Hansard

I welcome the new minister to his post and wish him well in the job. I congratulate the two new deputy health ministers, although it is perhaps appropriate to remind them of the old saying that quality is more important than quantity—as Shona Robison and I regularly demonstrate.

I also place on record my personal and sincere good wishes to Susan Deacon. Susan and I have crossed swords on many occasions over the past year and I have—with good reason—been a regular critic of her record in office. Having said that, I think that we would all agree that being the minister with responsibility for health in Scotland is one of the most difficult jobs in the country, if not the most difficult. I for one have never doubted the energy, commitment and, I believe, principle that Susan Deacon brought to the job. I wish her well in her future parliamentary work.

I am delighted to support the general principles of the Community Care and Health (Scotland) Bill, subject of course to the reservations expressed in the SNP's amendment, which I will turn to shortly. It is appropriate, while I am being nice, to place on record my thanks to all the witnesses who gave evidence to the Health and Community Care Committee. Something that will emerge from today's debate—it has already emerged from the committee's report—is the consistency in the themes that emerged from the evidence that the committee took. I hope that we will have the opportunity to explore many of those themes today.

I would also like to thank the committee clerks. It never fails to amaze me how a group of people can manage to distil the sometimes wandering deliberations of the Health and Community Care Committee and produce a report that is comprehensive and eminently readable. They are due some credit for that.

The main provisions of the bill are extremely welcome. As Malcolm Chisholm has said, the bill will regulate charging for care home services and, I hope, bring an end to the postcode lottery that has characterised community care for far too long, with local authorities charging wildly differing amounts for the same services.

The bill promotes choice for users of care services. Extending access to direct payments for community care will empower individuals who need care but who do not necessarily wish to relinquish control over their lives; it will enable them to access services that are more tailored to their needs. However, the Health and Community Care Committee is right to point out that that provision will make a real difference in practice only if local authorities are placed under a duty to advise people of their right to access direct payments. Local authorities must also provide people with support in exercising that right.

The provisions on third-party payments—allowing people to make extra payments from their own resources to secure a place in a more expensive home—are also welcome, as long as they are used only in circumstances where individuals have genuine choice. It would not be acceptable if people were expected to top up local authority payments in circumstances where the only care home place on offer is in a home that charges more than the local authority is willing to pay. The use of third-party payments must be closely monitored to ensure that they are not abused to plug gaps in local authority funding.

The bill also enables local authorities to make loans to people to pay for their care. Such loans will be secured against the value of people's houses. The arrangements have the potential to remove the need for anyone to sell their home—even to pay for the accommodation costs of care packages, which will continue to be chargeable after the introduction of free personal care.

The Convention of Scottish Local Authorities expressed legitimate concerns about the practical ability of local authorities to act as lending institutions. The committee took the view that preferably a national scheme, administered by a single body, should be established for that.

The bill contains some welcome news for carers. It gives them the right to request an assessment of their ability to care, regardless of whether the cared-for person is being assessed. The committee heard powerful evidence from Carers Scotland about the need to place local authorities under a duty to inform carers of that right. The experience of authorities is that if authorities are not placed under a positive duty to do that, giving carers that right will not be enough to improve the lot of carers meaningfully. I hope that the Scottish Executive will heed that advice.

The bill includes provisions that are designed to ensure effective joint working by local authorities and the national health service in the delivery of community care services. Those provisions are welcome, although there remains a degree of scepticism among the committee members and some of the many witnesses who gave evidence about the ability of senior NHS managers and local authorities to overcome their cultural and institutional differences to work together in the interests of service users. Frankly, the factionalism that often exists between those who run local authorities and those who run the NHS would make the Labour group look united.

Last year, in its report on the delivery of community care, the Health and Community Care Committee recommended that

"A single body should be given responsibility for … planning and commissioning of community care services."

Notwithstanding the minister's remarks about the need to ensure flexibility and the dangers of imposing a uniform structure, I firmly believe that that recommendation should now be given serious consideration. I hope that the minister will not rule it out as a longer-term option.

Before I discuss the most important aspect of the bill—its paving the way for the introduction of free personal care—I will make a general point. The committee heard evidence from a number of witnesses to the effect that the bill should clearly state the principles that underlie it. It is becoming more common for bills to include statements of principle, but the Executive's approach to that is inconsistent.

Two weeks ago, we debated the proposed mental health bill. In that debate, Susan Deacon accepted the need to include in that bill a clear statement of the principles underlying it. For some reason, it appears that that approach is being resisted in this case. The minister says that that is because legislation must be precise. Of course, he is right about that, but if it is possible to produce a precise, workable statement of principles for the mental health bill, it is surely possible to do the same for the Community Care and Health (Scotland) Bill or for any other bill for which that is deemed appropriate. A clear statement of principle would undoubtedly be an aid to the interpretation of the eventual act and would help to ensure that the will of the Parliament was upheld. I hope that the minister will—as he has indicated he might—lodge an amendment at stage 2 to incorporate the principles of equity, fairness, joint working and partnership.

The debate should mark the beginning of the end of a hard-fought and well-won battle on the part of the Parliament to force the Executive to implement the key recommendation of the Sutherland commission, which is to make personal care free for all those who need it. I hope that this is indeed the beginning of the end of that battle.

The bill paves the way for free personal care by giving ministers the powers that they need to introduce that but, as Malcolm Chisholm has conceded, the bill does not enshrine in law the principle of free personal care, nor does it give any sense of what is to be included in the definition of personal care. The bill leaves it to ministers to define personal care by regulation. I warmly welcome Malcolm Chisholm's assurance that he will lodge an amendment at stage 2 to enshrine the definition in law. It is worth spelling out why that is so important.

Even if we accept the commitment of the current ministers to free personal care, what if a future Government, possibly a Tory one—I ask members to suspend their disbelief for a moment—which would probably be a malevolent one, something that does not require any suspension of disbelief, decided to scrap free personal care? Would we be happy to accept that a minister in such a Government—perhaps a new-generation Mickey Forsyth—should be allowed to do so by regulation, without having to pass primary legislation? I think not. But enough of fantasy. The Tories are not the real threat to free personal care.