Hansard

I am pleased—as convener of the Health and Community Care Committee—to lead on this debate on our report into community care. At various points during the past year, the Parliament has discussed the report as we have undertaken our inquiry. I will obviously speak in support of the motion in my name.

The committee's report has already had quite an impact inside and outside the Parliament. I believe that it has played its part in delivering improvement and change in an important policy area that we all care about.

Even after the Executive rejected the arguments for free personal care last autumn, the issue did not go away. In no small measure that was because, after a year's work and after taking evidence from all the main stakeholders, politicians of all parties unanimously signed up to the committee's report and to the implementation of free personal care. Some of us who began that investigation were at that time convinced in our hearts that the implementation of the Sutherland report was fair, good and right. It became clear over the months of investigation that it was also the best thing to do to deliver a better service. That came through in the evidence from all the stakeholders.

As well as effecting change, the work of the committee has been appreciated by people throughout Scotland. The Confederation of Scotland's Elderly wrote to me recently. They said:

"We write to record our thanks and that of all Scotland's elderly for your excellent report, which recommends the implementation in full of the Sutherland Report on long-term care for the elderly. It vividly reflects the virtues engraved on the mace - compassion, wisdom, justice and integrity - the action of this committee shines like a beacon."

I have told my mother to stop writing to me at work.

I assure members that that was written not by my mother, but by pensioners who reflect the views of pensioners throughout Scotland. Many others—pensioners, dementia sufferers, professionals and carers—have written to me since the committee published its report and following the debates on the issue in the Parliament.

The committee worked in partnership and as a team and, as the leader of that team, I have a number of people to thank. They include the former deputy convener of the Health and Community Care Committee, who is now the Deputy Minister for Health and Community Care, Malcolm Chisholm; the committee clerks, who are Jennifer Smart, Irene Fleming and Joanna Hardy; our Scottish Parliament information centre research staff, who are Murray McVicar, Morag Brown and Murray Earle; and our two advisers, who are Professor Alison Petch and Dr Gordon Marnoch. It is most important that I thank the people from the organisations who gave evidence to the committee and those who shared their experiences with us as we visited community care projects and facilities, carers and service users throughout Scotland. Their testimonies filled us with the enthusiasm and determination that we needed to carry on with our work. Their evidence led us to call for free personal care, across the parties and unanimously, and to make recommendations that I believe will lead to better community care services. I would also like to thank Sir Stewart Sutherland personally and on behalf of the committee for the support that he has given me and the committee over the past months.

Finally, I thank my committee colleagues. What can I say about them? What am I allowed to say about them? They represent the spectrum of political backgrounds in the Parliament, not only across parties but also—from time to time—within their parties. Just as organisations' evidence was overwhelming in pointing to the need for free personal care, so the unanimity among colleagues from different political persuasions was powerful in its own way. The committee's members worked hard and well; they set aside their differences—as well as their recesses. They rolled up their sleeves, delved into a complex and emotive issue and did so with intelligence, good humour and integrity. It has been a privilege to work alongside them. Having embarrassed the committee members suitably, even those who have managed to escape from the committee, I will move on to the substantive issues.

It is unfortunate that the Executive felt the need to lodge an amendment to my motion. [Members: "Hear, hear."] The wording of the motion was given unanimous support at the committee last week and the report was unanimous. The amendment is unfortunate and unnecessary—but I believe that it is no more than that and that it should not deflect the Parliament from the course of action that it has set itself. The amendment allows us to focus on, yet again, only the single issue of free personal care. That is a shame. If the Executive has substantive problems with any of the report's recommendations, I look forward to hearing them. It would have been helpful to have had any such problems outlined in the amendment. The amendment is also unfortunate because there is now a high degree of genuine cross-party unanimity on the issue.

The Sutherland commission's report was about more than personal care, and the Health and Community Care Committee's report is about more than the Sutherland report. I make no apologies for being one of those who, over the past year, has talked endlessly—so unlike me—about free personal care.

I make no apology for believing the evidence that we heard from the professionals, the service users and the carers. I make no apology for seeing the events of the past few weeks as good news for Scotland's elderly and for Scotland's Parliament.

I hope that today's debate will focus on some of the other strands in the community care web—believe us, it is a tangled web. Several key themes emerged during the year that we spent taking evidence; those are reflected in our report. The vast majority of the Sutherland recommendations have been accepted and are being acted on by the Executive. I would like to welcome the commitments that were made in October and again last month by Scottish ministers. In October, Susan Deacon announced substantial extra funding for community care—funding that will rise to £100 million in 2003-04. She announced that joint working—joint managing and resourcing of community care services—would be in place by 2002. She also announced measures to improve the availability of respite, aids and adaptations and additional home care and rapid response packages. All those announcements were welcomed by the committee and by members in the chamber.

In January, those announcements were followed by further commitments to joint and holistic needs assessments—as outlined in the chief nursing officer's report—and the introduction of proposals to implement free personal care for all. The Executive has set up the care development group and will consider the means with which to implement change. The time for talking is over and, as the motion says, now is the time for action.

The events of the past few months and the work of the committee and the Executive have taken us part of the way along a journey towards free personal care and, beyond that, to greater dignity for our pensioners and others. Over the next few months, the development group, the Health and Community Care Committee and the Scottish Parliament will finish the job of implementing free personal care and will complete the community care jigsaw. Members should make no mistake—one way or another the job will be completed. The development group will produce conclusions in August to form part of a bill on long-term care. That bill will be scrutinised by the Health and Community Care Committee as well as by every member in this chamber—in which there is a majority in favour of free long-term care. If we do anything other than implement free personal care, the people of Scotland will never trust us again and they will be right in that.

It is clear to all of us who considered the issue that several key difficulties lie between us and our goal. There is a great deal of work to be done. Sutherland did not have all the answers and neither do we. As a committee, we decided unanimously against putting a timetable on our final recommendations, partly because when work has been completed on what needs to be done and how it needs to be done, we will be in a much better position to grasp when it can and must be done.

The excellent news is that, despite the amendment, the Parliament is moving forward together down that path. There is a high degree of unanimity and central to that is the belief of the Parliament that the service user is at the heart of every change in the community care system. Our report states that our

"concern has been to put the individual and their needs at the heart of the Inquiry and to explore how structures, resources and services can best be structured to respond to these needs."

The Scottish Health Boards Network told us that

"There is still a tendency to fit people into services rather than fitting services around people."—[Official Report, Health and Community Care Committee, 6 September 2000; c 1138.]

We want a system in which people are not only given fair and equitable access to quality services irrespective of where in Scotland they live, but where we can gauge the level of unmet need, from aids and adaptations to respite care. We welcome the news that the care development group will examine current service provision and identify gaps and duplications. It cannot be right that people pay different amounts for the same services in different parts of Scotland. We welcome the fact that the Executive is working with the Convention of Scottish Local Authorities to investigate such an unfair example of postcode prescribing. We also welcome the fact that the Executive will take reserved powers to issue guidance on charging for councils if necessary. Services should be supplied on the basis of need, rather than on the basis of a person's address.

The committee discovered a general view that service delivery throughout the country is distinctly patchy. That led us to call for a more systematic national approach. We felt strongly that there is a real need for systematic change in Scotland's community care services to assist in the fair distribution of services and in their financial planning. We highlighted the needs in the areas of prevention and convalescence: the work that is done in rapid response teams to avoid hospital admission or intensive home care packages following discharge. Members were able to see such schemes around Scotland.

Those comments echo the proposals that were outlined by the Executive in October. We must remember that all the work—in the committee, the joint future group and the Executive—was being carried out at the same time. We have all been moving towards an end point, but we are taking slightly different approaches to reach the same end.

We need a work force that is properly trained. We also need services that are based on the individual. We appreciate that that will depend upon the good will and skills of our community care work force, but we believe that they will continue to rise to the challenge. We are keen to see social work service provision available round the clock, and a more holistic approach to assessment and care. We welcome the development of the role of generic care workers, who combine home and health care tasks. We are keen to see greater multidisciplinary training for all sectors of the work force. We recognise that our proposals involve the need for work force planning. Multidisciplinary team working is a fact of life, and the sooner members of staff are trained in that and take that training as a matter of course, the better for future services.

The Health and Community Care Committee also feels that there is a need for greater funding of community care in future, so we welcome the announcements on extra funding that were made in October and January by the Minister for Health and Community Care. Several submissions highlighted the fact that local authorities were failing to spend up to grant-aided expenditure on care of the elderly and community care services, with children's services being a particular drain on social work budgets.

While evidence suggested that the total sum that was being spent on community care was inadequate, it also highlighted the lack of a systematic method of calculating community care expenditure. Horrifyingly, current systems not only fail to record what is being spent on community care, but they fail to record what should be spent. The Executive's commitment to the introduction of best-value criteria should be welcomed as a step in the right direction in examining current deployment of resources. It has said that it will introduce legislation that will facilitate single funding streams. Generally speaking, we are looking to build a new community care service in which every service is based on best-value evidence and best practice. That view is shared by the joint future group.

We felt that resource transfers lacked accountability and were a continuing source of mistrust across professional boundaries, and that further work should be done on quantifiable targets. We also highlighted some of the difficulties that face the voluntary sector in community care.

It is clear that a great deal of work must be done to break through the community care funding fog, and to allow professionals to work together in a more integrated way. Against a background of a funding imbalance between community and institutional care, we would like to see a further shift of people into the community, and to see the total funds that will result from the closure of long-stay beds being released for community care services, with joint agreements agreed prior to closure. There should be a full audit of the remaining capital resources that will be released through hospital closure. There is a need for greater funding clarity.

That is a major area for further work if we are to deliver the best use of Scotland's community care pounds. The Health and Community Care Committee calls for a full audit of funding needs and available resources, which would allow the production of a national financial framework for community care services. I am pleased that the Executive's response to the committee's report agrees that that is the way forward. The delivery of community care services should be a national priority, and the Executive should signal that through the production of a national service framework for community care services, which should be monitored annually.

Ultimately, financial accountability, national standards and quality services are delivered locally and it is necessary for us to look at local organisations. The Health and Community Care Committee feels that there should be local freedom to decide on the best means of care delivery. However, we set that against a clear belief that a single body should be responsible for budget holding and the planning and commissioning of community care services, as opposed to the current situation in which health boards, local authorities and primary care trusts are all involved. The evidence that was given to us was not clear-cut on which of those organisations should be the single body or, indeed, whether there should be a joint board. We are aware that the Executive has been working on this issue. We want a single point of entry to the service for users and their families and we want staff to be encouraged to work together by systems, organisations, funding and training.

We hope that the needs of citizens who require community care services will be met in a way that gives them dignity and a good quality of life. Our report touches on the importance of appropriate housing and planning, as well as on social and health care.

We were reminded often by the evidence that we took that we were working on behalf of thousands of Scots who cannot speak for themselves. Some are elderly, some are disabled, some suffer from dementia, and some care for loved ones in terrible situations, but all of them rely on community care services. We speak for them—our committee has listened to their voices. I believe that we have produced on their behalf a piece of work that will change their lives for the better and give our elderly a brighter and fairer future.

I commend the report to the Parliament, and I sincerely hope that colleagues on all sides of the chamber will support it.

I move,

That the Parliament notes, and calls upon the Scottish Executive to act upon, the recommendations contained within the 16th Report 2000 by the Health and Community Care Committee, Inquiry into the Delivery of Community Care in Scotland (SP Paper 219).