Private Residential Care Homes (Accountability)
The final item of business is a members' business debate on motion S3M-3933, in the name of Jeremy Purvis, on private residential care homes accountability. The debate will be concluded without any question being put.
Motion debated,
That the Parliament recognises the vital support for vulnerable elderly people provided through well managed care homes in Scotland; notes the increase in the number of privately managed and financed residential care homes in the Scottish Borders and further notes the role of the Care Commission in ensuring that all care homes in the public and private sector are delivering a high standard of care; also notes that financial mismanagement of private sector homes operations has caused worrying disruption in care but considers that there are very limited statutory powers for the Care Commission and local authorities to scrutinise the financial capability and security of private care homes operations, and believes that it would be beneficial for there to be more regular financial accountability as there is for the standard of care.
I am grateful to members who have supported my motion, which I lodged in advance of what I hope will not be a significant crisis—or, indeed, a crisis at all—in the residential care homes estate for older people in Scotland. The issue is the financial security of the network of care homes. Some care homes are displaying financial difficulties because of the recession or other factors and there have, increasingly, been changes in care home ownership throughout Scotland.
I do not wish to cause unjustified concerns, but I do not believe that there is no issue to be addressed. Cases in the Borders and in my area over the past year have caused concerns about the financial security and responsibility of some private sector care home operators. I know that there are also such concerns in East Lothian. That said, I know of outstanding private care homes that operate to the highest standards with the best management, and which are led very well.
I declare an interest in that I have a 98-year-old grandmother in a local authority-operated residential care home in the Borders. Such care homes are in the minority. In March 2008, there were 765 registered places for older people in residential care homes in the Borders, 448 of which were in the private sector, 207 were in local authority-operated care homes and 110 were in the voluntary sector. The proportion is higher in the Midlothian part of my constituency. Across Scotland there were, at that time, 942 care homes for older people, 623—two thirds—of which were privately owned.
The trend is that the number of places in the private sector is growing, with a 19 per cent fall in local authority places. Overall, the trend is a reducing number of places, but that does not mask the fact that the number of places in the private sector is growing. Demographics suggest that there will be increasing demand.
My concern is not necessarily the quality of care per se, but the financial security of care home owners and the ability of the regulators—the Scottish Commission for the Regulation of Care or the local authorities that provide funding for places with contractors—to ensure that there is proper transparency in the operation of care homes, and particularly in the operation of private companies and their parent companies and in transactions within them.
Concerns have been expressed to me that some operators have a greater interest in a home's asset worth—in its bricks and mortar, the land that it is on and the developable value of that land—than they have in the value of the provision and the standard of care.
I know that our aim and priority is the provision of the best care. I do not have a view on the right way to provide it or on whether it should be provided by the private or voluntary sectors or by local authorities: indeed, a strong case can be made that a mixed profile is welcome. However, in that mixed profile, there is an imbalance in respect of scrutiny of financial aspects. Under the Regulation of Care (Scotland) Act 2001, the care commission is tasked with the regulation of care.
On financial supervision, regulation 16 of the Regulation of Care (Requirements as to Care Services) (Scotland) Regulations 2002 provides the statutory basis on which the care commission can scrutinise a private provider's financial aspects. The regulations require a private provider to provide the commission, on request,
"with such information … as it may require in order to consider the financial viability of the care service".
That sounds reasonable—indeed it is, but the issue is not whether that power exists; the issue is the use of the power. It is certainly not used routinely or regularly and there is no policy that governs its operation. My understanding is that the power is activated if concerns arise about the standard of care that is being provided. For example, if a building's internal fabric is considerably below par or if there is concern about staffing arrangements in a home, that might give the care commission cause for concern about the home's financial aspects. However, that is different from examining the sustainability and viability of the company that owns the home.
There is an imbalance in the scrutiny of private homes and charitable homes. As I said, a minority of care homes are in the charitable sector, but it seems to me that the strongest requirement in relation to securing financial information from providers is in that sector. The Office of the Scottish Charity Regulator requires every charity to submit an annual return and accounts, as well as a trustee report that outlines what the charity has done over the year and how it has spent money, and highlighting any specific issues. That scrutiny is not about provision of the service—it is about the charity and its financial security. Any financial problems are brought proactively to OSCR's attention annually.
Such a power does not exist for the care commission. It can ask for up-to-date accounts from the owning business, but it does not do so regularly. Last year I had, as a result of several concerns, a meeting with Scottish Borders Council and East Lothian Council. The care commission had told me that it does not have sufficient capacity to regularly scrutinise the financial aspects of companies that own residential care homes. The practice seems to be that the care commission calls in such expertise on a reactive basis, either when there is a requirement under the legislation for an operating plan, or if concerns arise about the provision of care.
There is a template for a national care home model contract for local authorities, which is a good and welcome development. However, the situation with regard to contracts is patchy throughout Scotland and they have no statutory basis. The matter depends on what happens when a contract for the provision of care is signed. Councils have limited statutory ability to carry out on-going scrutiny of the financial security of the provision.
I do not have to remind members about the damage that is caused to elderly residents, many of whom are vulnerable, by the disruption that results from changes in the ownership of residential homes and the care that is provided. I regret that there have been too many cases in which disruptions in care have occurred as a result of financial issues. My concern, which I hope the minister will address, is that we put on a more equitable footing the scrutiny of the financial backing of residential care homes and the provisions on transparency and probity of the owners of homes, regardless of whether they are local authorities, charities or private companies. I hope that the minister will respond positively and that we can make progress on the issue.
Thanking the member who has secured a members' business debate is often more a matter of protocol than anything else, but I genuinely congratulate Jeremy Purvis on bringing this matter before Parliament. Mr Purvis and I do not often congratulate each other, but I think that he made a very well-informed and researched speech that raised important issues not only for the Borders, but for Scotland in general.
In the Borders, about 24,000 people or 30 per cent of the population are of pensionable age. Recently there have been some good moves. In the Peebles area, in particular, £22.2 million of Government funding has been made available to replace Dunwhinny Lodge, which I have to say is a rather grim place. That is not because of the staff; the building is simply old and not fit for purpose. The money will be used to build high-support accommodation and to do up Tweed Bridge Court, which is right in the middle of Peebles and just needs a little bit of work done to it. Such accommodation provides the kind of mix that elderly people want; if they cannot stay in their own home, they want to live in semi-sheltered or extremely supported accommodation.
Jeremy Purvis is quite right: many such facilities are slap bang in the middle of great development opportunities. For example, the privately owned Cockenzie House, which is next door in the East Lothian constituency, was the subject of a campaign that turned out to be very distressing for family members, who wanted it to be retained. The building was in a prime location, and the battle was lost. The elderly people involved—and their families—were in great distress and faced a real crisis, because they had been told that they were going to be moved to various parts of Midlothian, Edinburgh and West Lothian, well away from their family, their friends, their community and the voices and accents that they knew and which kept them in good spirits. As we know, such things have consequences for the health, wellbeing and, indeed, longevity of elderly people.
It was a privilege to be an MSP when the Parliament passed the legislation that introduced what we call free personal care for the elderly, but which I know is not totally free. I notice that that legislation is under review by Lord Sutherland. I know that it is not part of his usual remit, but I wonder whether the Minister for Housing and Communities—and if not him, Ms Robison—can come back and explain to us what will happen as a result of that review. After all, given the demographic projections for Scotland, we face major funding issues that will need to be addressed; in that respect, I credit Susan Deacon for raising that very matter at the time. The legislation is right, but there are huge funding issues that need to be tackled.
I have not done the research that Jeremy Purvis has undertaken, but it is my understanding that, although the care commission does not routinely examine the financial viability of care homes, it looks into the matter before a care home is registered. Perhaps the minister can clarify that issue and tell us whether the care commission will look into the continuing viability of a care home if, as a result, say, of MSPs and councillors receiving certain information, there is any sign that something is going amiss.
What, if anything, can the Government do in the event of real crises such as that which arose at Cockenzie House? After all, by the time that local MSPs and councillors get involved, the matter has gone too far down the track for them to do very much and they find themselves simply firefighting. Is there a point at which provision can be made not only for elderly people, to ensure that they are not parcelled out all over the place, but for the staff, who are also distressed by what happens?
Another aspect of the debate is the cutting of services in sheltered accommodation. For example, Heinsberg House in Penicuik has lost its in-house warden and now has someone on call. However, what is happening is that the elderly person in the nearest flat is answering the front door, sometimes late at night. That is wrong. The same thing is happening in Galashiels, where sheltered complexes—
The member is not only straying from the motion but is over her time. This might be an appropriate time for her to sit down.
You have been extremely good to me so far, Presiding Officer.
I very much welcome this debate. After all, we measure a society by how it cares for its vulnerable and elderly, and sometimes we do not do that very well.
I congratulate Jeremy Purvis on securing tonight's debate. I admit that I am not familiar with the specific case to which he refers, or with the local circumstances in the Borders; I am sure that the member will understand that. I am also unsure whether the problem that he highlights is a local one, limited to the Borders and East Lothian, or whether it is causing national concern. From the information that I have gleaned tonight, it is evident that the problem has not crossed my desk. For that reason, my comments will be general, rather than specific to the Borders.
There is no doubt but that financial mismanagement or irregularities must be taken seriously, but surely that is the task of the appropriate authority. If there is an indication of foul play, mismanagement or fraud, the police should be involved. I appreciate the responsibilities of the care commission, but I am not sure that we should ask it to employ accountants and auditors to scrutinise the finances of private care homes.
I appreciate the difficulty of introducing outside accountants to private businesses, but we are dealing with a very different sort of business. Besides the possibility of illegality in the management of funds, there is a huge possibility of undercapitalisation in homes. Someone must look at that issue, because people are involved.
That is exactly my point; I want to concentrate on that aspect of the motion. However, we should not forget the role of the police and local authorities when allegations are made.
The point of most serious concern in Jeremy Purvis's motion is the "worrying disruption in care" that has been caused. Although any financial problems must be addressed, the number 1 priority must, as Margo MacDonald said, be the standard of care for the residents of our care homes. As Christine Grahame said, in the first session, with Margaret Smith at the helm of the Health and Community Care Committee, the Parliament passed the Community Care and Health (Scotland) Bill, which brought about the national care standards that were revised in 2007.
Today several issues relating to those standards and the regulation and inspection of care homes were raised in oral questions by John Farquhar Munro and Margo MacDonald. The questions related to palliative and end-of-life care, on which the findings are shocking. Fifty-four per cent of services have not trained their staff; 36 per cent of care homes have not assessed services to meet residents' palliative care needs; 43 per cent of care home providers and staff do not recognise that they should deliver palliative and end-of-life care; and 9 per cent of care homes do not even have a copy of the national practice statement. What has the care commission been doing for the past five years? How can care homes with shockingly poor standards—as a result of financial mismanagement or for other reasons—continue to provide care, at the expense of individuals and the taxpayer, with so little dignity and respect for the person?
As Jeremy Purvis said, all care homes should meet the same standards, regardless of whether they are run by councils, voluntary sector organisations, the Church of Scotland, other faith-based charities or private companies. It is the care commission's responsibility to ensure that that happens. I am concerned that the commission is not rigorous enough in encouraging homes and other care providers to meet the standards.
I acknowledge the recent Government and media campaign to raise awareness of the issues. The campaign was much needed, given that only 15 per cent of people were aware of the national care standards. Last year, the care commission published a review entitled "Pressure for change", which confirmed that the commission found serious failings in the standards of care of every care home that it reviewed. However, enforcement notices were served on only 11 of the 62 care homes that were involved in the review. Recommendations may have been made to the rest, but we know that recommendations, unlike requirements and enforcement notices, can be ignored.
I, too, congratulate Jeremy Purvis on securing the debate. We have seen history in the making tonight, with Christine Grahame congratulating Jeremy Purvis in the chamber. I should explain that winding up this debate is not within my ministerial responsibility—I am standing in for Shona Robison, the Minister for Public Health and Sport, who is in Luxembourg dealing with urgent issues related to swine flu.
I do not think that Jeremy Purvis should be apologetic about raising the issue and considering the prevention of a major problem before it happens. Too often, the Government and the Parliament can be left reacting to problems after they have arisen. It is right for members to raise concerns about such possibilities—in this case, the possibility of financial problems in the care home sector—so that we can be absolutely sure that the Government and the Parliament are doing everything that they can to address the issues.
Given the ageing population and all the economic pressures on individuals—particularly those in old age—as well as the pressures on government budgets at national and local levels, it is important that we ensure that the appropriate financial standards are adhered to in our care homes. To develop the point that Margo MacDonald raised, we should ensure that care homes are properly capitalised before it is too late and people end up being moved as a result of a possible closure, caused by financial or other problems.
Given the devastating impact of home closures, would the minister agree that it should be acceptable for the care commission to be able to ask basic questions about whether an operator has any impending financial difficulties in the forthcoming period, whether it be a year or two years, or about whether an operator foresees any changes that could lead to closure? I was going to use the analogy of the Financial Services Authority in relation to banks, but that is perhaps not the best example.
The FSA has perhaps not always been the best at ensuring that such things do not happen. It might be useful if I spell out in some detail exactly what the powers of the care commission are in this regard. As Jeremy Purvis indicated, Scottish Borders Council uses the national care home contract for publicly funded residents. That contract does not currently have a specific clause in relation to financial viability, but it does have a specific clause relating to monitoring, and there are a number of general references to councils' rights to access information for contract monitoring purposes, which enables them to request financial information such as audited accounts.
However, when financial viability concerns are apparent, they are difficult to manage, as a home closure obviously means more distress for people. As far as statutory responsibilities are concerned, I should explain that the care commission has certain powers in relation to the financial aspect of care services, which are set out in regulation 16 of the Regulation of Care (Requirements as to Care Services) (Scotland) Regulations 2002. The care commission seeks information as part of the registration process. Any queries relating to the financial viability of a proposed service are taken up with the applicant. That provision is already there. Failure to provide adequate responses to any queries from the care commission is likely to result in refusal of the application to register. That applies at the registration stage.
I wonder whether there is a record of how often that provision has been utilised.
I do not have a ready-made one, but I am sure that Shona Robison will be happy to write to all members participating in the debate with a detailed reply to that question.
The issue is under discussion. On 24 March, the care commission's strategy and regulation committee considered the issue of financial viability. The committee discussed the implications for the care commission and service providers of extending responsibility to include an examination of on-going financial viability. It was agreed that the care commission needs to set out its responsibilities in a broader context in future. We anticipate that the commission will submit policy proposals to the Scottish Government with a request for endorsement in late May or early June.
I am extremely grateful for that information, which will be warmly welcomed. I understand that Alex Neil is not the minister with responsibility for the issue. Through his good offices, will he stress to the Minister for Public Health and Sport on her return my request that she meet me and councillors from East Lothian Council and Scottish Borders Council? Such a meeting might be part of the process of taking forward the information that the Government will receive from the care commission.
I am sure that the minister will be happy to meet Jeremy Purvis and others to discuss the issues. It might be better to do so after we have received detailed proposals from the care commission.
I stress on the minister's behalf that although there are fairly stringent financial criteria in relation to registration, the potential weakness relates to homes' on-going financial stability and viability. That is the area on which we want to focus additional effort.
On that point, throughout Scotland councils pay higher fees to council-run homes—sometimes £200 to £300 per person per week—than they do to homes in the independent and voluntary sector. Is that acceptable, given that all homes must achieve the same care standards?
Although fees are related to financial viability, fees policy is not the subject of tonight's debate. However, Mary Scanlon raises a valid issue.
Our main concern in the debate is to ensure financial viability, with a view to preventing problems from arising. From what I have gathered in the brief time in which I have been studying the subject, it seems that there are two major potential causes of problems with financial viability, the first of which is a rundown in the number of people in the care home, whatever the reason for that. I suspect that there is a pretty close relationship between the quality of care and the number of people who use a particular care home. I know that that is the case in Lanarkshire and in other parts of Central Scotland. Secondly, I think that care homes in rural areas have a particular problem, for obvious reasons to do with access, because people want to be fairly near their families. Access problems can intensify problems with numbers and, potentially, intensify problems with financial viability.
Jeremy Purvis has raised a valid issue, which the Government, the care commission and the Convention of Scottish Local Authorities are actively considering. As I said, within the next few months we hope to receive proposals from the care commission, which will be considered in depth. I am sure that the minister will then be happy to share in detail the outcome of that consideration with members who have a particular interest in the subject.
Meeting closed at 17:38.