Social Care (Self-directed Support) (Scotland) Bill
The next item of business is a debate on motion S4M-04995, in the name of Michael Matheson, on the Social Care (Self-directed Support) (Scotland) Bill. I invite members who are leaving the chamber to do so quickly and quietly. When you are ready, minister, you have 10 minutes.
16:31
I am pleased to open the debate on the Social Care (Self-directed Support) (Scotland) Bill. I thank the conveners and members of the various committees—in particular, the Health and Sport Committee—for their scrutiny of the bill. I also thank the members who lodged amendments to the bill at stages 2 and 3. The committee took great care in considering every aspect of the bill and in challenging, probing and questioning every provision.
In many respects, we have followed the bill’s principles in adopting a truly collaborative approach to framing the legislation. I am sure that Parliament will join me in acknowledging the considerable contributions that have been made by disabled people’s organisations, carers’ organisations, provider organisations and the many others who have played a crucial role in developing and informing the bill.
Perhaps more than most legislation, the bill is a testament to the conviction and detailed work of individuals and groups who work every day to make a real difference to people’s lives. It is their bill as much as it is Parliament’s bill. We are debating legislation that is very close to the hearts of citizens and professionals who are involved in the health and social care sector.
Scotland is a diverse place and we have a diverse people. We should not be surprised when we hear that people want a rich and varied range of options, that they have higher expectations and that they want to shape their own support and lives. In 21st century Scotland, we must adopt a more collaborative approach to delivering our public services. The Christie commission set the benchmark, and self-directed support is one of the many reforms that will help to deliver against that benchmark.
We should consider what the bill means for public services as a whole. In my opinion, it means that we should challenge our services to become much more flexible and creative. It means that public services should have confidence in sharing control and should, when a person wants it, pass control to that citizen—in short, they should respond to people’s desire to shape their own lives.
We should also acknowledge the roots of the bill, which go back to the activism of disabled people who claimed their support to be their own and not a service to which they must adapt.
Independent living is at the heart of the bill. That is why disabled people’s organisations approached the committee to include a general principle on independent living, and it is why I was happy to make further adjustments to that principle at stage 3. However, collaboration involves more than one party, and this is about professionals as well as citizens. The Scottish Association of Social Workers has stated that its profession
“promotes social change, problem solving in human relationships and the empowerment and liberation of people to enhance well-being.”
Self-directed support helps to deliver the core values and principles of the profession—to work alongside individuals and to develop creative solutions to the problems that people face. Indeed, in some respects, the bill helps us to return to the original principles of the Social Work (Scotland) Act 1968—the principles of promoting social welfare and taking a broad and flexible interpretation of what it means.
I move on to the bill’s content. The general principles within it set out the aspirations for care and support and the basis for the collaborative approach between the professional and the citizen. The bill contains a variety of options for individuals to choose, it places a clear duty on councils to give effect to people’s choice, and it imposes further duties on councils to facilitate that choice through information, advice and support. In some respects, that might sound fairly straightforward, but too often that approach has been sidelined as being too difficult and having too many challenges. However, a number of social work professionals, adults, children and carers have proved that it can be done, and the bill enshrines such an approach for all.
We should take a few minutes to reflect on some of the challenges that lie ahead for the sector as it is called upon to implement the legislation. Our regulations and statutory guidance will help in that respect. The guidance framework will help to clarify the limits of choice, and where it is simply not appropriate for choice to be offered. It will seek to provide reassurance to professionals in balancing their duties on protection with their duties to enable and to support. It will also encourage; it will provide practical examples that demonstrate instances in which self-directed support works, which will help professionals to overcome barriers, be they real or imagined.
Of course, the legislation on its own will only go so far. That is why we will develop and issue further regulations and statutory guidance. In addition, the Scottish Government intends to provide a robust and comprehensive framework for monitoring and evaluating the legislation—an aspect that will become more important as we move towards implementation.
We must also remember that self-directed support, important though it is, is only one part of the solution to the challenges that we face in health and social care. In the not-too-distant future, Parliament will consider proposals for greater integration of health and social care. We are implementing a number of strategies across a diverse range of user groups, including strategies relating to people with mental health problems, people with dementia, carers and young carers, people with learning disabilities and people with autism. The legislation forms one part of a much wider strategy to deal with the challenges of an ageing population, increased expectations and pressure on resources.
In choosing to pass the bill, Parliament will play its part in delivering choice and control for people and ensure that there is greater flexibility and creativity across the sector. In short, the bill marks a significant step towards meeting the expectations of those who receive social care now and into the future. I look forward to the debate.
It gives me great pleasure to move,
That the Parliament agrees that the Social Care (Self-directed Support) (Scotland) Bill be passed.
16:40
I associate myself with the minister’s remarks and thank the Health and Sport Committee, which is so ably led by Duncan McNeil, the committee clerks, the bill team and, indeed, the minister himself. Having been on that side of the fence myself, I know the effort that will have gone into the bill. Last but by no means least, I thank the organisations and individuals who helped to shape the bill. We are grateful to organisations for disabled people, carers, children and many more besides for taking a direct and considerable interest in the bill, because it has strengthened the end product.
The bill itself has been a long time coming but, in fairness, the minister has created a degree of momentum in the past year. At its heart, the bill is about choice, flexibility and empowerment and rightly enshrines principles of independent living for adults and children who receive social care services.
As we know, those who exercise choice and control over the services that they receive and how they are delivered get better outcomes—nowhere more so than in terms of provision of social care. At stage 1, I cited the example of a tuck-in service that was provided to an older constituent, who was to be tucked up in bed by care workers between 7 pm and 8 pm. With the exception of Jackson Carlaw, who at stage 1 told us that he went to bed that early, I know of no other adult who goes to bed at that time. That was perhaps more an illustration of the needs of the service being the determining factor, rather than the needs of the individual and how they want to live their lives. Self-directed support turns that experience on its head—and rightly so.
Of course, as the minister made clear, the local authority will offer four choices: receiving direct payments, where people will be given the money from which they can meet their needs directly; directing how the local authority arranges services on a person’s behalf; continuing with current local authority support; and a mixture of all three. Although direct payments have been available for a while, take-up remains low. In 2001, only 207 people accessed them; by 2011, the figure was 4,392. There is clearly scope for many more direct payments to be made.
I also want to look wider than social care. After all, self-directed support sits in the wider context of the personalisation of services—a concept that was first advanced by the previous United Kingdom Labour Government very much in consultation and partnership with disabled people. Essentially, personalisation recognises that different things shape people’s lives. We are not simply defined by our condition or by the care that we receive; education, housing, employment and transport all contribute to how we live our lives. The Scottish Government itself recognised as much when it set up the direct payment pilots in the national health service for that small group of people with health and social care needs. Although I understand that the Government is reluctant to go down that road at this stage, the issue will undoubtedly return with the advent of the integration of health and social care.
If we honestly believe that outcomes benefit as a result of direct support in social care services, we must surely believe that similar benefits can be gained in the limited circumstances in which people’s health and social care needs merge. I hope that the minister will discuss the issue further with all of us in the chamber to ensure that we can truly create transformational change for people.
A number of amendments were moved this afternoon with varying degrees of success. Some were supported by the Government; others were not. Nevertheless, I recognise that the Government has moved the bill on since its introduction, and I am grateful to the minister for that.
Touching briefly on certain amendments, I think that, with regard to the debate about whether to charge carers for services, Parliament needs to decide whether we believe that carers should be treated in the same way as care providers. Of course, the second test is whether there is evidence to suggest that spending our money in such a way has a clear benefit. All of us, including the Government, regularly state that carers save the state £10.8 billion each year simply by caring. By comparison, the amount that we would spend on them for respite and training would be absolutely tiny. We should invest in order to save, and to enable carers to do the job of caring that they do so well.
I welcome the minister’s commitment to introduce regulations that will waive charges for carers. He has come to the process slightly late, if I may say so, but I am delighted that he has. Although I believe that the power to charge and the power to introduce regulations lies in the 1968 act, and that there is no need for section 16, the bottom line is that the minister will create those regulations and create change.
However, I urge the minister to be quick. As matters stand, local authorities currently charge; section 16 tells them that they can charge if they want to and, as local government is genuinely shouldering a burden of cuts, authorities may be forced into the position of having to apply charges. Speed is therefore essential.
I ask the minister to bring some clarity to the issue in his closing speech. Is he simply limiting the waiving of charges to those who are in receipt of self-directed support for carers, or will it apply more widely? I welcome the wider debate about the role of carers and charging, and I am clear that the power that the 1968 act gives the minister allows him to direct local authorities in all charging that is associated with social care—not just direct payments. Can he therefore advise members on the scope of his intentions with regard to future regulations? He will be aware that there are still concerns about the postcode lottery in care charging, which must be addressed.
I will touch briefly on advocacy. Although the bill extends choice and control so that there is greater direction over how support is provided, there remains a need for independent advocacy. I recognise that that will not be required for all, but it is nevertheless essential for some if we want the bill’s provisions to be realised.
On regulation of personal assistants, it is incumbent on Parliament to recognise the needs of all and to balance the opportunities that the bill presents with the risks. Those risks may be small, but if the Government’s own agency believes that in limited circumstances personal assistants require to be regulated, we must consider that.
There is much to welcome in the bill, and overall it is a good piece of legislation. If it has the transformational effect that we believe it can have, we will have positively changed the landscape of social care in Scotland. For that reason, I am happy to support the bill.
16:47
I place on record my thanks to the Health and Sport Committee clerks, the bill team and the Scottish Parliament information centre for their advice and support to committee members throughout the bill’s progress. I acknowledge the valuable input from the city council carers and users of social care services in Glasgow, whom we met during our informal visit to the city in the early stages of our information gathering, and I thank all the many witnesses who gave written and/or oral evidence to the committee.
I pay tribute to the various organisations and individuals who suggested at stages 2 and 3 amendments that they believed would strengthen and improve the bill, some of which will be included in the final version of the bill that we will vote on at 5.30.
The bill is popular and its general principles have been widely accepted throughout Scotland. It will introduce legislation that, if it is properly implemented, will embody the principles of independent living for everyone, giving all citizens the same freedom, choice, dignity and control in their lives at home, at work or in the community, and empowering those who use self-directed support to participate in society and live a full and ordinary life.
The bill’s essence is the intention that people should achieve true independent living, and the focus must be on what the system enables the individual to achieve, not on the system of support. There are high expectations that the bill will allow individuals who require social care to maintain a good quality of life and to fulfil their potential.
Today we have set out the framework, which will have to be fleshed out by guidance and regulation. The key to success will be how the bill’s provisions are implemented across local authority areas by councils and by independent and voluntary sector providers.
We heard as a committee that the changes that are required to ensure the policy’s success will be seismic. Some local authorities will be well prepared in areas such as creating individual budgets around packages, decommissioning group services and embedding the concept of self-directed support in their procedures. However, a culture change will be required, which some councils will find more difficult than others.
It will therefore be important to oversee the implementation of the policy and to impose sanctions on any councils that are deemed to be failing. There will be tensions, as a public sector that is used to providing services for users must accept that council-run facilities may not be what the user wants, and that, as an alternative marketing service develops, it must give more choice to service users. The commonly cited example is that facilities such as council-run day centres might wither on the vine if they are not what service users want and they therefore become financially unviable.
Undoubtedly, there are still concerns about the funding of social care packages. For example, where direct payments are made, they may attract less money, while those who opt for local authority provision of social care receive more. At a conference on taking the next steps in delivering self-directed support, which I attended last week, the local authority representatives were in no doubt that that happens in a number of council areas. They felt that the bill does not go far enough to put a stop to that, and I know that they will be disappointed that Richard Simpson’s amendments on that were not accepted by the Parliament today.
There are also concerns about the failure to include in the bill a right to independent advocacy, and I am not sure that the Government has that one right. Children’s welfare organisations, such as Barnardo’s and Children 1st, are concerned that the bill focuses much more on adults than on children, even though it will have a significant impact on the type and kind of services available to many children and their families. The children’s welfare organisations were particularly keen to ensure child protection and safeguarding by seeking a system of registration and regulation of those who might be working either directly with children or with adults who live with children under 16 in the home. That was one reason why I supported Jackie Baillie’s amendment on personal assistants, even though the amendment was not popular with a number of the disability groups.
I do not think that the bill is perfect—legislation never is—but I think that, overall, it will be of significant benefit to those who are assessed as requiring social care. Provided that self-directed support is perceived by councils not as a cost-cutting opportunity but as a chance to provide greater independence and a better quality of life to service users, I think that the bill will be warmly welcomed across Scotland. However, its implementation will need to be carefully monitored. With that, I can say that the Conservative group will vote for the bill at decision time.
We now turn to the open debate. Time is very tight, so members have four minutes maximum. If members can speak for a shorter time, I might get everyone in.
16:51
I echo the thanks to the minister, his team, my fellow committee members and all those who gave evidence to the committee, who have helped to shape and improve the bill.
I will reiterate what was said during the stage 1 debate about empowering those in need of care. A few of us mentioned then the evidence that Margaret Cassidy gave to the Health and Sport Committee. In the limited time available to me, I want to ensure that I put her views on the record again, because what she said is so powerful. When asked what life was like before personalisation and before she could direct her own budget, she said:
“It was so-so. I will tell you a wee thing. One time I wanted milk and the woman who was helping me said that that was not her job. I was only asking for a pint of milk, but she said, ‘By the way, that’s not my job.’ I said to her, ‘What is your job?’ We had a falling out and I told her, ‘There’s the door. Don’t come back.’”—[Official Report, Health and Sport Committee, 29 May 2012; c 2358.]
Margaret Cassidy now has a personal assistant and is doing wonderfully because she is directing the resource for her care that best meets her needs. That is what self-directed support is all about.
Following today’s stage 3 consideration, during which we had constructive engagement—and some disagreements—on the best way to improve the bill, it is important to remind ourselves that we are all travelling in the same direction. The bill has been improved—not always in the direction that some would have wanted—but I think that we can agree that it has been improved. Putting to one side my amendments, which were agreed to, I listened with interest to what Jackie Baillie said about charging. I think, however, that we all welcome the proposed regulations. If the minister is correct—and I believe that he is—we will be in a far superior position on charging when the bill is passed than we were beforehand. That is what legislating in this place is all about.
We have reinforced the principle of independent living and we now have greater transparency on the cost of the various options for self-directed support and the cash that follows that cost. That may not be in the way in which Richard Simpson proposed, but the Government has moved to improve the process. At every step of the way, the Parliament has come together to improve matters.
However, we will need to ensure that the changes that we are proposing sweep through every local authority in the country and that we back the culture change that will be needed in local authorities to make the bill work. For example, in my local authority—I do not always agree with what Glasgow City Council is doing, but in making this point I am talking about not self-directed support, but the local debate on the best way in which services should be delivered—the personalisation budget for those who would receive a resource allocation under self-directed support has been cut by 20 per cent. I have consistently disagreed with that, but it was a local political choice; it is not connected to the principles of self-directed support.
If members do not like what is happening in their local authority areas, they should challenge that and fight to improve the situation to make self-directed support work. However, no action that a local authority takes will undermine the principle of empowering people through self-directed support.
The other night, I promised a constituent who came to my surgery that I would mention the reform of day centres for adults with learning difficulties that is taking place in Glasgow. The reform will reduce the number of day centres from seven to four. That is a move away from the traditional service, but my understanding is that there was no consultation at any point with the clients who use the day centres and that the centres are to be closed, possibly as early as January. If self-directed support is to mean anything in service redesign, there must be consultation with service users to find out what type of service they want.
To return to the bill—
I am afraid that you must close.
In my last six seconds, I will just say that the bill will be a step change in empowering people across Scotland.
16:55
As convener of the Scottish Parliament cross-party group on carers, I am glad to have the opportunity to speak about this important bill. I hope that I will shed some light on the carers’ perspective and put down some markers for the future.
I have listened carefully to the views of kinship carers, carers and young carers through, for example, the Midlothian kinship carers group. This Friday is carers rights day 2012, the theme for which is getting help in tough times. The Princess Royal Trust Lanarkshire Carers Centre is holding a drop-in day in my regional office, and I know that other members will support the theme that carers should know what their rights are. That is only part of the story; the other part is ensuring that carers have rights and respect across Scotland.
As highlighted in “Caring Together: The Carers Strategy for Scotland 2010-2015”, carers should be seen as “equal and expert partners” in the provision of care. The cross-party group on carers has talked through and fought on many issues. Many members have supported carers’ concerns, not least Bill Kidd and Johann Lamont, who are previous conveners of the cross-party group.
The bill will provide local authorities with the power to provide such support, rather than a statutory duty to do so. At present, a discretionary power is the only workable option, because of the uncertainty over costs and many other issues. However, it is disappointing that the Scottish Government has had years to cost the implications of a duty. I ask the minister to consider bringing the issue back in future and to address the possibility of that in his closing remarks. As convener of the cross-party group on carers, I challenge all local authorities to provide the high-quality services that are needed without a specific duty to do so in the bill.
There is already good practice in some local authorities. One key recommendation of the 2010 Carers Scotland report, “Sick, tired and caring: The impact of unpaid caring on health and long term conditions”, was for free or concessionary access to leisure services, as many carers found the cost prohibitive. Not all local authorities specify the carers allowance in the range of eligible benefits. Glasgow does so, whereas North Lanarkshire does not. That simple and not very costly support for carers should surely be available Scotland-wide.
I turn to the issue of carers employment and associated training. In many situations, people want only small amounts of care, such as two hours a week to drive a person for whom they care to an activity and home again. As it can be difficult to employ someone for such a small number of hours, particularly in isolated, rural or island communities, I am sure that members will agree that in many circumstances close relatives are ideally placed to do that type of work. With high-level disabilities such as autism, the advantages of having close relatives as carers can be valuable. People with autism require their carers to show consistency and understanding of their routines, and family members can be well placed to provide that. I hope that members will join me in welcoming the provision on that in the bill.
Training for unpaid carers should be supported by local authorities. I look forward to hearing from the minister what the clear guidance will be on the issue. Can the minister also confirm that any provision of self-directed support to an individual carer will be kept separate from the provision to the person whom they care for, as that is crucial for the wellbeing of carers?
My colleague Jackie Baillie’s amendment to leave out section 16 did not receive the required support but I, along with many carers organisations, will look carefully at what seems to be a rather last-minute agreement by the minister to introduce regulations on the issue. I hope that the consultation on that will be produced in the near future.
17:00
It has been just over two months since we debated the bill at stage 1. I am pleased that, over that period, the Scottish Government has taken on board a number of the issues that were raised during that debate and the subsequent stage 2 proceedings.
The bill’s main aim is to give more of those who need to be cared for the independence that able-bodied persons take for granted. By ensuring that that principle is adhered to, it is hoped that those with disabilities can be better included in society and that they can have greater responsibility for securing the care that they require to function. Giving them control over the financial side of the equation allows them such responsibility.
There are currently two options for receiving support that are available to people with disabilities. Direct payment involves the local authority paying the supported person directly, who then spends the money on the support that they require. We also have the more traditional method, in which local authorities are given the responsibility for selecting the required support and make payment without the direct involvement of the supported person.
The bill aims to strengthen both those methods while offering further options. In some cases, people would generally feel more confident if they could choose the support that they receive, without being burdened with having to deal with the financial side of the equation. The bill offers that possibility to people while recognising that individuals have different support needs, which is why I am pleased that the fourth option is a mixture of the three options that have already been set out.
My main concern during stage 1 was that a situation could arise in which those in receipt of support could face the prospect of having undue pressure put on them to employ a family member. That could, of course, result in the removal of a better qualified individual who already offers support in place of an unqualified family member. A further concern was the emotional stress that someone may come under were they to feel that they needed to replace a family member with someone who is qualified, which is something that could cause a great deal of stress to the individual.
I particularly thank the Government for taking those concerns into consideration and for producing legislation that has the right balance. The bill offers support to unpaid carers across Scotland. Those unsung heroes in our country must be praised for the work that they put in. The Government is approaching the matter in the right way.
There has been some concern about the charges for carers that local authorities would be able to levy under section 16 of the bill. The Government’s proposals will be clear about restricting charges that can be levied on carers. I am pleased that the Government will issue regulations that will make it clear that all charges for support to carers should be waived in full. Crucially, that recognises carers as providers of services to those they care for. If the Government did not retain section 16, there would be no legal basis on which to make such regulations, and carers would be left in the same position as they are in right now.
I beg members to support the bill.
17:04
I thank the Health and Sport Committee for its useful report and the interesting discussions at stage 2. Most of all, I pay tribute to the many organisations that gave written or oral evidence and that also sent us very helpful briefings.
As the minister said, independent living is at the heart of the bill, and the principles of freedom, choice, dignity and control underlie that. I therefore particularly welcome the minister’s additional amendment to section 1A to facilitate the principle of the person’s right to participate in the life of the community. Many organisations already aim to do that. I pay particular tribute to the Lothian Centre for Inclusive Living, which I visited recently and which has supported people to take control of their lives and live independently. I saw LCIL’s living and work choices course in action, and took part in it. LCIL illustrates in practical terms the principle that underlies the bill. I am pleased that local authorities are being obliged to facilitate that principle.
Although the bill is absolutely right at the highest level, there are still concerns. In particular, there are concerns that the policy could be used as a cost-cutting exercise. That was the reason for some of Richard Simpson’s amendments this afternoon.
There were, of course, disappointments around some of the amendments that failed this afternoon. I spoke in the advocacy debate, so I will not repeat the points that I made then, except to say that I believe that the minister’s amendment is particularly weak, given that 50 per cent of local authorities provide a service only to those statutorily entitled to it under the Mental Health (Care and Treatment) (Scotland) Act 2003. I hope that some action will be taken to ensure that local authorities expand that provision.
I will not rerun the debate on charging carers, although I was struck by the way in which the minister gave detailed explanations that were not produced at stage 2. I have some concerns about that, because it is difficult for members, at the very last stage of a bill, to judge what a minister is saying in such technical detail. I urge the minister and his colleagues to ensure that that level of technical information is presented at stage 2 in future, so that members can consult the details of the 1968 act—or whatever else it is—and see whether what the minister is saying is convincing. In the stage 2 debate the minister said:
“Section 16 is largely a technical provision”.—[Official Report, Health and Sport Committee, 30 October 2012; c 2943.]
That is certainly not what he said today, so I was quite unprepared for the information that he provided, and in that sense was forced to vote blind, although obviously I was guided by my able front-bench colleagues, who were very persuasive in their contributions.
The issue of regulation was quite contentious. What struck me was the common ground between proposals from the Scottish Social Services Council—which I was attracted to for most of the time that I was looking at the bill—and what organisations representing disabled people in particular are saying, such as, “Let’s have training of personal assistants,” and, “Let’s support personal assistant employers to recruit safely.” There is a lot of common ground on the issue of training. I hope that a great deal of emphasis will be put on that because it is quite important, and is central to making the legislation work well.
I welcome the legislation and will follow closely how it works out in practice.
I apologise. I can give the next two members only two minutes each.
17:08
The bill presents an important step forward in providing adults and children, including carers and young carers, with more choice and control over how their social care needs are met. Informed choice and collaboration are two of the key principles behind the bill, which will allow individuals to decide exactly how much control they want and will remove the current default in which local authority-arranged services are assumed to be the norm.
The bill will also enable care packages to be tailored more closely to individual needs and will, I hope, address the low and varied take-up of direct payments that we have seen over the past few years. The Christie commission was right to highlight that further action is needed to increase uptake of self-directed support. The bill is important, but Christie also emphasised the need to build awareness to encourage participation.
I welcome the new right for carers to receive self-directed support, which will allow carers to exercise the same control and choice as other service users in directing their own support in whatever way they wish. However, as I argued earlier when I moved my amendments, that right will apply only if a local authority decides to provide carers with the support that they have been assessed as needing. I hope that the Government’s decision to oppose my amendment 34 will not result in inequality of service provision across the country—perhaps a postcode lottery.
At stage 2, my colleague Alison McInnes raised concerns about the provision in the bill to allow the supported person to change their choice of self-directed support. Since stage 2, that issue has been looked at closely and will now be addressed through statutory guidance.
Although I believe that my amendments would have strengthened the bill and supported carers even more, the Liberal Democrats will support the bill at decision time.
17:10
I thank all the organisations that took the time to meet me or to contact me through email, Twitter or Facebook to give me their thoughts and concerns on the bill. It is clear that there is major interest in self-directed support, and I was pleased to be able to make a small but not insignificant change to the bill at stage 2. I thank Barnardo’s very much for its help in drafting the amendment that was successful.
As my time is limited—for fully understandable reasons—I will focus on the issue of carers. I, too, am a member of the cross-party group on carers and believe that carers have a vital role to play. The bill puts the individual very much at the centre of the process and allows for a much greater degree of personal independence, but we should not forget the important role that carers play, often in situations in which the individuals whom they help may not be able to exercise their choices. It is clear from everything that the Government has said in its strategies that carers are a fundamental part of the process.
I have seen at first hand the experience of carers prior to and following this Government coming to power, and I think that the shift in the prioritisation of carers has been quite dramatic. I look forward to the minister bringing forward the regulations, and I welcome the assurances that he has provided on charging in relation to carers. The regulations will be of critical importance, and I and my colleagues—and, indeed, carer organisations and individual carers—look forward to scrutinising them and discussing them in more detail.
We come to closing speeches.
17:12
This has been a well-informed debate on a bill that has commanded widespread support across the country. It is generally accepted that genuine independent living for every citizen is a goal that we should be aiming for in a fair 21st century Scotland, and that the Social Care (Self-directed Support) (Scotland) Bill provides the legislative framework for that to happen.
No voices were raised against the principles of the bill, and the amendments that were lodged in the later stages of its parliamentary progress were aimed at strengthening some of its provisions to ensure its robustness as a piece of legislation. Not all those amendments were accepted, but they were given a fair hearing, and the Scottish Government appears confident that their aims can be satisfied within guidance and regulation.
There are high expectations that the bill will bring greater freedom, choice, dignity and control to individuals who require social care to maintain a good quality of life and to fulfil their potential. The system of direct payments that has been in force in recent years has not had in Scotland the success that was hoped for when it was introduced, with some local authorities preferring to continue with their traditional role of provision, rather than to free up users to purchase the care services that they feel would be best suited to their needs.
I remember when I was a councillor in Aberdeen that there was a degree of reluctance in the social work department to encourage the use of direct payments, and a slightly paternalistic attitude that the professionals knew best what was in the best interests of their clients. However, time moves on, and there is now a recognition that recipients of care know best what suits their lifestyle needs and that, with appropriate assistance, they can live a pretty normal life, earn a living, contribute to their local community and have a social life like other people. Whether that assistance is blow-drying their hair, which Pam Duncan of the independent living in Scotland project finds very useful, filling in job application forms or helping with bus travel, which Omar Haq’s personal assistant does for him, or even being an escort and companion at a football match, which was a commonly cited example, the freedom to purchase care that suits personal needs is supremely liberating for many people with assessed social care needs.
Achieving the goals of the bill will undoubtedly require a change in culture in our local authorities, and that will be difficult and will take some time. It will take more time for some councils than it will for those that have already set out on the road to freeing up their clients, but in the interests of the many people who would benefit from the provisions of the bill, it is important that those local authorities that are lagging behind catch up, and that the implementation of the legislation is carefully monitored.
As we have heard, there is an enthusiasm to make the bill achieve its goals—within councils and within the voluntary, private and third sectors—to try to secure genuine choice of provision for those who are assessed as requiring social care, as well as their carers and families.
Like other members of the Health and Sport Committee, I have enjoyed engaging with the many people who have shown an interest in the bill and I am full of admiration for how they have communicated freely and openly with committee members—particularly the service users and carers I mentioned previously who took the time to speak to us in Glasgow.
I am sure that there will be issues along the way as the legislation beds in but the will is there to make it work and I hope that we have strengthened the bill, to some extent at least, as it has gone through Parliament. I have felt from the outset that it will not reach its full potential until we have integration of health and social care in Scotland and I look forward to seeing the details of the proposed legislation on that.
I look forward to the bill being approved this evening, to its implementation in the months and years to come, and to the freedom of choice that it should make possible for all those who require social care.
17:15
I thank colleagues, the minister, the bill team and, crucially, the many organisations involved across Scotland, for the critical but collaborative approach that has been taken to the bill.
Self-directed support is not new, but the bill moves us further down a pathway of respect and dignity for those who require support, giving them control in so far as they may wish to take it. Supporting independent living should reflect the principle that a partnership of collaboration between the user and the professional is central to how we wish to take things forward.
Self-directed support has been in place for a number of years—since about 1996. However, as Jackie Baillie said, the number of people who have availed themselves of that option in Scotland has been quite small; uptake has been about half of that in England. There has been a perception that some Scottish local authorities and some social workers have been quite reluctant to encourage SDS.
The bill will not in itself change the culture; many subtle and some not-so-subtle pressures to retain direct local authority services could remain. The not-so-subtle pressures should be transparent—as my amendment tried to make clear—to ensure that any discrepancy between payments under the various options is justifiable and, more important, can be monitored. I hope that the Government will require local authorities to record the variations and that the inspectorate will be rigorous in examining why there are differences.
The bill has been amended with regard to children and young people and the minister’s amendments in that respect have been welcome.
We have not been able to reach agreement on independent advocacy. We all believe that it is important. The minister clearly believes that the provision of information is sufficient, but as many members have pointed out—Nanette Milne, Malcolm Chisholm and others—availability of independent advocacy services is patchy. It will fall to the minister to ensure that the wishes that he has clearly expressed are followed through in every local authority.
Carers remain critical to all aspects of support for those with disability and, as Claudia Beamish said, they should be equal partners. The fact that carers are still not assessed in large numbers is worrying, but the minister’s announcement that he will take forward a number of aspects of that is welcome—particularly his comments about promoting preventative work because the threshold for support is often far too high. However, there is a continuing need to ensure that where carers play a significant role, detailed emergency plans are in place so that care continues without additional stress in the event of a carer being incapacitated.
The issues around charging have been debated and we await with interest what the minister brings forward. I would be grateful if he would give us some indication of a timetable for what he proposes with regard to charges because the unfairness that already exists in community charging, with huge variations across councils, is—for us, at least—a worry. The charging of carers for some aspects of their work would be important. There clearly needs to be a balance between localism and national aspirations, which will not be easy. I look forward to further enlightenment on that from the minister in his closing speech.
One of the problems with individuals is that they do not always fall into neat categories. Those who have a defined incapacity within the Adults with Incapacity (Scotland) Act 2000 or the Adult Support and Protection (Scotland) Act 2007 should be protected. However, those who are not vulnerable should be given the freedom to act to maintain their independence within the requirement of prudent expenditure of public money. That prudence should not be prescriptive and many members have given examples of what can help.
A holiday may sufficiently improve a person’s mental health and wellbeing to make a big difference. Unorthodox measures can improve self-confidence and be a highly effective use of public money. Riding for the disabled in my constituency is just one example, and gym membership is another. Other members have given other examples. We need to support the individual’s wishes about how they want to use their money. That is important.
The Law Society of Scotland’s concerns about the risk assessment of those who are involved in providing assistance remain. The amendment on that was rejected today by the Government party, but we need to look at that, perhaps in terms of regulation. The minister also declined to take the powers to regulate on personal assistants. It should be remembered that we did not say that he should do so immediately; we said that he should take the powers to do so in the future. The minister suggested that they are already available, but I am not sure that they are. It will be interesting to see how the organisations respond in the debate on that. I hope that he is correct.
As Malcolm Chisholm said, many organisations that represent disabled persons think that things such as the training of personal assistants are desirable. That part of regulation is important. After all, protecting vulnerable groups schemes are not compulsory, and people may be persuaded not to proceed down that line by someone who is overinfluencing.
To conclude, the bill will help to ensure that the legitimate aspirations for flexible support of those with a disability are achieved. The independent living movement has been very supportive in helping us to get a useful bill, which is a further step in a continuing journey that began with the Social Work (Scotland) Act 1968 and the Disability Discrimination Act 1995, and which will progress the changes in society’s attitudes to disability. Those changes were given glorious expression in the support for the Paralympics.
We commend the bill and look forward to the post-legislative scrutiny, which may be particularly important to ensure that all our hopes are fully realised.
17:22
I thank all members for their contributions in the debate, which has been considered and thoughtful. There is a clear sense of cross-party support for this important piece of legislation. From stage 1, when the bill’s scrutiny process started in the Health and Sport Committee, right through stages 2 and 3, there has been a real and genuine desire across the parties to make further improvements to it, and the bill that we have at the end of the process is better than that which was introduced in Parliament in February this year.
I started out in my career in a health and social care setting around 20 years ago. I know that many people will be looking at me and thinking that I could not have started my career then. [Interruption.] I hear noises of approval from Jackie Baillie, which I am particularly surprised about. There was a culture that we should give people much greater choice about how their care should be provided, but the choice was very constrained. It was defined by the local authority and the professionals.
Direct payments were introduced, but uptake of them has been very slow over 20 years. I think that there has been resistance at times, which professionals and local authorities can often create, to encouraging people to take up direct payments; that resistance is unhelpful, given the way in which direct payments give individuals much greater choice. The bill is crucial to changing that environment and giving people much greater choice and opportunities to make decisions for themselves and to take more control over their lives. We should not underestimate the direction of travel over the past 20 years to get to this point with the bill, where that level of personal control will be provided in a way that simply has not been provided universally before.
The bill is relatively short, but I see it as one that will create considerable change in the way in which care will be delivered to people in the future. It is much more about doing things with people rather than to them, and it is much more based on the co-production model of working with people to find the best solutions for them in managing their care. It is often said that the people who are the experts in knowing what their care needs are are the cared-for people themselves, who know more than anyone else in that regard.
Jackie Baillie raised a point about the use of self-directed support for health. We have had health pilots in Lothian, which have thrown up a number of issues around the way in which self-directed support can be used in that field. We now have a group working on statutory guidance for that area and on how we can take that forward with the integration of health and social care, and how the joint budgets can be used much more effectively. Some of the findings from the Lothian pilots are informing that discussion on how we can shape matters.
Minister, may I stop you for a second? There is an awful lot of chatting in the chamber, and I remind members not to stand with their backs to the chair for any length of time.
A number of members raised the issue of carers charges. I recognise the importance of that issue. The technical provision in section 16 is to provide us with the route to regulate in that area. As it stands, it relates to specific pieces of legislation—Jackie Baillie referred to the provisions of the Social Work (Scotland) Act 1968—that allow us to regulate on areas of charging. Section 2 creates a new area that allows us to regulate in the area of charging in a way that is not available at present. That is why removing section 16 would have left us with the status quo, which is that local authorities could charge if they chose to do so. However, by creating a system, we can regulate the process. It is for that reason that the provision in section 16 was largely technical.
The minister was looking at me throughout that contribution. My point was that that should have been explained at stage 2, because it was all new to us today and we could not judge whether the minister was talking sense or not. [Laughter.]
I do not think that Mr Chisholm was at the committee meeting at which, because of time constraints, we had an abbreviated discussion on the issue. However, in the discussion that I had with Jackie Baillie I intimated that there would be regulations in that area. When it is recognised that someone is wrong, they should just admit that they are wrong. I know that that is hard for Jackie Baillie, but in this instance she is simply wrong. That is why we are taking forward the regulations in this area.
Will the minister take an intervention?
I give way to Jackie Baillie because she has been wrong today and I am sure that she wants to correct the record on that matter.
The minister invites me to be bad, but I shall resist. Does the minister not agree that bringing forward his proposal at this late stage indicates that previously he was not thinking in those terms at all and that the issue was not raised? I welcome the outcome today, but does he recognise that he was encouraged to get there?
No, that is simply not the case. We were always going to regulate in this area. We had to create the provision that would allow us to do so. Today, carers are in a much better position as a result of the actions that we have taken rather than following Jackie Baillie into a situation that would have created greater uncertainty and the possibility of carers being subject to charges.
It is important to recognise that carers have often been dealt with piecemeal, in that issues have been dealt with here and there. As a society, we must look at how we can deal with carers issues much more comprehensively and effectively. I intend to discuss that with the national carers organisations to explore the best way in which to address some of the fundamental issues more effectively in the future.
A point that has not been touched on during the debate is that we intend to make greater provision for individuals to be able to employ a member of their family as a personal assistant. There has been a real barrier to people taking direct payments because of the thresholds that are set around employing a family member only in exceptional circumstances. We intend to produce statutory guidance to allow us to increase the numbers of people who can employ a relative. On the regulation of personal assistants, we already have the powers that allow us to do that, hence there was no reason to agree to the amendment that Jackie Baillie proposed in that regard.
There is strong support for the bill’s general principles and for its aims and objectives. I believe that the bill will command support across the chamber today, because it will make a real change in people’s lives by giving them the power to make decisions and to arrange care in a way that best suits them. I call on members to support the bill at decision time.