Elder Abuse
The next item of business is a statement by Shona Robison on elder abuse. As always, the minister will take questions at the end of her statement, so there should be no interventions or interruptions.
Yesterday's debate on reshaping the care of older people considered the challenge of providing appropriate and fair care now and for future generations. In doing that, we must focus on supporting people to feel safe and valued. We can and must do more to reduce instances of neglect of or harm to any of our citizens. Elder abuse is a matter of great concern to us all, so any discussion that raises awareness of the issue is welcome. We can debate whether the incidence of abuse of older people has risen or whether a greater focus on the quality of adult care and encouragement to raise concerns about it, along with features such as the recent one in The Herald, are providing more evidence of harm. Whatever the case may be, the point is that one case of abuse is one too many and we must deal with it robustly.
Mistreatment of older people has been a hidden and often ignored problem in society. Whether it involves physical injury, neglect, sexual abuse or financial exploitation, we know that older people often have difficulty reporting abuse. Abuse can lead to a lack of self-esteem and a lack of confidence to report it. We must therefore continue to raise public and individual awareness of the issue. We must promote zero tolerance of harm to those who are most at risk in our society. I am seriously concerned about any instance of abuse that could have been prevented. Although it will be difficult to eradicate completely all cases of abuse of older people, I am convinced that our work on a number of fronts will reduce opportunities for harm and provide a more effective response when harm is suspected.
Partly in response to earlier campaigns on elder abuse, the previous Administration introduced legislation to protect adults who are at risk. We are implementing the Adult Support and Protection (Scotland) Act 2007, which came into force only last October and which has a major role in identifying and responding to adults who are most at risk in society. The act sends a clear message that harm and neglect of those adults is not acceptable. The Herald has suggested that Scotland's older people are suffering record levels of abuse. The basis of the suggestion seems in part to be information about the use of the act—on the number of people who have been identified as being at risk or who have been referred to adult protection committees. Of course, that information was not available before the act came into force a year ago, because it is about activity that was not co-ordinated or recorded in the way that the legislation now prescribes. Awareness of the abuse of older people is therefore growing through activity to address it and through the scrutiny and reporting of abuse.
The act brings about new responses to suspected harm. It gives local authorities and their partners the power to gain access to premises to investigate complaints of abuse and it provides for various orders to protect individuals from harm, including removal and banning orders. The act involves close co-operation between local authorities and the police to address harm. The first biennial reports from the APCs, which will be produced in October next year, will provide good information on progress on implementation. The current informal evidence from local authorities shows many referrals to and from the police.
To date, the act has been backed by funding of £24 million from the Scottish Government to allow local authorities to recruit and train more staff and to establish local adult protection units. Much has been happening at national level, too, to support implementation activity. Multi agency and multi disciplinary training took place during 2008. The feedback from the training and awareness events was particularly positive, with evidence that the materials are being used at local level.
The quality of care, particularly in the private sector, was a major focus of The Herald investigation. We have supported the private care sector workforce initiative, in co-operation with the independent sector, to roll out training in the care sector. The aim is to ensure that adult protection training reaches staff, providers, service users, carers and families in the care home and care-at-home sectors.
Members will be aware of the role and remit of adult protection committees. To support their development, we have put in place a new network of adult protection committees that covers every part of Scotland. I recently met the committee chairs to discuss the way forward. The committees provide new opportunities to share practice and learning and ultimately to help shift attitudes towards older people. All those implementation activities will contribute to reducing the abuse of older people.
The Protection of Vulnerable Groups (Scotland) Act 2007, when implemented, will deliver a system that offers further protection by excluding from working with vulnerable groups those who are not suitable to do so. For the first time in Scotland, the act will introduce a new list of those who are barred from working with protected adults. That is an important step forward in adult protection and very much complements the measures in the Adult Support and Protection (Scotland) Act 2007.
The Herald highlighted the incidence of abuse in care homes, using evidence from the work of the Scottish Commission for the Regulation of Care. As members know, the care commission inspects all registered care services with a specified minimum frequency. Last year, the commission introduced a grading system, which allowed clearer interpretation of the quality of care services in Scotland, thus showing people what they should expect from a care service. With the aim of improving the quality of service, the commission works with care providers to encourage and support improvements. Providers are expected to act on any recommendations, but the commission has a wide range of powers—it can issue statutory improvement notices, impose conditions on a service and, as a last resort, cancel a service's registration, which means that the service will close.
The care commission has reviewed how it inspects care-at-home services to ensure greater emphasis on the people who use them and their families. The commission has increased the use of lay assessors and is shadowing care-at-home staff to spend more time speaking directly to service users. In recognition of the concerns about the commissioning and procurement of social care, we are working with the Convention of Scottish Local Authorities and stakeholders to draft new guidance on the procurement of social services, with a view to publication in February 2010.
Nutrition in hospitals is a major issue for some older people. We are taking forward a comprehensive programme to improve and enhance patient care. The measures include a key role for senior charge nurses with patients who are most at risk; protected meal times; better support from nursing staff for patients who need assistance to eat and drink; and clinical quality indicators for food, fluid and nutrition, which are currently being implemented across the national health service.
We recognise the need to raise awareness and challenge attitudes among the public about adults who are at risk of harm. Our new multimedia awareness-raising campaign on the issue, which runs across television, radio, the internet and print media, encourages people to be alert to and to report abuse. We want the act against harm campaign to reach those who are at risk of harm and those who think that they know someone who might be being harmed. We want to ensure that those who are at risk know that they can take steps to prevent harm. The issue can be sensitive, given that abuse sometimes occurs within the family. It is therefore crucial that we ensure that people can raise concerns in confidence.
We have been running a campaign to raise awareness of the national care standards and the work of the care commission. The campaign, which was launched in June 2008, encourages those who use services and their families to find out more about the national care standards, so that service users get the right quality of care. The final phase of the campaign will focus on people who receive care in their homes and the carers who provide that service.
We are committed to delivering the highest level of health and care services for everyone in Scotland, regardless of their circumstances or age. We are already driving forward a major nationwide campaign to stamp out age-related discrimination through the see the person, not the age campaign.
As I said at the outset, we must focus on ensuring that services and support for older people lead to better outcomes and that older people are valued as individuals and feel safe wherever they live. Yesterday, I outlined our major programme of work on reshaping care for older people. Our dementia strategy will be key to driving forward our commitment to provide better care for people living with dementia and to improve services in all settings. Our carers strategy, which is under development, will look at improving support for carers who play a significant role.
Poor communication between agencies has been a major contributory factor in tragic fatalities and the horrific abuse of vulnerable adults. Multi-agency inspection looks to improve that. Looking ahead, bringing together the functions of the care commission and the Social Work Inspection Agency into social care and social work improvement Scotland will bring a joint focus not just on child protection services but on all services for children and adults. That work will better help to address the findings of inquiries into critical service failures.
I do not underestimate the strength of concern about the abuse of older people. Health and care professionals, family carers and volunteers have provided and continue to provide quality care and support to thousands of older people but, sadly, in too many cases that care falls short of what we expect and demand.
As we focus on anticipatory and preventive care, we will aim to shift not only the balance of care but the balance of power between those who provide care and support and those who rely on it. Abuse of older people, wherever it takes place, is completely unacceptable. It is our collective responsibility to address that. I am happy to take questions.
We have until exactly 10 o'clock, therefore I would appreciate it if all questions and answers were as brief as possible.
I am grateful to the Scottish Government for accepting our request for an urgent statement on elder abuse and I thank the minister for the advance copy of her statement. However, I must be honest and express my serious concern about the complacent tone that it strikes.
In June, "Panorama" exposed evidence of shocking neglect and abuse of older people in their homes, and more recently The Herald confronted Scots with the reality of abuse of far too many of our elderly and vulnerable citizens. Both are to be congratulated on work that deserves but has not received a commensurate response from ministers.
The statement said little of certainty to give confidence to those in our local communities throughout Scotland who are living in fear of abuse in their homes or in care homes. It also said little about what will be done to change those circumstances. What meetings has the minister had with local authorities since June to discuss how services are procured, and what changes have been made as a consequence? What meetings has she had with the care commission to identify what more it will do to protect people, particularly those who do not have family to speak up for them, and what specific decisions have been made as a consequence? What meetings has she had with the justice ministers to decide on action to improve the prosecution rate of those who abuse older people? What specific actions are being taken?
Given the brutal reality of elder abuse with which we have all been confronted, does the minister agree that now is the time for an independent inquiry into elder abuse to identify the extent of the abuse and measures to improve the quality of care to give older people a voice and protection, and to ensure that the justice system will act against perpetrators? Does she agree that an inquiry that will not only signal our concern, as the statement does, but make a real difference to the protection of older people is the right way forward at this stage?
I am disappointed that Johann Lamont thinks that I struck a complacent tone in my statement. What I did was to lay out the comprehensive work that we are doing on numerous levels with numerous partners.
I set out clearly that discussions about procurement with COSLA and other stakeholders are at an advanced level. The fact that COSLA will produce new guidance on procurement in February suggests to me that those discussions, which began in response to concerns that were raised, have taken place over several weeks and months. We are now taking action with COSLA to address those concerns.
I have met the care commission on several occasions. I laid out in my statement that in direct response to concerns raised in our discussions, the care commission has reviewed how it inspects care-at-home services. However, as we said yesterday, when care is delivered in someone's private home, we cannot be in their living room 24 hours a day, so we must think of ways to inspect and monitor care-at-home services as best we can. I assure the member that that is a priority for the care commission. The fact that the Minister for Community Safety is sitting beside me is an indication of his interest in the matter.
I say to Johann Lamont that the forthcoming biennial reports on the implementation of the Adult Support and Protection (Scotland) Act 2007 will be scrutinised and monitored not only by me but by the justice ministers to ensure that the act works in practice, including in the area of prosecution that she mentioned. Informal feedback from local authorities is encouraging. Many cases are being referred not only by the police but to the police, a number of which have resulted in prosecution. That should tell Johann Lamont that a comprehensive array of work is on-going and should reassure her and other members who should support such action.
I welcome measures to address nutrition in hospitals, but I put it on record that I feel sad that the Government needs to tell hospitals how to support patients to get food, fluid and nutrition.
My questions are short and sharp. Is the training that was rolled out in 2008 to all carers and those who manage carers sufficient and extensive enough to help them to identify elder abuse? Will the merger of the care commission with other agencies, as proposed in the Public Services Reform (Scotland) Bill, help to raise standards and address elder abuse?
My final question refers to page 9 of the statement. Is it enough for the minister to say that the Government is encouraging service users and their families to find out about care standards? Should not that encouragement be strengthened, so that the Government gives all people who receive care and their families the right to know what to expect and what the care standards are, so that they know what to do if they feel that the standards are not being met?
On nutrition in hospitals, it is not the case that NHS staff do not want to pay attention to food, fluid and nutrition issues. The intention is to sharpen the focus on nutrition and to ensure that in busy acute wards time and effort are put into that. The importance of the senior charge nurse's role in protecting meal times cannot be overestimated. They should ensure that attention is given to that important area, particularly when it comes to building someone up after an operation or illness.
Training on elder abuse will be on-going. We were keen to roll out quickly information that staff in all sectors required to be aware of the 2007 act and what it meant for them. That training programme will continue.
Mary Scanlon asked whether the new agency, social care and social work improvement Scotland—or SCSWIS, as it has become known—will raise standards. As I set out in my statement, it will allow for far more cohesion through joint inspections of services for vulnerable adults, in the cases that we are talking about. The new agency will be able to examine in great detail where there have been communication failures, which are a problem. Through the merger, there will be opportunities to ensure that such systematic failures are fewer, but where they happen they will be properly investigated.
We cannot force service users to know about national care standards, but we can ensure that those standards are promoted at every opportunity. We have done that through the campaign that I mentioned, and a lot of work has been done at local level to ensure that people, including carers, are given copies of the care standards so that they know about the care standards as far as possible. We will continue to do that where we can, because it is important that people know their rights and what they can expect.
At Hallowe'en, old-fashioned guisers used to be happily anticipated by the elderly, but this week the Caithness Courier painted a rather more worrying picture under the headline "Elderly folk ‘nervous' over trick or treating". The article stated that trick or treating is
"a none-too-subtle means for gangs of teenagers … to torment or intimidate"
elderly people. It even said that trick or treating can be a form of casing the joint, whereby people knock at someone's door and, when they get no reply, they return to burgle the house in the middle of the night when people are asleep. None of us wants to be a killjoy, but will the minister assure me that she will look into that issue and discuss with the police and other appropriate agencies how the problem can be eradicated?
Perhaps the issue that underlies Jamie Stone's question is the fear and misunderstanding between the generations that has developed in recent years. Seeing a group of young people hanging about can sometimes cause older people fear and alarm, simply because it is a group of young people. I am not sure that that was the case 30, 40 or 50 years ago, but it is the case now. Perhaps young people also have a particular view about older people. We are doing a lot of work to try to break down those barriers and change attitudes through our intergenerational projects and our age discrimination campaigns, which challenge people's assumptions. My message around Hallowe'en, or at any other time, is that people should be respectful and realise that certain behaviour may cause fear and alarm, particularly among older people who live on their own. It is worth sending out that message from this chamber.
We come to open questions. We do not have long, so members should ask one question and get one answer. I assure members that if they do not press their request-to-speak button, they will not be called.
Who is involved in ensuring that the Adult Support and Protection (Scotland) Act 2007 is being properly implemented?
The stakeholders who are involved include the Scottish Government and COSLA. As I set out in my statement, we have also worked closely with the independent sector, the voluntary sector and other stakeholders to ensure that we get across the message that the act places a responsibility on not just service providers but the public at large to look out for cases of suspected abuse and to do something about them. In my days as a home care organiser, there was no mechanism to do something when we had suspicions. We now have that, and we need to ensure that everyone knows about it. We are working hard with all stakeholders to do so.
I welcome the work that has been done to produce the new guidance on procuring social care services. However, does the minister recognise that, rather than seeing the action that she describes, we find that the guidance has been delayed by at least nine months? Will she accelerate that work, listen to organisations such as Community Care Providers Scotland and consider adopting the framework approach that is used in England, where care services are not retendered unless they are not performing to the required standard?
I know that Community Care Providers Scotland has raised that issue, which will be debated in the context of a possible stage 2 amendment to the Public Services Reform (Scotland) Bill. We look forward to that further discussion.
Jackie Baillie should remember that new guidance was produced in 2008 in recognition of the issue. However, we felt that more had to be done, given the concerns that were expressed. As I said yesterday, the procurement of social care services is about people, not tins of beans or paper clips. That is the message that we will continue to put across, with which COSLA agrees. Some local authorities have very good procurement practice, but we need to ensure that such practice exists everywhere.
I want to press the minister a little further on the issue that Jackie Baillie raised. I accept that the Government is working with COSLA and others to produce guidelines, but that still means that today, tomorrow or any other day, contracts that have caused much concern could be renewed. Has the minister considered issuing interim guidelines to prevent local authorities from entering into the very worst kind of contract?
The fact that we have been having these discussions and that a spotlight has been shone on some of the bad practice has been a bit of a wake-up call for local authorities. Local authorities the length and breadth of Scotland have made it clear that they do not intend to use reverse e-auctions to procure services in the future. The message is getting through to local authorities. We have to ensure that quality is the predominant consideration. We are in straitened financial times, and we know that budgets will be tight over the next few years, which is why it is even more important to get the quality right, because that can be cost-effective in the long run for not just service users but councils. We will continue our discussions, and I hope that Ross Finnie will be reassured by the guidance that is issued in February.
I welcome the multimedia campaign to raise awareness of elder abuse. However, what actions have been taken to ensure that professionals and the public are aware of the new powers under the Adult Support and Protection (Scotland) Act 2007?
The act against harm campaign, which I hope that members throughout the chamber have seen, is powerful. It is not pleasant to watch, but it gets across the message that people in all walks of life need to be alert to elder abuse. That includes service providers, service users, carers and members of the public who might see something going on with their neighbour that they do not think is appropriate or about which they are concerned. We should send the message today that whatever concerns people have, it is better to report them so that they can be checked out than to do nothing at all. Everyone in this chamber can promote that strong message.
The minister will agree that the care commission is central to addressing these problems. Is she satisfied that downgrading the second inspection of many care homes within any one year is risk free? Is she considering extending the care commission's powers to enforce the care standards using the legislative opportunity of the Public Services Reform (Scotland) Bill? Will she address the problems of the care commission's information technology system, which are wasting the valuable time of many staff?
The care commission's approach involves risk-based inspection. It wants to be able to spend the most time with the services that need the most time to improve. I am sure that everyone agrees with that approach.
The care commission does a hugely important job. It was established by the Parliament to ensure that the level and quality of services are monitored and that action is taken where there are failings in the system. In 2008-09, the care commission issued 134 statutory notices to 84 care providers.
I accept Malcolm Chisholm's point about the IT system. However, despite some of the issues that have arisen, the care commission is doing an important job and we should support it in its efforts.
How have authorities, police and partners reacted to the new powers that they have under the 2007 act? How have they responded to the fact that closer co-operation to address harm is expected of them?
They have reacted very well. I hope to be able to share more information with the Parliament about that in the new year. We have informal information from local authorities about how the act is being taken forward. My message is that there is huge co-operation between the police and the adult protection committees. A lot of action is happening throughout Scotland. We are conducting a survey with COSLA in advance of the first biennial report next October. I am happy to share the results of that with the Parliament once we have them.
The thrust of the minister's response has been on improving monitoring and inspection, but will she look again at improving the rights of individuals who are being cared for, and their families, to make it easier for them to challenge neglect and abusive behaviour?
The whole premise of the act encourages them to make such challenges. The problem is making them feel confident enough to do so. That can be very difficult, especially when the abuse is happening within the family. That is why we need to ensure that people know who they can speak to and how, and that they can do so in confidence. That is the message that all of us can try to get across within our local communities.