Chamber
Meeting of the Parliament 09 June 2011
09 Jun 2011 · S4 · Meeting of the Parliament
Item of business
Caring for Scotland’s Older People
I thank the Labour Party for using its time to debate this topic and I commend Jackie Baillie for her well-considered and measured speech.
An estimated £4.5 billion—14 per cent of the Scottish budget—is currently spent every year on care for older people. With a projected increase of 84 per cent in the number of people aged over 75 in the period to 2033, that figure is likely almost to double. We therefore need to plan services and support for older people in a much more co-ordinated and proactive way than the current system, which tends more towards crisis management. As Jim Eadie said in his maiden speech yesterday, the starting point must be the £1.4 billion—a third of that budget—that is spent on emergency admissions to acute hospitals at an average cost of £3,349 per week.
The 943 care homes in Scotland provide more than 39,000 places, but there can regularly be up to 5,000 empty places in them. Each place costs around £500 a week to the public purse, which is £2,800 cheaper than an acute bed. Given the fact that those care homes are able to provide the appropriate care, tailored to the person’s needs following hospital treatment, surely that resource could be more fully utilised to benefit patients and taxpayers. In talking about care homes and SCSWIS, we should remember that there are good and bad providers in both the private and public sectors. The old days of “public good, private bad” are long gone—one has only to read the care commission’s reports to see that. I hope that the fact that 85 per cent of care homes are in the independent and voluntary sectors will not present an ideological barrier to placing elderly people in high-quality appropriate care. For years, we have heard that elderly people become more dependent and less mobile the longer they stay in hospital and, as we all know, they often fall into the delayed-discharge category.
Care homes could also provide more day care, respite care and home care. They have the knowledge and the management skills as well as the facilities to do so. Now that the cabinet secretary has personally taken charge of elderly care—which I welcome—I ask her to investigate the fees that are paid by councils for placing people in council homes, which can be up to 80 per cent more than the fees that are paid in the voluntary and independent sectors, despite the fact that all care homes must meet the same quality standards that have been set by the care commission.
Although we can criticise care homes and care at home, many elderly people are cared for in our NHS. I found it very worrying—I found it very upsetting, actually—to read “Starved of care”, the Mental Welfare Commission’s investigation into the care and treatment of Mrs V at Ninewells hospital in Dundee. It begs the question of who inspects and monitors care and treatment in our hospitals. Yesterday, Joe FitzPatrick seemed to think that because we have a dementia strategy everything is going to be all right. Surely we do not need strategies, actions plans and legislation to get nurses to feed patients. That is all that the woman needed.
It is also alarming that the case was only brought to the attention of the Mental Welfare Commission two months after the death of Mrs V, by an independent doctor who was a psychiatrist. That doctor thought that the Mental Welfare Commission had received information about his concerns, yet following the tribunal hearing it had no record of any contact. It was only when the independent doctor took action to send his report to the Mental Welfare Commission in March 2009—to register his concern that Mrs V had experienced distress and agitation as a result of being prevented from eating—that the investigation took place. The response to her agitation and distress at being starved was, instead of giving her nutrition, to give her sedation. This is our national health service. If this lady could be so badly treated and the case could come to light only due to one independent doctor’s diligence and conscience, how many more elderly people are starved of care and nutrition in our national health service? How do we all know that our parents—indeed, ourselves, one day—will be cared for, fed and treated with respect and dignity not only in the care home sector, but in our national health service?
One of the main problems for older people is loneliness, with families being dispersed and older people being unable to go out alone. That is why I cannot understand why when councils—in particular, Highland Council—look for cuts, the first place they go to is day centres, which are a lifeline for many people.
Regarding the motion and amendments, we will support the Government’s amendment, but we will not support Labour’s motion. We all supported the merger of the Social Work Inspection Agency and the care commission under the Public Services Reform (Scotland) Act 2010 because we knew that there would be efficiency savings. I do not know whether the 25 per cent is a reduction in duplication, and that is why we will not support Labour’s motion.
I move amendment S4M-00234.1, to leave out from first “believes” to end and insert:
“notes the criticisms of the community health partnerships identified in the Audit Scotland report, and calls on the Scottish Government to bring forward a comprehensive strategy to support older people that will include plans for the integration of health and social care and proposals for better utilisation of existing care home capacity in the independent sector.”
An estimated £4.5 billion—14 per cent of the Scottish budget—is currently spent every year on care for older people. With a projected increase of 84 per cent in the number of people aged over 75 in the period to 2033, that figure is likely almost to double. We therefore need to plan services and support for older people in a much more co-ordinated and proactive way than the current system, which tends more towards crisis management. As Jim Eadie said in his maiden speech yesterday, the starting point must be the £1.4 billion—a third of that budget—that is spent on emergency admissions to acute hospitals at an average cost of £3,349 per week.
The 943 care homes in Scotland provide more than 39,000 places, but there can regularly be up to 5,000 empty places in them. Each place costs around £500 a week to the public purse, which is £2,800 cheaper than an acute bed. Given the fact that those care homes are able to provide the appropriate care, tailored to the person’s needs following hospital treatment, surely that resource could be more fully utilised to benefit patients and taxpayers. In talking about care homes and SCSWIS, we should remember that there are good and bad providers in both the private and public sectors. The old days of “public good, private bad” are long gone—one has only to read the care commission’s reports to see that. I hope that the fact that 85 per cent of care homes are in the independent and voluntary sectors will not present an ideological barrier to placing elderly people in high-quality appropriate care. For years, we have heard that elderly people become more dependent and less mobile the longer they stay in hospital and, as we all know, they often fall into the delayed-discharge category.
Care homes could also provide more day care, respite care and home care. They have the knowledge and the management skills as well as the facilities to do so. Now that the cabinet secretary has personally taken charge of elderly care—which I welcome—I ask her to investigate the fees that are paid by councils for placing people in council homes, which can be up to 80 per cent more than the fees that are paid in the voluntary and independent sectors, despite the fact that all care homes must meet the same quality standards that have been set by the care commission.
Although we can criticise care homes and care at home, many elderly people are cared for in our NHS. I found it very worrying—I found it very upsetting, actually—to read “Starved of care”, the Mental Welfare Commission’s investigation into the care and treatment of Mrs V at Ninewells hospital in Dundee. It begs the question of who inspects and monitors care and treatment in our hospitals. Yesterday, Joe FitzPatrick seemed to think that because we have a dementia strategy everything is going to be all right. Surely we do not need strategies, actions plans and legislation to get nurses to feed patients. That is all that the woman needed.
It is also alarming that the case was only brought to the attention of the Mental Welfare Commission two months after the death of Mrs V, by an independent doctor who was a psychiatrist. That doctor thought that the Mental Welfare Commission had received information about his concerns, yet following the tribunal hearing it had no record of any contact. It was only when the independent doctor took action to send his report to the Mental Welfare Commission in March 2009—to register his concern that Mrs V had experienced distress and agitation as a result of being prevented from eating—that the investigation took place. The response to her agitation and distress at being starved was, instead of giving her nutrition, to give her sedation. This is our national health service. If this lady could be so badly treated and the case could come to light only due to one independent doctor’s diligence and conscience, how many more elderly people are starved of care and nutrition in our national health service? How do we all know that our parents—indeed, ourselves, one day—will be cared for, fed and treated with respect and dignity not only in the care home sector, but in our national health service?
One of the main problems for older people is loneliness, with families being dispersed and older people being unable to go out alone. That is why I cannot understand why when councils—in particular, Highland Council—look for cuts, the first place they go to is day centres, which are a lifeline for many people.
Regarding the motion and amendments, we will support the Government’s amendment, but we will not support Labour’s motion. We all supported the merger of the Social Work Inspection Agency and the care commission under the Public Services Reform (Scotland) Act 2010 because we knew that there would be efficiency savings. I do not know whether the 25 per cent is a reduction in duplication, and that is why we will not support Labour’s motion.
I move amendment S4M-00234.1, to leave out from first “believes” to end and insert:
“notes the criticisms of the community health partnerships identified in the Audit Scotland report, and calls on the Scottish Government to bring forward a comprehensive strategy to support older people that will include plans for the integration of health and social care and proposals for better utilisation of existing care home capacity in the independent sector.”
References in this contribution
Motions, questions or amendments mentioned by their reference code.
In the same item of business
The Presiding Officer (Tricia Marwick)
NPA
Good morning. The first item of business is a debate on motion S4M-00234, in the name of Jackie Baillie, on caring for Scotland’s older people.09:15
Jackie Baillie (Dumbarton) (Lab)
Lab
I welcome the opportunity to open this debate on caring for Scotland’s older people. I can think of nothing more important that deserves the Parliament’s urg...
The Deputy First Minister and Cabinet Secretary for Health, Wellbeing and Cities Strategy (Nicola Sturgeon)
SNP
I begin by doing what I failed to do yesterday when I spoke, which was to welcome Michael Matheson to his new role and to say how much I am looking forward t...
Murdo Fraser (Mid Scotland and Fife) (Con)
Con
I am very grateful to Nicola Sturgeon for giving way. One of the major concerns for residents is the future of the homes. Has the cabinet secretary had any d...
Nicola Sturgeon
SNP
A variety of discussions of that nature are taking place, as the member would expect. I am sure that landlords of the homes will be having discussions with a...
Michael McMahon (Uddingston and Bellshill) (Lab)
Lab
I welcome the fact that the cabinet secretary has spoken directly to COSLA and that discussions are continuing. Have the cabinet secretary’s officials been t...
Nicola Sturgeon
SNP
The Government has a direct interest not only in ensuring that plans are in place overall but in ensuring that arrangements are in place authority by authori...
Neil Findlay (Lothian) (Lab)
Lab
Will the cabinet secretary take an intervention?
Nicola Sturgeon
SNP
I will take one more intervention on Southern Cross, but I have to make progress.
Neil Findlay
Lab
Thank you. West Lothian Council advises me that its contingency plans include seeking placements for residents with other local authorities, suspending respi...
Nicola Sturgeon
SNP
I have already said, in response to an earlier intervention, that the presumption that underpins our contingency arrangements is that older people will not b...
Jackie Baillie
Lab
Will the cabinet secretary take an intervention?
Nicola Sturgeon
SNP
I have a lot of material to get through, but if the Presiding Officer will bear with me, I will take an intervention.
Jackie Baillie
Lab
It is really just to correct what the cabinet secretary said. For the record, I have received no such e-mail.
Nicola Sturgeon
SNP
I have a copy of it here, so I am sure that Jackie Baillie will take it up with the leader of West Lothian Council. I am holding a copy of an e-mail to Ms Ba...
Mary Scanlon (Highlands and Islands) (Con)
Con
I thank the Labour Party for using its time to debate this topic and I commend Jackie Baillie for her well-considered and measured speech.An estimated £4.5 b...
The Presiding Officer
NPA
We move to the open debate. I remind members that they have six minutes in which to speak. We have a wee bit of time in hand, so if you take interventions we...
Claire Baker (Mid Scotland and Fife) (Lab)
Lab
Today’s debate addresses a significant issue that is facing the new Scottish Government. Scotland has an ageing population. People are living longer but not ...
Fiona McLeod (Strathkelvin and Bearsden) (SNP)
SNP
As a returning MSP, I have to say that it is a great privilege to make my first speech in what, to me, is a new Parliament. It is also an honour and a respon...
Neil Findlay
Lab
Perhaps the people in Strathkelvin and Bearsden buy food for their older people in M and S, but where I come from many certainly do not.
Fiona McLeod
SNP
I apologise—I was probably being a bit flippant. All I was trying to say was that older people in such situations tend to eat something in a plastic microwav...
The Deputy Presiding Officer (Elaine Smith)
Lab
I call John Finnie, to be followed by Alex Johnstone. John Finnie is making his first speech in the chamber.10:01
John Finnie (Highlands and Islands) (SNP)
SNP
Care of our older people has always been a priority, and older people were the major beneficiaries of the achievements of the previous Government, which deli...
Alex Johnstone (North East Scotland) (Con)
Con
I congratulate John Finnie on his maiden speech and I welcome the fact that he raised a number of constructive issues that we will need to deal with in the d...
Jackie Baillie
Lab
Does the member acknowledge that the overall spending on social care, particularly for older people, runs to billions of pounds and that free personal care i...
Alex Johnstone
Con
Indeed, but I believe that it is indicative of the problem that our commitment to such things will always be more expensive than we hoped it would be.I want ...
Mark McDonald (North East Scotland) (SNP)
SNP
Does the member accept the point that the private sector is good in some areas but there are other areas in which profit-driven motivation is neither require...
Alex Johnstone
Con
I do not believe that there is any evidence to support the idea that the public sector is somehow intrinsically better than the private sector, and I do not ...
The Deputy Presiding Officer
Lab
I call Bill Walker, who is making his first speech.10:13
Bill Walker (Dunfermline) (SNP)
SNP
Thank you, Presiding Officer. I am proud to be the first Scottish National Party MSP for the Dunfermline constituency, which comprises both the city of Dunfe...