Hansard

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 urgent attention.

We often remark that a society is judged by how it treats its young people, older people and most vulnerable people. Given the events of the past few weeks, I am afraid that we have been found wanting in the case of caring for our older people. Although much of the debate will focus on the challenges that we face, we must not lose sight of the fact that there are some really good care homes and excellent care providers across Scotland. However, it is a matter of considerable regret that some are just not fit for purpose.

In the past fortnight we have witnessed shockingly poor standards of care at the Elsie Inglis nursing home, the case of the most appalling treatment of Mrs V at Ninewells hospital in Dundee and the potential that Southern Cross Healthcare will go into administration, which threatens continuity of care for 4,700 of its elderly residents. There has been one problem after another. It appears from my mailbag that those are not isolated incidents, and that concerns about standards of care are emerging in different parts of Scotland.

Elsie Inglis nursing home is but a stone’s throw from Parliament. The poor standards of care there have resulted in two residents dying and six being admitted to hospital. There have been distressing reports of residents sleeping on stained and ripped mattresses and being forced to eat food with their hands, and of open wounds and sores being evident. In 2010 alone, there were 20 separate recorded outbreaks of infection affecting 72 residents. Yet, just a year earlier, the Scottish Commission for the Regulation of Care inspected the home and gave it a good report. Relatives of old people studied those reports before securing places in the home for them, believing that it would provide their loved ones with a good standard of care. They have little confidence in those reports now.

How could something go wrong so quickly? What will happen in the future under the new risk-based approach to assessment? The care commission joined with the Social Work Inspection Agency on 1 April to create a new body: Social Care and Social Work Improvement Scotland—otherwise known as SCSWIS. It is not exactly the most user-friendly title, but I believe that it is right to bring together inspection and improvement in seeking to raise the standards of care across the sector and the country. What was not right was to start the new organisation off with an overall budget cut of almost 25 per cent and, by the end of this year, a staff reduction of just under 20 per cent—that is a recipe for trouble.

Let us remember that the new care inspectorate is not responsible for inspection only of care homes for older people, but that it also inspects a range of children’s services and other adult services. So, the new organisation is starting out with a huge range of responsibilities but fewer resources to deal with them effectively. We have moved to a position in which the new care inspectorate will base its inspection regime on a system of online self-assessments, with targeted unannounced inspections of a smaller number of care homes. There is to be a greater maximum period between inspections for better-performing services and more focus on poorly performing services. We are therefore moving from a position in which there were twice-yearly inspections to much less frequent inspections in cases of good-performing homes.

Although that may, on the face of it, seem to be entirely reasonable, it is less than clear what would trigger more attention from the inspectorate. How is risk determined? I would hate to think that there could be a scenario in which people who are skilled at filling in self-assessment forms could escape inspection for longer periods but may not operate to the standards of care that we would deem acceptable.

Might I offer a little observation on self-assessment more generally? It was a system of self-assessment that was in place for health boards to report on their activities in relation to hospital-acquired infections and it was a system of self-assessment that underpinned infection control in NHS Greater Glasgow and Clyde and which operated in the Vale of Leven hospital, which witnessed the worst outbreak of Clostridium difficile in the United Kingdom, so members will forgive me if I am slightly cautious about self-assessment systems.

I will go back to the care centres and take the Elsie Inglis care home as an example. It had a good report; there were no problems a year ago. The first intervention of the inspectorate appeared to be in April, but I know from relatives who have e-mailed me that there were concerns in October last year. Was the care commission aware of that? Could it have acted sooner? Would the new risk-based assessment approach have helped or hindered the process? If problems were identified more than six months ago, it is unforgivable that action to close the home was taken only in the past fortnight.

If we are serious about inspecting and improving standards of care, we need to ensure that the new inspectorate has the resources to do so. It cannot start life with one hand already tied behind its back. I welcome the cabinet secretary’s personal commitment to making care of the elderly a priority. I had hoped that that would have been the case during the past four years of the Parliament, but I welcome the renewed focus. However, I would be grateful if she would outline what that “personal commitment” will mean. What differences will be made to policy? What resources will be in place? How can the cabinet secretary ensure that the standards of care remain the highest possible? I respectfully suggest that a welcome sign of her intent would be to reverse the budget cut to the new care inspectorate, but from her amendment I see that she is unlikely to do so, and that is truly disappointing.

In the context of the recent news about Southern Cross care homes, will the cabinet secretary consider giving the care inspectorate responsibility for addressing the financial viability of care providers as a condition of continued registration? The situation at Southern Cross is serious. The possibility of the company going into administration has been known for some months now. With 98 care homes and 4,700 residents, Southern Cross is the largest private care provider in Scotland. There were more than 3,000 staff in Scotland, but after yesterday’s announcement of job losses, there will be 400 fewer, which will have a direct impact on the quality of care. Frankly, Southern Cross is putting its shareholders’ interests before the care needs of its elderly residents. That is shocking and should be condemned by all parties in the chamber. It is becoming increasingly likely that Southern Cross will go into administration and our paramount consideration should be the continuity of care for the elderly residents.

The scale of that challenge is such that it cannot be left to 32 individual local authorities; it must be for the Scottish Government to develop the contingency plan. I know that some local authorities have done little in the way of contingency planning, while others openly acknowledge that they will be unable to cope with relocating all the elderly residents because they lack local capacity. Others have said that they will need to use hospital beds, which will take our policy on care for the elderly back decades.

Local authorities also point out that they have powers to take over the running of care homes in emergencies, although few can afford to do so. That might not be required for every Southern Cross care home, but it might apply to a few where there is no local capacity. In those cases, will the Scottish Government make emergency resources available, should that be necessary in the short term?

Last week, the First Minister said that the cabinet secretary was in “daily” contact about Southern Cross, but we have discovered that, by that point, only two meetings had taken place: one in March and one in April, and those were with Scottish Government officials. That information came from a written answer to my colleague Neil Findlay on 2 June, which was the very same day that the First Minister said that contact was “daily”. There is a real need for urgency in the Scottish Government’s approach. Sitting on the sidelines waiting to see what will happen is not the proactive approach that I expect the Government to take in ensuring that our older people are protected and cared for.

I will comment briefly on the case of Mrs V at Ninewells hospital. She suffered from dementia and died in hospital at the age of 80. The indignity of her treatment was quite extraordinary. Mrs V was not given any food orally and when she became distressed at that, the response was to medicate her. In the space of 16 days, she was administered with 95 separate doses of sedative. Her care and treatment were described by the Mental Welfare Commission for Scotland as

“degrading, unnecessary, and may have breached her human rights”.

I welcome the new dementia care standards, but we must ensure that those standards are the norm across every health board and in every hospital and care home, so that what happened to Mrs V does not happen to any other older person.

For me, what all those cases have exposed is that older people and their relatives feel quite powerless and confused in navigating our care systems. They place their loved ones in homes after following all the advice, reading all the inspection reports and even visiting the homes themselves, but that still does not offer comfort. They complain but feel that nothing is done and are not convinced that lessons are learned more widely across the system. They need someone who is very much on their side—someone who is independent of Government and who can look across care and hospital services and give voice to the wider concerns of older people more generally. In short, they need an older people’s champion. By working with all levels of government, voluntary organisations such as Age Scotland and older people themselves, such a person could help to drive fundamental change. I hope that the Government will give that proposal serious consideration, and I will be happy to discuss it further with the cabinet secretary.

I turn to prevention and resources. In many areas of Scotland, local authorities are struggling. For the first time, they are making cuts to care services and introducing charges, which is resulting in some older people cancelling services such as community alarms. Different approaches to charging are being adopted by neighbouring local authorities—a service that costs £30 in one area can cost £300 in the area next door. I first raised that issue two years ago, but those differences still exist.

The national eligibility framework for determining who should receive care sets out priorities. Understandably, those who are in the most acute and critical need are top of the list, but there are swathes of people with lower-level needs who will not be provided with a service because budgets are just too tight. I hope that the Government will ensure that local authorities collect data so that we can capture and identify the scale of the unmet need. That approach flies in the face of everything that we in this Parliament and the Government have said about prevention. We all know that prevention is the real prize. Even though prevention is cost effective, and it is much better for the individual to be sustained in their community without the need for more formal care, cuts are being made to some community-based services that do not cost a lot of money, and which have the potential to save in the long term. It is a matter of regret that prevention on the basis of what is happening on the ground remains an aspiration rather than a reality.

Many of the organisations that are involved in the provision of care at local level are leading the way in preventative work, but they are being squeezed, too. The terms and conditions of staff who work in the voluntary sector are being substantially diminished. Some care staff are being asked to take a wage cut from £17,000 a year to £13,000 a year, while others are being asked to work on zero-hours contracts—they are being asked to do more, but they are being paid less. Worryingly, there is evidence of the emergence of cuts to training budgets, with the result that care staff are being forced to do their own training in their own time and to fund it themselves. It is inevitable that that will have an impact on the quality of the care service that is provided, so there is an urgent need for us to look again at procurement policies and to put in place minimum standards that seek to protect the quality of care.

I turn to the challenge ahead. Before the debate is over, we will all have swapped figures to illustrate the scale of the demographic change that we face. Whether we cite the statistic that there will be 75 per cent more 75-year-olds in about 15 years or the one that the number of people over 60 will rise to 50 per cent of the population by 2033, what is clear is that the status quo is not an option. Scotland’s population is getting older and we are living longer.

However, not all of our older people need care. About 90 per cent of them are sustained in their own homes and communities with very limited input from care services, so we should think about older people not in the context of their care but in the context of what they offer our communities: experience, time and knowledge. Many of them are the volunteers who make our communities strong, but they need to know that should the time come when they need care, it will be there for them.

Labour believes that we will cope with that demographic change only by integrating health and social care and by having a local service with local accountability that is based on reformed community health partnerships and involves general practitioners, but which has one clear priority, which is to focus on the care of older people. The issue is not about structural change; it is about a better vision for the care of our older people, and I am happy to co-operate with the Government on that.

I move,

That the Parliament welcomes the Scottish Government’s new focus on the care for older people; further welcomes the commitment given by the First Minister that vulnerable residents in Southern Cross homes will not be compromised as a result of Southern Cross’s business model; notes with concern the report by the Mental Welfare Commission regarding the appalling treatment of Mrs V at Ninewells Hospital and the recent disturbing events at the Elsie Inglis Nursing Home in Edinburgh where standards of care were totally inadequate; further notes that one in 10 of the city’s care homes have been criticised and deemed weak or unsatisfactory in at least one area of assessment in the past year; believes that the 25% cut to the budget of Social Care and Social Work Improvement Scotland (SCSWIS), charged with the inspection and improvement of care standards, should be reversed; agrees that radical reform of community health partnerships is urgently required following the serious failings identified in a recent Audit Scotland report; recognises that funding prevention work will delay services for older people requiring formal care; believes that the care and safety of Scotland’s older and vulnerable people must be a major priority for the Scottish Government, and therefore calls on it to come forward urgently with plans to integrate health and social care so that Scotland’s older people and their families can have full confidence that they will receive the best possible standard of care when they need it.

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