Hansard

The contents of this excellent report show quite categorically that the well-being of our citizens and the health of our nation can come before party politics or in-built dogma. I commend the committee on the depth of the report, on the consensus achieved in drawing up the report and on making community care a priority for the Scottish Parliament. The public perception is that the report is purely about Sutherland, as has been stated, and it is perfectly easy to understand why.

Last year, at the height of the fuel crisis, I had the privilege of addressing more than 1,000 pensioners who had struggled to get to Edinburgh and had marched to their rallying point at the National Gallery. I said to them that the full implementation of Sutherland had less to do with health and care than it had to do with dignity, and that dignity was not an issue over which any pensioner should have to demonstrate. I congratulate the committee on its recommendation that the dignity of care of the elderly be restored. Sadly, I remain unconvinced of the Executive's resolve to implement that section of the committee's report. That feeling is only strengthened by the nature of the amendment that the Executive has chosen to lodge.

As others have said, however, the report is not purely about Sutherland. I have particular sympathy for the recommendation that the budgets for health and for social services should be amalgamated into a single budget. That single budget, if properly administered, would provide clear accountability, remove artificial distinctions between health and social work and ensure that the services work in a unified way to provide what is best for the patient at the time it is required. Ensuring such a unified service as opposed to the fragmented and disjointed one that exists all too often today would speed up both assessment and service provision as well as ending disputes over which agency pays for different aspects of the patient's treatment. In other words, that should provide a better service at a better value. It would also excise the practice of bedblocking, which has resulted in some 3,000 patients being kept in NHS beds when they should be in community care. That is double the number that there was three years ago and takes up almost 8 per cent of the average number of available staff beds in our hospitals. Bedblocking is ludicrously expensive and any initiative to end it should be grasped with both hands.

As a member of the Rural Development Committee, I am particularly pleased that the report pays considerable attention to the mentally ill, the disabled and those with learning difficulties because, in rural Scotland, those people face even greater problems than do their peers in urban areas. I am particularly concerned about such situations as one in Dumfries and Galloway that was recently brought to my attention. There, residential facilities are being closed and patients are being placed into often unsuitable housing in surrounding communities.

Although I understand the intentions behind such moves, I am not convinced that the policy has been properly thought through. Residential facilities have previously been a training ground for people's eventual return to the community, with appropriate support. The worst-affected patients remain in the residence, which becomes their home and, in a sense, their family. To close that home without putting the savings back into increased support services seems to be utter folly. We are surely past the days when financial savings come before patients' interests. If policy is properly thought out, the two can go together. All that is required is a little joined-up thinking. The committee's report encourages just that.

Still on Dumfries and Galloway, I cannot miss the opportunity of mentioning the consequences of that council's policy of externalising its care homes. Within two years, that policy led to a 68 per cent decrease in the number of patients referred to private nursing homes—from 186 in 1999 to only 60 last year. It has affected costs in the externalised homes, which enjoy a guaranteed 100 per cent occupancy rate and about £420 per patient per week, as opposed to approximately £260 per patient per week in a private home. In short, it has led to discrimination against private care homes. I believe that the minister needs to ask serious questions to get to the bottom of that inequality.

The Executive must not think that this debate on the Health and Community Care Committee's excellent report is the end. I hope that it is only the beginning, and that the Parliament will take every opportunity to ensure that the Executive puts into practice the committee's recommendations.