80s, who rose out of his bath and laid out the woman to such an extent that she is still injured to this day. The safety of home helps, which I have mentioned in previous debates, is an issue that we should not forget when we discuss the safety of elderly people.
We talk about people coming out of institutions, or staying in their communities rather than going into institutions, and I say amen to that—it is a thoroughly laudable aim. However, I remind members again of the case in my constituency of William Hunter, who lay dead, undiscovered, for far too long. We cannot blame the housing association, the health service or the police, because everyone did their job within their terms of reference, and yet that gentlemen fell through the net. That case gave every single elderly person living in Scotland and elsewhere a most chilling and terrifying message. Co-ordination is important, and I know from my conversations with the minister that she recognises the problem.
I make one final point. I recently had occasion to visit a home for the elderly, where one old lady was very pleased to see me. She held both my hands and said that it was a great honour to meet me. I am a naturally modest man, so I did not—
The member must close now.
She told her friends and neighbours the next day that she was very pleased to have met Jeremy Thorpe.
This afternoon's debate has been welcomed by members throughout the chamber. My preparation for it has illustrated for me the many and varied perspectives of the organisations that engage with older people, which have been articulated by members in the chamber.
Frankly, the only firm conclusion that we can reach is that the challenge ahead is daunting. In general, policy must deal with the here and now or the immediate period ahead, but in many of the health briefings that members receive, there is invariably a common paragraph somewhere that says in so many words that we have the ageing demographic challenge to consider.
It is not that we are unaware of what lies ahead, but we know that the challenge is, as I said, daunting. We are an ageing population. In many ways, that is a tribute, despite all our other failings, to so much that has been achieved in the past 50 years, but that success in living longer has been outperformed, if you like, by Scotland's birth rate. More of us will be retired and dependent in some way on fewer younger people. The minister set out the figures in detail, as did my colleague Mary Scanlon. That position is recognised implicitly by all the organisations that submitted comments before today's debate. Their responses essentially amount to two propositions. The first is that we need to do more in almost every area and that that will cost money—at a time, too, when resources will be scarce—although some of that investment might release resources, the seemingly insignificant and trivial matter of toenail care being an example.
Secondly, there is recognition that with a scarcity of resources, or even simply in recognition of the affordability issues that are presented by a changing demographic balance, we have to rethink the means of delivery. That thoughtful analysis is encouraging because, frankly, if the discussion were to be distilled down to the notion that politicians will just have to find the money to go on as we are but with incremental increases to support both the burgeoning demographic and all the worthwhile initiatives that are actively canvassed, planning would simply run into the sand. Des McNulty made a thoughtful contribution in focusing on that point towards the end of the debate.
From the perspective of funding, the Scottish Parliament's policy achievement of free personal care, which Duncan McNeil discussed, will be an enormous challenge to sustain. Successful planning for that alone will be a considerable achievement and we cannot take it for granted.
Elsewhere, Conservatives have proposed an increase in the age at which people retire coupled with a restoration of the link between the state pension and earnings, so Christine Grahame can relax and take comfort from the many and varied benefits that the union can and will confer. An unwelcome rise in the retirement age will fund a more financially secure future for older people.
I want to right the historical wrong to which Robert Brown drew attention. The Liberal Government did introduce the state pension back in 1906. Perhaps it is worth while to say how sad it was that an ungrateful nation was shortly thereafter to consign his party to the fringes of political history. If Jamie Stone has the disc of Mr Asquith that puts him so happily to sleep, I am sure that many older people would welcome the opportunity to purchase it, because I am sure that it would have a similar effect on us all.
We are still at the crossroads of the lifestyle change that has seen many more people choose to live alone for the majority of their lives, and those people will move into old age having enjoyed and lived capably with that status. We have both an ageing demographic and a general lifestyle change that has seen more people choose to live alone. It is possible that some of the issues around education will be mitigated by the experience gained by those in the generation who have lived a single life prior to old age, whereas it is still common today for many older people who live alone and need support to be those who have been left behind.
However, Age Concern in particular has identified that too many issues—such as general malnutrition, lack of knowledge about or unwillingness to take up the many income benefits for older people, which Christine Grahame mentioned, or an issue that I mentioned earlier, toenail cutting—can lead to problems being severely compounded. Johann Lamont drew attention to the lower-level services that combat feelings of isolation, and I agree that it would be a mistake to class those as luxuries. All this, of course, before the emerging challenge of dementia, which we have debated before, and of which every family must anticipate a future first-hand experience.
Scottish Conservatives welcome the debate. We recognise and applaud the reasoned analysis by all the organisations that are involved that what we do now will not work in the future and that effective resource management will be vital if we are to sustain the imaginative breadth of initiatives that are envisioned. We support the view that there is an urgent need to develop a policy approach that commands as much support as possible, but it is more urgent still that we take the required time to think through the options and thoroughly discuss the potential consequences—both intended and unintended—of any changes that we implement.
As I read the various submissions, I was somewhat stopped in my tracks by one that defined older people as those aged 50 and over. It is one thing for our children to say that we are ancient when we still feel very much in our prime or, at least, we can just about remember what that felt like. In a previous debate, Dr McKee entertained us at some length by talking about his passion for silk underwear. He was at it again today with the sex and games activities of Saga members. However, it is another thing to realise that the debate that we are having today is about a future, which is not so far away, in which we will be the very older people whom we have been discussing.
This is not an abstract population concept; as the minister noted, we must ensure that older people are not seen simply as a problem and that we create an atmosphere in which people who say that they are 50 or over do not elicit the response "You poor thing." As Mary Scanlon pointed out, not everyone who is aged 65 or over is in need of care. As I say, this is not an abstract concept. We are talking about the care and dignity of our friends, our families and our fellows, so we had better get it right.
I call Dr Richard Simpson. You may have no more than eight minutes, Dr Simpson. [Interruption.]
I am sorry, Presiding Officer. I did not hear how many minutes I had.
You can have absolutely no more than eight minutes—seven, if you can.
This has been quite a good debate; as all members have agreed, it is certainly a very important one, given the demographic issues that are coming down the line. I will not go into those issues in any detail, because members have already put the facts on the record. However, a very important point that has not been emphasised enough is that although life expectancy has increased massively, with a subsequent significant increase in the numbers of older people, the healthy life expectancy that they will experience has grown at a far lesser rate.
There have been two elements to this debate: first, how we have arrived at the current situation over the past few years since the Parliament's establishment; and secondly, the challenge of the future. We all agree that the Parliament has done a considerable amount to improve the lot of our older colleagues through, for example, free personal care, which righted a discriminatory wrong against people with dementia; the central heating programme; concessionary travel; and the many other measures that members have mentioned.
However, as the "Panorama" programme and the Herald investigations that Johann Lamont, Duncan McNeil and others referred to have indicated, we face a very serious problem. Indeed, I would go so far as to say that we are beginning to see in a community care setting the same kind of massive institutionalisation and inappropriate care in an institutional setting that my generation of psychiatrists saw in the asylum depicted, for example, in One Flew Over the Cuckoo's Nest. As members have pointed out, we are in grave danger of warehousing people in their own homes.
The fact is that we should begin to look at these problems when people turn 50—not because they necessarily become older people at that age but because that is when we can begin to prevent some of the problems that might materialise later. Recent Swedish research has shown that, even for couch potatoes, beginning to exercise at 50 can have huge benefits for older people's physical and mental wellbeing.
Many older people want to remain active. Indeed, in many families, it is almost a joke that the 75, 80 or 85-year-old family member goes off—as they put it—"to look after some older person". As Des McNulty has said, we have to recognise that needs change as we get older. Such changes might be rapid or slow, but we must never consider older people as some unitary whole. Their problems must be dealt with on a completely individual basis.
As a result, we need to consider the activity in which older people are engaged and look at allowing and encouraging them to continue in work. We should consider the role of part-time work, for example, in helping older people to manage the sudden move from full-time work to retiral. We also need to consider individual elderly people's aspirations, the skills that they can bring to our communities, their desire to acquire new skills and any opportunities in that respect.
The most important element in creating the necessary resilience in our communities will be volunteering. Unless we see older people as a resource, not a problem, we really will have problems. As a result, it is a matter of considerable regret that, despite a members' business debate and a Labour-initiated parliamentary debate on this issue, the retired and senior volunteer programme has lost half of its development workers, who are the very people who can train and support older people and help to fulfil their desire to contribute. The programme's £350,000 funding is no longer provided centrally but has been given to the local authorities, and the move has resulted in four redundancies out of a staff of nine. That is disastrous for what I am sure the Government wants to achieve, yet the Government has failed to recognise that.
Many members, particularly Robert Brown and Ross Finnie, emphasised the other major change for volunteering, which is that charitable organisations' income has gone down and they are no longer able to contribute in the same way. Organisations such as Lloyds TSB might not be able to make any contribution. We are faced with a funding crisis that has been generated by the banking crisis, and a second funding crisis that has been created by local authorities withdrawing services that voluntary organisations provide. The other day, I spoke to Crossroads Care, which is facing the worst situation that it has faced in the 12 years under the current chief executive. Crossroads is fundamental to the provision of respite care, which supports the carers who then support older people who are in need. We are destroying the system that has been established in the past 10 years. The Government must recognise that and start from that point.
If we want people to remain in their homes, it is absolutely vital that we ensure that our adaptation programmes are adequate. Christine Grahame and Mary Scanlon alluded to that. Adapting people's homes gives them a much better opportunity to stay there. We need to maintain people's independence and provide them with support. As Jeremy Purvis, Robert Brown and others said, we must ensure that people are not isolated. The concessionary travel scheme helps with that, but we must also allow support to be provided in the home.
Members have referred to the fact that the majority of funding goes to the NHS budget and is spent on institutional care and, within that, on unplanned admissions. We can certainly do a lot to improve that situation. Many programmes are being operated. For example, Peter Gabbitas in Edinburgh has a programme of support and rehabilitation for people coming out of hospital. In Lanarkshire, the Monklands integrated discharge and assessment service—MIDAS—does the same and Christine Grahame referred to a similar project in the Borders. There are many projects that aim to enable people to maximise their independence when they come out of hospital and therefore to prevent their return.
As Johann Lamont said, community care is facing a major challenge. There is a retrenchment to dealing with the most serious issues, rather than preventing people from developing those issues. We need continuity and consistency of care. As Malcolm Chisholm eloquently put it, we must ensure that users and their carers are consulted fully. Please, can we get away from the present system of retrenched funding and cutting costs? If we do that, we will improve care for the elderly.
I thank members for a stimulating and useful debate. We hoped to provide an opportunity for Parliament to initiate a long-term discussion on how best to respond to the challenges—demographic, financial and otherwise—that will affect our planning for caring for older people. I think that we have achieved that initial goal. We are also here as a first step towards the wider public engagement that I referred to in my opening remarks, which will take place next year, when we will invite discussion on proposals for change. It is important that we all play a part in that.
I turn to some of the points that have been made, starting with Johann Lamont's comments on voluntary sector engagement. I reassure her that, over the summer, officials worked actively with the voluntary sector through meetings, events and other engagements. We have involved the sector in a wide range of activity on the agenda. The next stage will be the more formal and structured element. The voluntary sector is well aware of what we are doing, but the formal engagement will begin next year. I hope that that reassures Johann Lamont on that issue.
I continue to discuss with the care commission the issue of home care and what has been done to respond to the concerns that were raised in "Panorama". However, I can tell Johann Lamont that the care commission has reviewed its inspection methodology. She will appreciate that knowing what is going on in an individual's home is not without its challenges. The care commission has tried to provide greater emphasis on direct engagement with service users and their families. For example, it has increased the use of lay assessors in inspections, and it has been shadowing care at home. When the commission visits people's homes, its staff spend a lot more time talking to service users. The area is challenging, but I am keen to see what else we can do to monitor what happens in people's homes.
There is concern that services that users and the care commission regard as being excellent are losing their contracts because of a retendering process that seems completely unnecessary because it is not about a new service.
Local authorities have always tendered for services. That has gone on for years. The concern is how they do it. I have always said that procuring social care services is not like buying tins of beans—we are talking about people.
I am sure that Dr Simpson is well aware that guidance on social care procurement was issued in August 2008. However, we recognise the need for further guidance, which is why we are working with carers, users, the Convention of Scottish Local Authorities and service providers, including the voluntary sector, to ensure that we have robust guidance on what is expected. Local authorities have made it clear that they do not believe that methods such as reverse e-auction are appropriate, and they have signalled their intent not to use such methods. That is to be welcomed.
Johann Lamont talked about the important work that is being done jointly with the Minister for Housing and Communities on older people's housing. As other members said, housing is definitely part of the solution. We need to consider how to develop housing options that change with the person—it is almost about future proofing housing so that care services can be built around a person without them having to move to another house. I hope that I can assure Johann Lamont about the importance that we give to housing.
Mary Scanlon raised a number of what were, as always, pertinent points. The area of psychology services for older people is one in which we need to improve. As we develop and expand psychological services, we need to ensure that older people have as much access to those services as other sections of society. I am keeping a close eye on that issue.
Ross Finnie rightly reminded us of the big issue of pensioner poverty in relation to pension arrangements, and the real challenges that face funding bodies such as the Lloyds TSB Foundation. Those challenges are a concern to us all.
I will pass over Ian McKee's Saga comments. However, he made an important point about the balance of risk and independence. Enabling and supporting people to live in their own homes will sometimes come with a risk but the issue is whether that risk is appropriate and proportionate.
Is the minister aware of anxieties among charities that receive money from community planning partnerships and are being told that they have to have match funding? Finding match funding is very difficult because of what has happened to the Lloyds TSB Foundation and others. Does the minister plan to issue further guidance to local authorities and community planning partnerships to ensure that that change is recognised?
We are well aware of the issue of match funding and the concerns that it has caused. We are discussing our response to that as a Government.
Duncan McNeil made some pertinent points, for example on the issue of e-auction, which I have dealt with. He said that the focus should be on supporting people, such as the 69,000 people who receive care at home. That is very much what the whole debate is about.
Malcolm Chisholm raised a number of local issues, about which I am happy to write to him in detail if he would find that helpful. He said that the issue of checks on people is complex. We recognise the issues and we are working with others to try to resolve them. The implementation of the Protection of Vulnerable Groups (Scotland) Act 2007 next year will help with the robustness of the system, particularly in relation to vulnerable adults. We are alive to those issues and challenges.
I must ask you to close please, minister.
Okay. Robert Brown and Des McNulty also made important points, which I am afraid that I do not have time to cover. I am certainly happy to respond to them in writing.
I genuinely hope that in future we can engage on a cross-party basis, in the way that we have done today, as we take forward this issue, which is one of the most important.