Hansard

I thank the Labour Party for giving us this opportunity to debate the procurement of social care services. Given the amount of information that I have on the care of the elderly, I will focus my comments on those care services, in the knowledge that similar procurement and pricing procedures are used for all vulnerable people who are in need of social care.

The briefing paper from the Learning Disability Alliance, which Jackie Baillie quoted from, was very interesting. As she said, it highlights the fact that the hourly rates for care at home range from £7.76 in West Lothian to more than £22 in Angus, which is three times more. It also says that, in Highland, the hourly rate is more than £15 per hour, which is £5 more than it is in neighbouring Moray. There is no doubt that there is a postcode lottery for care, and we need to focus on improvement, development and redesign of services to provide long-term value for money and, as important, to raise the quality standards of care.

Jackie Baillie said that she has raised those issues for three years. I have been raising the issue of the postcode lottery in relation to care home fees since 1999, and my persistence has not paid off—yet.

The postcode lottery with regard to care is true, with 7 per cent of care homes for the elderly in West Dunbartonshire being given the highest grading, compared with 70 per cent in Highland and 69 per cent in Inverclyde. Quality matters—let us not all get caught up with the issue of the costs and the fees. Several councils have no care homes in the weak or unsatisfactory categories, but up to 35 per cent of homes in certain council areas are in those categories.

Not only is there disparity between the gradings of care homes, but there are huge differences between the fees of those who self-fund their care and those who do not. As responsible parliamentarians, we need to do something to incentivise people to save for their old age but, with the way that things are at the moment, there is no incentive. I will give a few examples relating to council-run homes, which I obtained through a freedom of information request. In South Lanarkshire, a self-funding client pays £474 a week to be cared for in a council home. That rises to £552 a week in North Lanarkshire, £650 a week in Fife and East Lothian and £843 in Dundee—a difference of £369 between the lowest and the highest mainland councils.

The costs of care differ widely, too. They range from £474 in a council-owned and council-run home in Midlothian to more than £900 in one in Angus—a difference of 91 per cent. In the independent and voluntary sector, councils pay £474.16, in agreement with COSLA. For the same quality of care and support, a self-funding client in the same home can pay £950 a week—twice as much. How can it be fair that two people in the same care home receive identical care, with identical quality standards, when one has to pay twice as much as the other is funded?

We should ask why councils charge self-funders up to 78 per cent more in one area than in another, and so much more than they pay to fund a place in the independent and voluntary sector. How can there be a difference of 91 per cent in the costs of providing care between one mainland council area and another?

There is another postcode lottery in relation to self-funding clients. As they are self-funded they are placed instantly in a care home, while others—through no fault of their own—must wait for funding packages from local authorities and are labelled as bed-blockers, the numbers of whom are rising week by week. That is why we are seeking a review of the charges. There is nothing complex in it: anyone with basic mental arithmetic could compare those figures.

In March 2010, there were 39,150 places in care homes for the elderly, with 33,900 residents. In simple terms, we have 5,209 empty beds out there, yet the cost of emergency admissions to our hospitals is one of the largest health budgets. Those homes could be better used for respite care. If we were to concentrate on delivering high standards of care to people in their own homes, there would be many fewer emergency hospital admissions and less need for long-term stays in homes.

It need not cost more to improve, develop and redesign services. If a general practitioner and a pharmacist visited a care home more regularly, medication could be reviewed and potentially reduced. With the right skills, knowledge and training, much more effective personalised and appropriate care could be provided.

I find it quite upsetting that 75 per cent of elderly people in care homes are on psychoactive drugs, perhaps because they have become agitated in one instance. If our elderly people are constantly on those drugs, we are not serving them well.