Hansard

There have been many significant developments in community care in this Parliament's lifetime, and the Community Care and Health (Scotland) Bill marks a further milestone in the Executive's commitment to better community care services in every part of Scotland. Just over a year ago, Susan Deacon set out to the Parliament the agenda of joint management, joint resourcing, joint working, better home care, more flexible services, free nursing for our older people and help for all Scotland's carers. As members know, free personal care was added to that agenda in January.

The Community Care and Health (Scotland) Bill is the legislative framework for delivering that agenda. I am delighted to say that the bill has also received widespread support and that the Health and Community Care Committee's stage 1 report contains many comments and recommendations with which we also agree. I will consider in detail the many improvements that the bill will bring and the many people whom it will help, as well as referring to the widespread support that the bill has received.

I begin by spelling out the four general principles at the heart of the Community Care and Health (Scotland) Bill, which are choice, partnership, equity and fairness. Our commitment to choice is clear in the bill's provisions on direct payments, top-up payments for care home places and the creation of a deferred payments scheme. That commitment is part of a broader commitment to services that put service users first and that meet the real needs and wishes of the people who use them.

The bill's second general principle is partnership. Real change can be achieved through true partnership, which will involve national health service boards and local authorities working together to provide services that meet all of a service user's needs. To be fully effective, the partnership approach must be broad enough to include voluntary and private sector care providers, those who use care services and carers, who have for so long been the forgotten, unsung partners in care provision.

Equity and fairness are the final two principles on which the bill is built. Because of those principles, the bill gives ministers powers to introduce free nursing care. No longer will someone in a nursing home have to pay for the same nursing care that would be received free in hospital or at home. For the same reasons, the bill also gives ministers powers to introduce free personal care to bring to an end the current situation in which an elderly person with cancer receives free personal care, whereas someone with Alzheimer's has to pay for the same care. By combining the principles of equity and fairness with those of choice and partnership, we are laying the foundations for care services in 21st century Scotland.

In developing the policies and proposals in the bill, we have tried to give all those with relevant experience and expertise the opportunity to help us in this important work. In some cases, that has happened through the establishment of working groups such as the joint future group and the carers legislation working group. More recently, we have had the care development group and the integrated human resources working group, of which I shall say more in a moment. All those groups have made an important contribution to the development of the Executive's priorities.

In all of this, I have been encouraged by the widespread support that the bill has received. Time after time, those who responded to consultation around the bill said how much they welcome the bill and the changes that it will bring. In session after session, those who gave evidence to the Health and Community Care Committee praised the bill's general principles. The committee, in its stage 1 report, welcomed the main changes that the bill is intended to make and recommended that Parliament approve the general principles of the bill. I thank the Health and Community Care Committee and the other three committees that considered the bill at stage 1. In particular, I thank the lead committee for a very constructive stage 1 report, which was the result of many painstaking hours of evidence taking, research and discussion. I will comment on several of the report's recommendations in a moment.

Let us consider the important changes and tangible benefits that the bill will bring. It will mean that the Executive will be able to tackle existing inequities surrounding care for older people by introducing free nursing care and free personal care. We will ensure that nursing care is finally free for all who need it, regardless of the context—free at home, free in hospital and, for the first time, free in nursing homes. In the same way, we will ensure that personal care is free for all Scotland's oldest people: the dementia sufferer and the stroke victim; those at home as well as those in care homes. The committee made it clear in at least three places in its report that it supports the inclusion in the bill of a definition of personal care. We have, of course, considered the committee's views carefully, and I am happy to announce that the Executive will lodge an amendment at stage 2 to include a definition of personal care in the bill, based on the definition that was arrived at by the care development group.

We will need to consider carefully how we can combine such a definition in the bill with the need for flexibility in its implementation. As I made clear to the committee in my evidence, I believe that that will be crucial to the bill's successful and sustainable implementation. I am therefore pleased to note that paragraph 32 of the committee's report

"recognises the need for a degree of flexibility".

The report also recommends that regulations that are made under the bill's powers should be subject to the affirmative procedure, and I am happy to accept that recommendation as well. I hope that this commitment to amending the bill will address the points that have been raised by the committee in its report and that we can all agree that the bill will mean a fairer future for Scotland's older people.

In line with its general principles, the bill will also extend choice. It will do that in many ways, above all by extending the availability of direct payments. Instead of service users being provided with services that are chosen by local authorities, direct payments give the service users the power to buy in their own services. The bill will ensure that direct payments are available throughout Scotland, while at the same time extending the scope of direct payments to all care client groups. In practice, that could mean that, whereas the care needs of someone with a learning disability are currently met by half a dozen different local authority staff, in the future that person would be able to employ one or two personal assistants to meet those same needs.

Changes such as that may be challenging, and perhaps difficult, for local authorities, but they will empower the service user, who will be able to commission the services that they need, when they want them and from the people whom they choose. The service user must come first. The extension of direct payments will help to deliver that change by increasing choice in home care.

The bill's provisions will increase choice not only in home care, but in residential care. Our commitment to improved choice in residential care is clear in the bill's provisions for top-up payments, in our removal of barriers to care home placements throughout the UK and in our introduction of deferred payment schemes, which will mean that people will no longer be forced to sell their homes to pay for residential care. Members will recall that a much smaller number of people would be in that position anyway, because of the introduction of free personal and nursing care. Those provisions will make a real difference for those in care homes and will combine with the improvements that arise from the Regulation of Care (Scotland) Act 2001 to bring better choice and quality into many people's lives. More than that, the provisions will ensure that anyone who is entering residential care for the first time will be able to experience real choice, with an assurance of quality services and the reassurance that they will not have to dispose of their home to meet the costs.

It is not only those who are in need of care who will benefit from the bill, however. As I said earlier, the Executive recognises the vital role that Scotland's carers play as partners in the provision of care. Our carers strategy acknowledges their immense contribution and our firm commitment to support carers better than ever before. This is no empty rhetoric; the resources that were attached to the carers strategy and the further new funding to expand short-break services throughout Scotland effectively mean that resources to support carers will have quadrupled in just four years.

One outcome of the carers strategy was the establishment of the carers legislation working group, which examined how we could support carers better through legislation. The group made a number of recommendations for change and those are an important part of our carers agenda. The majority of the recommendations do not require changes to primary legislation and we will be taking forward those changes in a variety of ways in discussion with carers organisations and other bodies that will be affected by them. The bill takes forward those recommendations for which new legislation is needed to improve support to careers. In particular, the bill gives carers the right to an assessment of their needs as a carer, independent of the cared-for person. I am pleased to announce that the Executive will lodge an amendment at stage 2 to ensure that the new right will be available to young as well as adult carers.

The new flexibility will improve carers' access to the support that they need to sustain them in their crucial role. It reflects their status as full partners in providing care, a principle that the Executive whole-heartedly endorses. I am aware that the Health and Community Care Committee suggested that that principle, and one other, be placed in the bill. We are considering what is reasonably possible, but we are concerned that the legislation should have precise legal meanings that will work in practice. If such meanings cannot be clearly set out in the bill, the interpretation might be left to the courts and might not reflect what Parliament intended. If it is not possible to give precise legal meanings, it is better to leave a provision out of the bill and avoid the problem. We need to distinguish between good intentions and good law and be sure that we deliver the latter.

The Health and Community Care Committee also suggested that there was a case for building on the extension of carers' rights by requiring local authorities and the NHS to identify carers and offer them information. I have also considered those points carefully. There would be practical and legal difficulties in imposing such a duty on the relevant people in the NHS in a way that would work. In any case, I do not believe that we need to go down that road as we can work with the NHS to build carer-awareness into the main stream of the health service through the development of a range of initiatives that are already under way. However, I recognise the committee's concern to ensure that carers are aware of their right to an assessment and I am examining carefully the scope that there may be for building further on the new right to assessment for carers with a view to lodging an amendment at stage 2.

The Executive will emphasise the importance of the partnership with carers in other ways. Good things are already being done to help carers in lots of different places, and the challenge for the Executive and other agencies is to spread that best practice. We plan to give clear new guidance to local authorities, the NHS and others to ensure that carers receive full recognition and support in their caring role and to ensure that best practice is turned into the norm.

No one should be mistaken about our commitment to improving support for carers, not only through legislation, but across the range of the Executive's agenda. That same spirit of partnership is equally important for local agencies working together to provide services. The joint future group provided a new lead on joint working between NHS Scotland and local authorities, and applied the good practice of pilot schemes and projects across Scotland to the heart of community care.

Our commitment is to enable and drive a joint approach between agencies rather than to opt for wholesale reorganisation by creating a new body for community care services—such as care trusts, which are being implemented in some parts of England—which might be perceived as a takeover of one agency by another. The bill delivers on that commitment by removing the final remaining legal obstacles to better joint working within the parameters of existing agency structures. I believe that agencies are signed up to the joint approach and that that is more likely to deliver results in the short to medium term.

Much has already been done within the scope of existing legislation, such as the joint resourcing and joint management of learning disability services in Glasgow and of mental health services in Dumfries and Galloway. In Perth and Kinross, the agencies have formed a high-level partnership and have recently extended those principles by appointing joint locality management. However, the full flexibility of delegation and pooled budgets was not possible. Sections 10 to 14 of the bill will achieve that. They will allow NHS Scotland and local authorities to deliver services in a more integrated way. They will also allow more flexible resourcing to support our goal of care that is designed around the needs of individuals.

Sections 10 and 11 will free up barriers to the transfer of funds between NHS Scotland and local authorities. That will empower the new NHS boards and local authorities to plan for healthier communities, to improve well-being and to resource plans with the emphasis on the outcome for citizens, not the constraints on agencies. Those powers, as well as those in section 12 to delegate powers and pool resources, will allow the new approaches to community care service provision and the fuller integration of services that are needed to meet the expectations of service users, carers and patients.

The bill will allow local agencies to determine their local balance of care and to ensure that the resources that are available to them are used and channelled to best effect. It will also allow them real flexibility of response, pooled resources and the delegation of functions to the agency that is agreed to be best placed to lead on any particular function. In that way, agencies can concentrate on outputs for users, carers and patients rather than be restricted by fruitless discussions about who can do what and how it will be resourced.

I agree with the Health and Community Care Committee's observation that community care needs a well-motivated workforce. That is why we have established the integrated human resources working group under the chairmanship of Peter Bates. Membership of the group is drawn from a broad range of players. It includes, for example, a local authority chief executive, a primary care trust chief executive, personnel managers from NHS Scotland and local authorities, and representatives from no less than five professional bodies and trade unions. The group, rightly, seeks to expand its membership to take account of the parallel interests of, in particular, the voluntary sector.

Already, the integrated human resources working group is consulting staff on the issues. Some issues, such as secondment protocols, training needs and personnel procedures to support new ways of delivering care, are short term. Other issues, such as pay and pensions, are clearly more complex and will require longer-term consideration. By the end of December, the group will have consulted more than 1,000 staff throughout the country on their concerns about, and aspirations for, joint working. A report will be produced for ministers by April 2002.

In the interim, section 13 is intended to reassure staff that their transfer between agencies will not affect them adversely. In section 14, Scottish ministers take powers to enforce joint working arrangements where necessary. That is not, and will never be, ministers' preferred option, but it may be necessary in the interests of users, carers and patients.

Of course, joint working is more than the sum of the statutory agencies. Voluntary organisations and private providers have a key role to play. We expect agencies to consult all the key players in care provision about joint working arrangements and to involve them in those arrangements. Agencies already have a statutory duty to consult the voluntary sector on community care planning arrangements; mechanisms to do that are in place throughout Scotland, and agencies should build on those. Our emphasis on the statutory agencies is deliberate. We want to improve joint working between the agencies as a matter of priority. From that, we anticipate better, more consistent engagement with the voluntary and private sectors.

The bill's contribution to better care services is matched by its measures to improve health services for all. Part 3 will extend the medical list system to all general practitioners, not just those who run practices. That will improve the coverage of our existing quality and discipline procedures. Patients can be confident that, whichever GP they see, that GP will be subject to high disciplinary procedures and standards. That may sound like a dry technical measure—if members have looked at the bill, they will see that it reads like one as well—but it is an important improvement to the quality of our health care service.

While I am on the subject of GP lists, I want to address the concerns that the stage 1 report raised about that issue. The Health and Community Care Committee recommended that the Executive should hold discussions with the Royal College of General Practitioners and the British Medical Association to clarify points in their submissions. I am happy to confirm that my officials have written to both bodies to resolve those matters.

I look forward to hearing the views and suggestions of my fellow MSPs during the debate. I also look forward to the detailed discussions with the Health and Community Care Committee that will follow at stage 2.

I remind members of the general principles that we have been discussing: principles of choice, partnership, equity and fairness, which have received broad support from many different quarters. I commend those principles to the Parliament and I commend the Community Care and Health (Scotland) Bill, which has been based upon them. I am confident that the bill will lay the foundations not only for better care services, but for better lives for many in our society: better lives for Scotland's older people, who will be able to live free from the fear of poverty and debt; better lives for service users, who will be able to choose how services are provided for them; and better lives for Scotland's carers, who will see that their contribution to Scotland's care provision is being recognised and valued.

I move,

That the Parliament agrees to the general principles of the Community Care and Health (Scotland) Bill.