Hansard

I am aware that, between the submission of evidence and today, there has been quite a bit of movement. That is why I say that the points that have been made are constructive. I am sure that there will be more movement at stage 2.

Alzheimer Scotland does not pay registration fees for currently registrable services such as day care or for unregistered services such as home support, so it would attempt to add any fees that are imposed to the price local authorities are charged. If local authorities refused to increase their payments, the costs would have to be absorbed by the organisation, which would have to reduce either the number of its staff or their remuneration or conditions of service. I do not think that anyone here would want that.

In Inverness, we have a centre called the Woodlands Centre for Alzheimer's patients. It is attached to a day care centre for the elderly. There seems to be confusion where two centres are side by side. Will there will be one registration fee, or will there be an additional fee because the council commissions services for Alzheimer's sufferers? I would like some clarification on that.

The Community Care Providers Scotland registration fee is likely to increase by as much as 300 per cent. In evidence to the Health and Community Care Committee, Annie Gunner said:

"we are … concerned that the bill will give us more of the same … except that the big difference is that we will pay a heck of a lot more."—[Official Report, Health and Community Care Committee, 7 February 2001; c 1524.]

That has to be a concern, especially for very vulnerable people.

The Scottish Association for Mental Health has estimated that it will need an extra £32,500. It has given evidence to the Health and Community Care Committee on the cuts in its community care service and the funding problems it faces.

Community Care Providers Scotland told the committee that although the fees per bed space were £65, the increase in fees this year for registration has been 44 per cent. The fees per bed space went up from £45 to £65. That massive increase has set a precedent for future increases, which is quite horrific. Another witness from CCPS said that the increase

"was intended to soften the blow and to bring registered care homes in line with nursing homes … we now face another 45 per cent increase over the next three years"—[Official Report, Health and Community Care Committee, 7 February 2001; c 1531.]

Those kinds of figures are frightening to many voluntary organisations.

Fees will not be a problem for local authority services as the authorities will retain £3.2 million of their current budgets for registration and inspection to retain some staff and to pay fees for regulation of the services that they provide themselves. The problem is to provide a level playing field for the private sector, the public sector and the voluntary sector.

A witness from the Carers National Association told the committee that costs would rise and that somebody would have to meet them. He added that if the money did not come from increased charges, the association would have to raise it elsewhere or limit the service. I can tell the minister that these are genuine concerns. I hope that they will be addressed at the next stage of the bill.

The written submission of Children 1st to the committee said that the organisation would

"be unable to absorb the costs of regulation or to secure the necessary funding to continue."

It is understandable that providers should absorb some of the cost, but most voluntary organisations have minimal management structures and must budget on a shoestring. It is difficult for them to absorb additional costs without paring down their staff or the service they provide.

Paragraph 162 of the financial memorandum refers to exceptions

"where full cost recovery through fees runs counter to other policy objectives."

Paragraph 168 states:

"Expansion of childcare is a key Scottish Executive objective and is linked to employment objectives. The Scottish Executive will therefore provide a continued subsidy … to be held to a maximum of £250 for day care providers and £50 for childminders."

I fully appreciate the commitment to children, but the same commitment does not apply to the mentally ill, the disabled or the elderly, although they are included in our social inclusion package and are the most likely to be affected by reductions in service.

The Leonard Cheshire homes raised another point with me, which undoubtedly needs clarification. Leonard Cheshire in Inverness has residential accommodation, a day centre, home care and flats with up to five people. It is unclear whether its home care, day care and residential care services and the flats will be registered and inspected separately.

There is also a need to define respite care, although I heard what the minister said about care in a person's home. The definition covers residential homes, but when respite care is provided in a child's own home, which is often the case for disabled children, is it a support service or a home care service? That needs to be clarified further.

There must be further clarification of the definitions in section 2(5) of an independent clinic and an independent medical agency. The definition of personal care in section 2(20), debate in the chamber about which is well documented, is quite clear in the bill, but it is of concern that the care development group is currently reconsidering the definition of personal care, as that has the potential to be quite confusing.

The minister mentioned the focus on quality of care and quality of life, which we, undoubtedly like the rest of the chamber, support. However, there is concern that the outcomes relating to care are difficult to find in the bill. In section 24, the only references to caring for the person are in subsection (2)(e), which states that regulations may

"make provision for securing the welfare of persons provided with a care service"

and in subsection (6)(a), which refers to

"(i) the promotion; and

(ii) the protection,

of the health of the persons in question".

I fully support what the minister said in her opening speech, but we ask that there be more positive emphasis not only on buildings, management structures, staff ratios, qualifications, training and registration, but on the quality of care and how it can be measured either by carers or others. More emphasis must be put on caring for the person.

Section 28(8)(f) refers to

"treatment using such—

(i) techniques; or

(ii) technology,

as may be specified in the regulations."

Again we are specifying treatments or technologies that should be covered by the regulations, but the concern is that we do not know which they are. I seek further clarification of that.

This week, I was asked whether the "diet clinics" mentioned in paragraph 208 of the explanatory notes will include Weight Watchers and Scottish Slimmers, whose sessions are attended by thousands of people throughout Scotland every week. I do not think so, but the matter was raised with me and clarification must be given.

Finally, a distinction must be made between care homes and sheltered housing. It is not entirely clear what "supported accommodation" is. Is it hostels for the homeless? There has been much documented evidence on that recently. If support is given for drug and alcohol services—regarding which bad practice has recently been documented on television and in newspapers—it is important to make clear exactly what supported accommodation is. We have hostels for the homeless that may or may not provide some level of care. That is an important point about a vulnerable group.

All the points that I have raised today I received in evidence. If Labour members do not agree with them, they are not disagreeing with me: they are disagreeing with those who gave evidence.

My final point is from Children 1st, which raised concerns about the risk to children from sex offenders who systematically target children and young people and spend time building up trust in order to abuse them in care settings. I understand from the Deputy Minister for Health and Community Care that the consultation process is under way. I must ask whether we should consider the consultation process and the protection of vulnerable children in the context of this bill. Is this bill the natural place to do that, or is it wiser to legislate on that at a later date?

I move amendment S1M-1523.1, to insert at end:

"but, in so doing, expresses its reservations about the level of charges and consequential supply of services."