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Chamber and committees

Meeting date: Thursday, November 8, 2018

Meeting of the Parliament 08 November 2018

Agenda: General Question Time, First Minister’s Question Time, Motion of Remembrance, Care Homes (South Lanarkshire), Lesbian, Gay, Bisexual, Transgender and Intersex Inclusive Education, Business Motion, Prescription (Scotland) Bill: Stage 3, Prescription (Scotland) Bill, Code of Conduct (Breach), Decision Time, Point of Order


Contents


Care Homes (South Lanarkshire)

The Presiding Officer (Ken Macintosh)

The next item of business is a members’ business debate on motion S5M-14123, in the name of Monica Lennon, on “South Lanarkshire Care Homes Under Threat”. The debate will be concluded without any question being put.

Motion debated,

That the Parliament understands that South Lanarkshire Council plans to reduce the number of its care home facilities; notes that the first phase of these plans includes the closure of McWhirter House in Larkhall and Kirkton House in Blantyre; considers that the proposed new community hub facility at the St Joseph’s site in Blantyre is not a like-for-like replacement and that this will result in a reduction in the number of long-term residential beds; understands that the closure of McWhirter House will leave Larkhall with no council-run care facilities for older people; believes that council-run care provision must remain a vital part of the delivery of residential care for older people and that the ageing population requires a shift in the model of care in South Lanarkshire and the Central Scotland region; recognises that the reliance of the older population on care is likely to increase in coming decades; acknowledges calls that this should be achieved without a reduction in the availability of long-term council care beds and with the support of the community; is concerned at reports that there has not been meaningful consultation with care home staff, trade unions or the communities that are affected by the plans; acknowledges in particular the concerns raised by the GMB, and notes the calls for the SNP administration in South Lanarkshire to halt the planned closures.

14:30  

Monica Lennon (Central Scotland) (Lab)

Ensuring good quality of care for older people who can no longer live at home and who need to live in a care home setting is an issue that should be important to us all, but such provision is at risk in part of the region that I represent.

On a positive note, South Lanarkshire Council has an excellent reputation for the eight council care homes that it operates—in 2016, it was rated the best residential care provider in Scotland by Which? magazine. However, South Lanarkshire Council is under new management, and the Scottish National Party administration wants to close down some of those fantastic care homes. Despite repeated pleas from Scottish Labour councillors, the residents, their families and trade unions such as the GMB and Unison, on behalf of their members who work in the homes, the council is refusing to listen to the case for keeping Kirkton house in Blantyre and McWhirter house in Larkhall open. I see that some of those care home workers and campaigners are in the gallery, where they are joined by Councillor Lynsey Hamilton and the MP for Rutherglen and Hamilton West, Ged Killen. As a member of the GMB trade union, I refer to my entry in the register of members’ interests.

The council claims that the care homes will be replaced by a new facility at the St Joseph’s site in Blantyre. Although it is welcome that the new Blantyre hub will include transitional care beds and services to help people who are able to return to their own homes, it is not a like-for-like replacement. It will not help people like Hugh Brady, a McWhirter’s resident who needs long-term residential care. So, the new SNP administration is making its mark, but not in a good way. It has made a deliberate choice to disinvest in long-term, council-run care, but it has not had the courage to be straight with the public.

In the fight to save McWhirter house, I had hoped that the people of Hamilton, Larkhall and Stonehouse would have found an ally in our constituency MSP, Christina McKelvie, but she refuses to condemn the council’s decision to close the care home. I have written to Christina McKelvie twice to ask her to speak out against the closures and to invite her to debate the matter publicly in the constituency. I congratulate Christina McKelvie on her recent appointment as the Minister for Older People and Equalities. She will undoubtedly be under pressure to toe the party line, but I must ask what good a minister for older people is if she cannot even stand up for the older people in her own constituency—the people who gave her the privilege of being a member of this Parliament in the first place.

Fulton MacGregor (Coatbridge and Chryston) (SNP)

Will Monica Lennon take an intervention?

Monica Lennon

I must continue, because I am struggling with my voice and it is affecting my timing.

The facts support the retention of the care homes. South Lanarkshire’s older population—those over the age of 75—is forecasted to increase, and research anticipates that by 2035, demand for care homes across the United Kingdom will have increased by a third. South Lanarkshire Council is making a dreadful mistake by reducing the availability of long-term, council-run residential care beds. When we have an ageing population and the likely need for care homes is set to increase, we should be doing all that we can to increase the availability of council-run, publicly owned and publicly accountable care. That is why the previous Labour administration in South Lanarkshire set aside £18 million to invest in our care homes rather than close them.

The council says that it wants to support people to remain in their homes for longer. Who would disagree? However, for many older people, staying in their own home is just not possible. I am extremely concerned about the consequences of cutting the long-term bed numbers, especially when delayed discharge remains a pressing problem in our area, with older people trapped in hospital for longer than necessary because of insufficient care availability. That is bad for older people and expensive for the national health service.

The way that the council has managed and communicated the decision has been extremely poor. I am told that some of the staff and the families of the residents at Kirkton and McWhirter’s first heard of the plans in our local newspaper, the Hamilton Advertiser. There are more than 90 members of staff between Kirkton and McWhirter’s, the majority of whom are female and work part time, many with their own caring responsibilities. Simply stating that they will be redeployed elsewhere is little comfort to a hard-working care workforce. There is zero clarity over what will happen to the residents and the staff when the homes are closed.

Stewart Stevenson (Banffshire and Buchan Coast) (SNP)

Nonsense.

Monica Lennon

Mr Stevenson does not represent Lanarkshire, but let me tell him about Hugh Brady, who is 92 years old and who is living with dementia and a number of other health conditions. McWhirter’s in Larkhall is his home. His daughter Anne, who has been tenacious in trying to get answers from the council, has said:

“I have had various meetings with different people, but still I am no further forward with a time-scale”—

Stewart Stevenson

As the member has named me, will she take an intervention?

Monica Lennon

 

—“and what care they hope to provide for my father. My dad has worked hard all his life and it was not an easy step to have him cared for in a home, but he is settled there and very happy. I, like many others, feel let down and I’m losing sleep over what will happen next.”

I have to say, Presiding Officer, there is often a robust debate in the chamber, but it is very rude of members to interrupt when I am reading a direct quote from a daughter who is worried about her 92-year-old father.

There is no good reason for closing down quality care-home beds at a time when we have an increasing reliance on them. The SNP in South Lanarkshire is willing to shut down older people’s care homes rather than speak out against austerity budgets and fight for a fair settlement for the people of South Lanarkshire. I will never stop standing up for my constituents on this important issue, even when others such as Christina McKelvie, wherever she is today, do not seem to have the courage to fight for them. The SNP in South Lanarkshire must start listening to the people and act immediately to save our care homes. [Applause.]

The Presiding Officer

I encourage members in the gallery not to applaud—sorry, I encourage members not to applaud as well, but I encourage people in the gallery not to applaud or intervene.

14:38  

Fulton MacGregor (Coatbridge and Chryston) (SNP)

I can associate myself with Monica Lennon’s comments about her voice and having a sore throat, as I, too, am carrying a cold, but I am afraid that that is probably the only association that I will make with her today.

I declare an interest, in that I was previously employed by South Lanarkshire Council. I believe that that is important, because I have great respect for the ethos in the social work department there. I did not work in older people or adult services, as I spent my 12 years there working across children and families and justice services, but there was always close working between teams. Perhaps most important for the debate is the focus on care in the community, whether in working with families to support children, in steering folk away from custody in the justice setting or in meeting the needs of older adults in their own homes.

That is the key. The motion that Monica Lennon has brought to the chamber shows a lack of understanding of the health and social care system in the very person who Labour says would be in charge of the area if Labour was in government. Thank goodness that we have an SNP Government. There has been a national shift in priority from residential care to care at home, which is universally agreed by all parties and experts to be better for those who are in residential care homes and their families. As we move more people into care at home, the requirement for long-term beds goes down. The important thing is that a proper plan is in place when doing that.

I have spoken to officials at South Lanarkshire Council and I am told that the closure of the two care homes that Monica Lennon has mentioned, which are not up to a sufficient standard to meet Care Commission requirements, will be offset by the opening of a new modern facility locally that will have a mixture of long-term and intermediate spaces.

I heard the issues that Monica Lennon raised about the staff, whom I, too, welcome to the chamber. I hope that the council will work with the staff to redeploy them and achieve a satisfactory outcome for them.

In contrast, the Labour administration in North Lanarkshire Council decided to close Monklands house in Plains—I admit that that is not in my constituency, but in Alex Neil’s—with no plans for the people who reside there, for the staff or for respite care for local people.

In her attempts to play politics with the issue, Monica Lennon would have us believe that the decision in South Lanarkshire was taken to save money, but service users’ wellbeing is the most important factor for any healthcare professional. I truly believe that the politicians who take such decisions base them on the experts’ advice. Let us not forget that the decision was taken not only by politicians but by the equal representation on the integration joint board of health board members.

When deciding whether to advocate for IJBs across Scotland to increase the number of long-term residential care facilities rather than pursue the current focus on getting people back into the comfort of their own homes, we should all reflect on the fact that, for every 10 days that someone spends in a hospital or care home bed, they lose the equivalent of 10 years’ worth of muscle capacity.

This stunt by Monica Lennon is even more embarrassing when we dig a little deeper into the process that led to the decision.

Monica Lennon

Will the member take an intervention?

Fulton MacGregor

I have to finish.

In 2016, South Lanarkshire IJB agreed its strategic commissioning plan, which included the shift of focus from residential care to intermediate care and care at home. Presiding Officer, I am sure that you will be as surprised as I was to learn that the four councillors on the IJB at that time were from the ruling Labour group, and the chair of the board was the Labour deputy council leader, Councillor Jackie Burns.

There are eight council-operated residential care homes in South Lanarkshire. The recent decision by the IJB means that the number will fall to seven.

Monica Lennon

Will the member give way?

Fulton MacGregor

No—I have a lot to get through.

In Labour-controlled North Lanarkshire, there were until last month two council-operated care homes. That figure has just dropped to one. Why is Monica Lennon not lodging motions about North Lanarkshire having one home? To its credit, North Lanarkshire is way ahead of most areas in shifting the balance of care from residential homes to the community.

That said, the Labour Party’s recent decision to remove the automatic entitlement of over-75s to a community alarm—a decision that the SNP and even the Tory member of the IJB opposed—is questionable to say the least. Surely community alarms are an integral part of keeping people in their own homes. For SNP councillors to have to rely on the support of Tory members against Labour in North Lanarkshire is unthinkable. It is right that we want people to stay at home whenever possible, and we should give them all possible support to do so.

This is not a debate that was required. We should work together to make community care as effective as possible and praise our services, which work tirelessly to make that happen.

14:42  

James Kelly (Glasgow) (Lab)

I congratulate Monica Lennon on securing the debate, which is on an important issue for people in Larkhall and Blantyre. The purpose of members’ business debates is to allow members to raise local concerns in the chamber and have the Government account for the decisions that have been taken.

The decision in South Lanarkshire will have an impact on people in Blantyre and, as a Glasgow regional list MSP who covers the Blantyre area, I know that people are deeply concerned about the closure of Kirkton house, which is why campaigners and staff are in the gallery, joined by Ged Killen, the local MP, and Councillor Lynsey Hamilton. People see the impact of having a home based in the Blantyre area that can look after their relatives and friends, and they see the signal that is being sent about the home closing.

The decision has two flaws. First, it is one thing to say that Kirkton house will be replaced with a hub on the St Joseph’s site in Blantyre but, if the hub has 100 fewer units, the care facility will be substantially reduced. The decision is also short sighted. In the past couple of days, a report from the Finance and Constitution Committee and the Fraser of Allander institute budget event have raised the important issue of demographics and Scotland’s growing elderly population, so why is a care facility being closed and replaced with a hub that will have substantially fewer units?

Fulton MacGregor

Will the member also condemn the decision of Labour-run North Lanarkshire Council to reduce the number of its care homes to just one?

James Kelly

I will tell the member what I will condemn: we are in this situation because councils have had to face £1.5 billion of accumulated cuts since 2011. The reason for that is that, every year when it comes to the budget, MSPs such as Fulton MacGregor and Keith Brown press their buttons for a budget settlement that penalises local government and introduces cuts. That is the scandal of this SNP Administration. When we come round to the budget settlement this year, if SNP members have any guts, they will stand up for their communities and argue for a budget that stops the cuts and supports local government.

It perplexes me to see that the minister responding to the debate is Graeme Dey, the Minister for Parliamentary Business and Veterans. Given that this is an important debate on the closure of care homes, why is nobody from the Government’s older people or health teams responding to it? The two MSPs concerned are Christina McKelvie and Clare Haughey—they are part of the relevant ministerial teams—and it is disappointing that they are not here to account for the Government in this debate of all debates, particularly when we have local people and campaigners in the gallery. I do not think that the SNP Government is treating the debate or the issues that it raises properly.

Monica Lennon deserves great credit for raising an important issue. I know, from the strength of feeling in Blantyre and Larkhall, that the campaign will go on. Labour will continue to press the case for proper care facilities and will oppose the closure of McWhirter house and Kirkton house.

Neil Findlay (Lothian) (Lab)

On a point of order, Presiding Officer. I wonder whether you could help me and my colleagues. I think that this is the first time—it is certainly the first time that I have seen it in a members’ business debate—that no minister for the relevant portfolio has come before Parliament to respond to a very serious debate. There are people in the gallery and in the community who are extremely concerned about the closure of care homes in their area. It is a huge discourtesy that a Government minister has not come before the Parliament to take part in the debate and, if necessary, answer questions on such an important issue.

I wonder whether you could help us, and the people who are being done a disservice. Is there anything that you can do to bring the Government here to be held to account for its budget decisions?

The Presiding Officer

I thank Mr Findlay for his point of order. It is up to the Government to decide which ministers to put forward. The Minister for Parliamentary Business and Veterans is, in many cases, responsible for a number of areas; it is not unusual for that minister to respond to members’ business debates.

I call Graham Simpson to be followed by Claudia Beamish.

Keith Brown (Clackmannanshire and Dunblane) (SNP)

On a point of order, Presiding Officer. I seek your guidance. I understand that, these days, members’ business debates are much more like political stunts and much less like members’ business debates than they used to be.

James Kelly said that he condemns the decision of the Scottish Government in relation to this matter, but the decision was taken by a council—in fact, it turns out that it was taken by previous Labour councillors, one of whom is present today. Given that that is the case, why are Labour members allowed to say that this was a Government decision, when it is plain, even from the terms of the motion, that it was a decision that was taken by the council?

The Presiding Officer

That sounded entirely like a point of argument, not a point of order. It is not something for me to rule on.

I call Graham Simpson to be followed by Claudia Beamish.

14:49  

Graham Simpson (Central Scotland) (Con)

Thank you, Presiding Officer—eventually. I thank Monica Lennon for securing the debate. I signed her motion to allow it to get to this point, which is important.

Monica and I were councillors in South Lanarkshire. I was on the social work committee of what was a Labour council, albeit it with support from the Conservatives. At the time, we saw the launch of a project that would start to change the model of care for older people—reshaping care for older people was trialled at Hairmyres hospital in East Kilbride. The thinking behind it was that it is far better to help older people to live independently or to be looked after in their own homes than it is for them to be in a hospital or care home. All the evidence shows that that is better for patients, and it is what most people want. There are also savings to the public purse—but as a result of doing the right thing and not for the sake of saving money.

The pilot, which was undoubtedly a success, started under the Labour council of which I and Monica Lennon were key members. I supported the pilot and, presumably, so did she. The reduction of care home facilities may be happening under an SNP Administration that is proving easy to criticise on many things but, on this, it is continuing a direction of travel that has been some years in the making.

Monica Lennon

For clarification—because there have been a few references to this, including from Fulton MacGregor—does Graham Simpson accept that to date the only votes on these specific care home proposals took place at June’s meeting of South Lanarkshire Council social work committee? That is where the decision was taken.

Graham Simpson

I do not dispute that, but I am saying that the direction of travel started some years ago, under Labour.

There has been a further pilot this year to focus on intermediate and transitional care beds in homes in South Lanarkshire. Fifty-six of the 80 people supported were able to return home, which is impressive. That model, which gives people more choice and control over their lives, can help more than three times the number of elderly people who are helped under the current system of residential care. That has got to be a good thing.

The motion focuses on the closure of McWhirter house in Larkhall and Kirkton house in Blantyre and says that

“the proposed new community hub facility at the St Joseph’s site in Blantyre is not a like-for-like replacement”.

The model of residential care in South Lanarkshire Council care facilities has provided an excellent service over the past 20 years, but the model itself has remained largely unchanged in that time and has not kept pace with changing demand. The new facility would have the potential to offer a service to 261 people who are at risk of hospital admission or who require support to return home post hospital admission—that is three times the number of such people in care facilities. The closure of the homes is just phase 1 of a new model of care; proposals for the next stage are yet to be worked up.

Increasingly, trends show that people in need of long-term care have their needs better met in a nursing home that offers clinical care. Council care homes do not have on-site, 24/7 clinical support. This is actually about increasing choice. In the future, the council will be able to deliver a mixture of residential, transitional and nursing care provision. Transitional care beds were not previously an option.

It is easy to criticise councils—particularly when they are not of our political persuasion; we can make capital out of it—but we must do so for the right reasons. I think that South Lanarkshire Council is on the right track here and, as I said earlier, it is a well-trodden path that started under Labour.

14:53  

Claudia Beamish (South Scotland) (Lab)

I, too, thank Monica Lennon for bringing the motion for debate.

We urgently need investment in our social care system. As we all know, demographics are changing: people are living longer and the population is aging. Because of that, and in the face of a decade of SNP cuts to council budgets, local authorities are struggling to manage care packages in the community. Scotland’s social care system is bulging at the seams.

A month ago, I was contacted by a constituent in Midlothian whose local authority could not provide the care package agreed by social services. My constituent was told that, with current resources, social services could not provide any more care. The situation was finally resolved and the care package was met, but not without months of uncertainty for the constituent and their family. What of others who are in a similar trap?

Increased care at home is part of the solution to increasing demand for social care. However, I highlight the comments of Graham Simpson, in that it seems that some people are saying that they will close what they already have and then analyse what they need to do more widely in future. However, that is causing enormous anxiety to people who are at present resident in our care homes in South Lanarkshire, which is not on.

I question the notion that many people who are currently living in a care facility would be better cared for at home—I stress the point that I am talking about people who are currently living in a care facility. It seems to me that most of those people went into a care facility or care home because they were no longer able to cope at home, with carers making shorter visits or unpaid carers no longer able to look after them. I know something about that, as does Graham Simpson, as we were co-conveners of the cross-party group on carers, although he has now had to resign.

McClymont house in Lanark is another such precious facility, which is very much valued in Lanark and the rural community around it. The hub-and-spoke method that is proposed for South Lanarkshire must not be an excuse to cut beds and reduce resources now, before there is a clear and broader future care plan.

We are at the tipping point for social care. Yes, people often want to stay at home, and they should be able to when that is practical and safe. There are even polls that show that people would prefer to pass away at home. However, the facilities must be there to make that possible, with the ability for more medical interventions to take place at home. Fuel poverty is also a real issue for elderly people who live in houses that are inadequately heated.

A local councillor recently told me the story of a 70-year-old constituent who is looking after her 86-year-old mother who has dementia. It is people like that who are worried sick about their future. The kind of care home facilities that Monica Lennon was talking about need to be kept open.

Fulton MacGregor

Will the member take an intervention?

Claudia Beamish

I am sorry—I have not got time.

We need investment now to improve care in the community, and we need longer visits with more structured care at home. Some interesting approaches, which I do not have time to go into today, are being explored or are happening in other countries. I saw a BBC documentary about a Dutch system that has students living in a nursing home and offering support in return for reduced rent. There are positive intergenerational effects, including tackling loneliness and isolation and helping to tackle depression in both the older and younger people. Social cohesion can be significantly supported by such sharing of experiences and life perspectives.

However, while we must look to the future for all our sakes, not just across South Lanarkshire, but in urban, rural and the whole of Scotland, the fear that the consultation on this particular arrangement has put into people simply has not been fair, as I understand it from the people who have spoken to me. A proposal was put to people and that was it; there was no choice or discussion. What has happened in South Lanarkshire, with the care homes that Monica Lennon has highlighted, and in Lanark, with the concerns about McClymont house, is not acceptable.

I support the motion.

14:58  

Stewart Stevenson (Banffshire and Buchan Coast) (SNP)

I am glad of the opportunity to speak in the debate and I thank Monica Lennon for providing the opportunity for us to have a broader-based discussion about how we support older people in our community. I do that from the perspective of being the only person in the chamber who is in his eighth decade. I am, therefore, perhaps most directly thinking about what my future may be in the event of my health deteriorating to the point that I need that kind of care.

I will make a few points of common cause with Monica Lennon at the outset, to show that we need not focus simply on what might divide us, but on what might unite us. It is entirely proper that Monica Lennon should bring forward a matter of constituency interest; I do not agree with all those members who might have suggested otherwise. She was also entirely correct to raise the issue of a 92-year-old with dementia. There are some very special needs for people with dementia that it is worth considering for a second or two. They are—in general terms, because dementia comes in many forms—people who are relatively intolerant of any change, however small it may be. They are people who require a regular routine and certainty and whose ability to understand change—however well intentioned it may be—is more limited. Therefore, it is correct to refer in the debate to individuals who may be affected by change.

Monica Lennon

Will the member take an intervention?

Stewart Stevenson

Forgive me, but I am going to speak very briefly.

Claudia Beamish said, quite correctly, that we need to look at longer visits by carers—I think that that is a Scottish issue—and more care at home. I fundamentally agree with her on that, and on the need to look at Scotland as a whole.

We need to give a bit of context to this, and the context is undoubtedly that we are making progress. If I recall the number correctly, there has been a 37 per cent reduction in what is commonly called bed blocking, which means that we have an opportunity to look at matters in a different way. In the context of the existing care homes being criticised by the care commission for their provision, the option to do nothing is not available to the council, as it would similarly not be available to councils across Scotland.

I will close my short contribution by saying that the difficult matters that affect those individuals in our community who are in the greatest need are best conducted by building coalitions of interest. I worked with Tam Dalyell—a man with whom I had fundamental disagreements on a wide range of issues, but with whom I had an excellent personal relationship—many times on matters of joint interest. For example, Tam and I worked together when someone was about to be thrown out of the UK by the Home Office in 1999 and that person is still in the UK. That is because we were able to put our political differences to one side and put the needs of our constituents at the heart of our concerns.

In conducting the debate and taking the issue forward, I encourage us all to focus less on our differences than on the commonalities, which may help in the constituencies of Monica Lennon, James Kelly and other MSPs who represent the area. The issue is difficult but it needs attention, and we will have to make change and adapt to changing needs, changing responsibilities and different models of care.

15:02  

The Minister for Parliamentary Business and Veterans (Graeme Dey)

Whatever else the debate has achieved, it has highlighted the vital role that care homes play in supporting people to live well in a supported, homely setting. Care, in all its guises, is something that the majority of us have had some form of personal contact with. It is an extremely important issue. It was therefore disappointing to note the tone that was set by Monica Lennon and her exploiting of the issue to launch a personal attack on another MSP, motivated by party politics. I would gently encourage her to reflect upon that point.

I acknowledge the more measured and considered approach that was taken by Graham Simpson and indeed Stewart Stevenson. Graham Simpson rightly pointed out that this is about doing the right thing. I want to continue the tone that was set by Graham Simpson and pay due respect to an issue that I recognise matters to many people.

The role of care homes is changing—that is a fact—and services are being redesigned to take account of our ageing population, who are living longer but not necessarily healthier lives; the number of older people with complex needs has increased.

Our models of health and social care need to change to ensure that we better meet the needs of an ageing population. That is why we have integrated health and social care and that is why this Government has taken steps to protect and grow services and integration by investing more than £550 million of resource.

At its heart, integration is about ensuring that people get the right support, in the right place, at the right time. Integration authorities are now responsible for almost £9 billion of funding to plan health and social care services so that they are sustainable in the long term.

Monica Lennon

Will the minister give way?

Graeme Dey

No, I will not—I am sorry.

Monica Lennon

Will the minister give way?

Graeme Dey

Monica Lennon refused to take interventions from any members; I am going to continue.

South Lanarkshire’s integration authority is one of many that are redesigning services in that way. It has put forward proposals to ensure that more people can be supported to live well in their communities. At the core is a commitment to redesign a number of care facilities to provide more short and intermediate rehabilitation care, with the aim of preventing prolonged delays in hospital and inappropriate admission to hospitals or residential care.

As Graham Simpson pointed out, the current model of delivery has remained unchanged for many years while the needs of local citizens have continued to change. At the same time, half of the council-run care homes have ageing layouts and condition. Of course, it is right to point out that the demographic growth projections for South Lanarkshire suggest that the 75-plus and 85-plus population will rise year on year by 2.7 and 5.2 per cent, respectively. However, the nature of the need is changing, too, and the provision must adapt accordingly. Perhaps most important of all, feedback has highlighted people’s expressed wish to remain at home and in their community, but South Lanarkshire is one of the highest users of care home beds in Scotland; it has 41 care home beds per 1,000 population, compared with 36 across the rest of Scotland.

The proposals have been subject to extensive engagement with elected members, stakeholders, staff, the unions and the public. Crucially, the integration authority directions for residential care were unanimously supported by all voting members on the integration joint board, as was the strategic commissioning plan for 2016 to 2019.

We know from international evidence that that approach is better for people. There is local evidence to back that up by virtue of a successful pilot of the model in South Lanarkshire in 2017-18, which resulted in 56 of the 80 people who were supported returning home instead of going into residential care.

It has been claimed that there will be fewer care home beds, but the new model will mean that up to three times more people will benefit from the new service compared with the old model. Such changes are being proposed across Scotland, thanks to the opportunities to tailor services that are opened up by integration.

As we have heard today, change is, of course, challenging. It requires leadership at all levels and appropriate engagement with service users and their families. As a constituency MSP, I have seen great examples of care model reshaping in Angus South; the new Kinloch care centre and the approach to step-down care are two such cases, and I commend those who are responsible for them. However, I have also seen day-care provision being removed in a cackhanded way that caused distress to all concerned. That reminds us all of the opportunities that are available to make meaningful change and to meet the changing need; it also highlights the need to take people with us on any change of course.

Monica Lennon

Will the minister take an intervention?

Graeme Dey

I have already indicated, Presiding Officer, that I will not take an intervention from the member.

The Government will continue to support our integration authorities to take the bold steps that are required to redesign services that reflect the changing requirements of our population. We are committed to free personal and nursing care. Scotland continues to be the only country in the United Kingdom to provide personal and nursing care that is free of charge, and funding levels have been increased over this Government’s period in power.

The debate has provided an opportunity for us all to recognise the important role of our care homes. However, it has also highlighted changing needs that require us to work differently and collectively across the health and social care sector. Integration authorities are doing just that, but they can do so only with appropriate leadership from local and national partners.

I reiterate this Government’s commitment to supporting integration authorities in developing services that are responsive to the changing needs of our population. I echo the words of the South Lanarkshire Council leader, John Ross, in his recent East Kilbride news column:

“I think how we look after the elderly is one of the most important issues we face. Our proposals are designed to give older folk exactly what we know they want: to live at home and in their communities and, when necessary, they want our support to help them do so for as long as possible. No one wants to go in a hospital, and when they do, they want to go home as soon as they are fit to. They do not want to go into a care home unless they really need to, and if they do have to, they want the facilities to be as good as possible. These are the principles at the heart of the care homes modernisation programme.”

I want to reflect on his final comment, which echoes the points that were made by Fulton MacGregor and Graham Simpson. He urged everyone to put people before politics on this vital matter.

The Presiding Officer

Thank you. That concludes our members’ business debate. We will shortly move on to the next item of business, which is a statement by the Cabinet Secretary for Education and Skills, John Swinney, on the educational experience of lesbian, gay, bisexual, transgender and intersex young people. Before we do that, I wish to draw the attention of members, particularly Mr Cole-Hamilton, to the fact that I have advised members not to wear ostentatious campaign material in the chamber. I noticed that every other member has observed that guidance. If Mr Cole-Hamilton wishes to be called to ask a question, I ask him to leave the chamber and change his tie. I have nothing against the TIE campaign to which it has drawn attention, and Mr Cole-Hamilton has made his point.