Hansard

I start by apologising to members for the fact that I will be unable to be in the chamber for the closing speeches. I have, of course, sought your permission for that, Presiding Officer, and am grateful that you have graciously agreed. I will study the Official Report with considerable interest to read the speeches that I will miss when I am absent.

I welcome the opportunity to debate rehabilitation and reablement. I welcome the minister’s comments about a national delivery plan, which I will touch on later. There is considerable support on Labour benches for both approaches, which are, of course, complementary, with rehabilitation involving services that are designed to help with recovery after a hospital stay, getting the person better more quickly and enabling them to return to their own home sooner, and reablement involving services that restore independence to people and enable them to manage their own condition, which decreases hospital admissions and reliance on home care support—it is very much a case of doing it for oneself rather than having someone else do it.

The attraction of both approaches is self-evident. When money is tight, getting people out of acute beds by providing focused rehabilitation that continues in a community setting saves money. Enablement provides for more self-care, saving money on hospital admissions and lessening the need for home care. Much more importantly, it is also better for the individual. Studies tell us that enablement leads to better health and social care outcomes, improved physical functioning and the restoration of independence. There is no argument about the principle of or the direction of travel for approaches that are founded on rehabilitation and reablement; as ever, the test is how that is delivered on the ground.

There is a pressing need to get this right, as the minister says. We all know the statistics about the growing population and changing demographics. The number of people over 75 is set to increase by 23 per cent by 2018 and by a staggering 84 per cent by 2033. In my view, this is the biggest challenge that we face in public policy, and I am genuinely worried that we do not yet have in place all the elements that we need in order to meet that challenge.

We should of course be empowering our older people to live active and full lives and preventing them from coming into contact with the formal care system for as long as possible. When they need help, there needs to be access to home care, to reablement and to rehabilitation. There is no doubt that, for rehabilitation and reablement to work well, teams need to be integrated between health and social care. Nurses and allied health professionals such as occupational therapists, physiotherapists and speech and language therapists all have a critical role to play, working alongside social care staff.

I very much agree with the minister’s positive comments about allied health professionals. Better integration is indeed required if we are to get the relationship with social care right. However, some seven months after the election, I am still waiting to hear the detail of the Scottish National Party’s proposals on how integration will be achieved. Scotland’s older people cannot afford to wait much longer. I urge on the minister a greater pace of change.

In recognising the importance of allied health professionals, how will the SNP deliver on a challenging agenda while it is presiding over a decline in workforce numbers? The numbers of occupational therapists, physiotherapists, speech and language therapists and podiatrists are down. Since the high point in 2009, the numbers have declined year on year.

In reality the position is worse, because the figures do not include vacancies in posts that have, in effect, been frozen or maternity leave. I know that the minister was an occupational therapist, but the workforce is predominantly female and maternity leave levels are higher.

The royal colleges have made the point that the workforce statistics mask a change in the skills mix, with the numbers in lower-paid grades increasing and less-qualified staff providing care. In some cases that might be appropriate, but it is not appropriate if it diminishes the quality of care. There are also huge problems for newly-qualified professionals in finding employment, but there remain long waiting times for services in many areas throughout Scotland.

I will give members a flavour of what is happening. In a 2011 survey, speech and language therapists said that health boards were widely operating a policy of natural wastage and downgrading and freezing posts. The therapists talked about reductions in service. They said that there is less speech and language therapy coverage on wards, that they are increasingly “firefighting”, and that waiting lists and times are growing, particularly for people with communication disability.

Some 93 per cent of physiotherapists said that they are required to make savings from the budget, and 43 per cent expected the cuts to have a negative impact on services. Some 80 per cent of managers reported that vacancy management is preventing recruitment to most if not all posts and 87 per cent reported an increased workload in the past year. I think that all members would agree with the 100 per cent of respondents who said that they expect demand for physiotherapy to increase; almost 70 per cent thought that they do not have the resources to meet demand.

There is a difficult backdrop for allied health professionals who want to deliver on the agenda that the Government and the Labour Party want. What action will the minister take to ensure that he arrests the decline in numbers among the people who have such a central role to play in rehabilitation and reablement? What action will he take to tackle waiting times—which he acknowledged are sometimes considerable—for essential services, which will be so important in shifting the balance of care?

The minister is a former occupational therapist and he will bring to the issue welcome understanding and insight. I also welcome the national delivery plan that he announced, but I wonder whether it will address all the concerns that have been expressed and I encourage him to make the scope as broad as possible.

The second issue that I want to raise is about the nature of reablement teams. Throughout the country, the teams that are being established and the staff recruited are—I think without exception—the preserve of the public sector. However, the independent and voluntary sector are the principal providers of care in most homes and communities throughout Scotland. In anticipation of the reablement agenda, many organisations in those sectors have been investing in training their staff to fulfil some of the reablement roles that the Government envisages. However, none of them has been involved in any way whatever. I do not want to think that that is deliberate; I think that it is perhaps an oversight. Whatever the reason, I will be grateful if the minister gives further consideration to the matter.

The third issue that I want to raise with the minister is the change fund for older people’s services. I think that we would all acknowledge that £70 million is but a small fraction of the £4.5 billion spent on social care, and the test—again—will be the change that that pot of money generates. There is some disquiet about the operation of the change fund so far and concerns about substitution. John Downie of the Scottish Council for Voluntary Organisations has said:

“The funds must not simply be spent on the same or alternative means of providing existing services or be used by local authorities and NHS Boards to plug existing funding gaps.”

There are concerns on the ground that that is, indeed, what is happening.

There are also concerns that the change fund is not focused on prevention, which I think we all acknowledge is the way forward in lowering public spending and improving outcomes. Only something like 18 per cent of the spend is currently identified for prevention. What is perhaps even more worrying is the discovery that the change fund is heading for a £12 million underspend, with real fears that it will end up being more than that.

It would appear that only £10 million—one seventh of the change fund—has been spent in the first half of the year and that local authorities are going to attempt, valiantly I am sure, to spend £60 million in the remaining six months. The difficulty with that is that it seems to be more about getting money out the door quickly than about considering what it is best spent on. I invite the minister to consider whether there is a better way of doing that and of enabling some of the money to be carried forward into the next financial year.

The minister will be aware of another challenge in helping people to stay in their own homes, which is the apparent reduction in budgets for aids and adaptations. Often, a small piece of equipment or an adjustment to a home is enough to give people the control and independence that they need to remain in their home and community. However, waiting times for them appear to be lengthening, people are facing charges that were not there before and local authority budgets are tightening.