Hansard

On behalf of the Scottish National Party, I welcome the Regulation of Care (Scotland) Bill. I also welcome the fact that the headquarters of the new Scottish commission for the regulation of care and the Scottish social services council will be based in Dundee, which is an excellent choice.

There are high hopes that the bill will lead to major improvements in our care services through effective and consistent regulation as a result of the establishment of the Scottish commission for the regulation of care and the strengthening of user and carer involvement in care delivery, standards setting and regulation. Of equal importance is the establishment of the Scottish social services council to register care staff and promote high standards of conduct and practice among the work force and to ensure that they receive high standards of education and training; the quality of social work services depends greatly on the quality of staff.

Why are the changes necessary? The current system of inspecting and registering care services is inconsistent and depends on the type of care establishment. Responsibility is divided between health boards and local authorities. Many services are not formally regulated at all. The Minister for Health and Community Care alluded to some of them. I am particularly pleased that day care and home care services will be brought into a regulatory framework. It will be interesting to see how we manage to regulate and inspect home care services with sensitivity, given that that will be done in people's homes, but I am sure that it will be achieved.

Local authorities inspect many of their own services. That is not satisfactory; a conflict of interest can arise. The lack of integration has made it difficult for residential and nursing care services to be provided in one establishment, which means upheaval for elderly people as their needs change and they have to move to another establishment. A single category of care home will end that disruption.

At present, no system is in place for the regulation of those who work in social work. That must be changed. Over the years, the vast majority of staff in social work have done a marvellous job and they should be commended, but we have seen a small number of serious incidents in all care sectors involving vulnerable children and adults. Through the effective regulation of the work force, this bill must put an end to abuse and protect the 500,000 service users in Scotland. That is quite a challenge, but we must ensure that the public has full confidence in care services and that they feel that they can speak out when things are not going well. There is no doubt that people worry when they read how one in five elderly people who are resident in care homes are malnourished. The public must believe that this bill will put an end to such scandals.

Whistleblowing is one of the most effective methods of policing poor standards or practice, but staff and service users have to be confident that the system will protect them. It has to be said that there is little confidence in the current complaints system. I hope that the bill will change that.

The commission will have a duty to promote the quality and improvement of care services through registration and inspection. An important function of the commission will be to provide the public with information and advice on the availability and quality of the care services it regulates. That fulfils a key recommendation of the Sutherland commission.

While on the subject of Sutherland, I want to draw to the minister's attention the very helpful definition of personal care in the bill. The minister will find that definition very useful in finally coming up with a definition of personal care for the full implementation of free personal care for the elderly. When he sums up, he may wish to take the opportunity to provide a guarantee that the definition that the care development group comes up with will not be narrower than the definition in the bill.

Some areas of concern have been highlighted through the Health and Community Care Committee. I have said that the general principles of the bill have been broadly welcomed by a range of organisations, but widespread consultation and the evidence have highlighted a number of key concerns, particularly around inspection levels, maintaining local links, the transfer of staff and the funding for the commission and the council.

The registration and inspection process will provide the commission with important powers to issue improvement notices that will list what improvements must be made. If those improvements are not made, a provider's registration can be cancelled. That is a very important sanction that the commission can use to drive up standards.

A key worry that was expressed to the committee concerns the Executive's proposal to limit mandatory inspections to one per year. The National Association of Inspection and Registration Officers said:

"NAIRO strongly opposes a retreat from the Executive's own current target of two inspections per year. NAIRO believes that unannounced inspections reflect everyday service standards more accurately and rightly enjoy greater public credibility."

Real concern was expressed about any reduction in the number of statutory inspections, given that two is the present minimum. It could be argued that organisations will be expected to pay higher fees for less of a service in that respect. Reductions could also be seen as rewarding bad practice and penalising good practice.

The recent Accounts Commission report on performance indicators showed that some local authority social work departments are not even meeting the target of two inspections a year, while others are prioritising inspection to go beyond that target. We should not reduce the number of inspections to the lowest common denominator. The evidence that the committee received was overwhelmingly in favour of retaining two inspections a year for residential care homes, of which one should be announced and one unannounced. Although the minister has argued that one inspection a year is only a minimum, the danger is that the minimum becomes the norm.

It is important for public confidence that the public are reassured that care homes are being regularly and thoroughly inspected. I was struck by the comment, which appeared in a recent Sunday Mail article, of the daughter of an elderly man who died in appalling circumstances in a private nursing home. She said:

"Health boards still do not go in and investigate vigorously. They give too many warnings that they're coming. So I'm not surprised that old people are still being mistreated and starved."

We must make sure that people are reassured. Reducing the level of inspections will not do that.

How staff will be transferred is a key area of concern for the 500 staff who will go to the Scottish commission for the regulation of care and the Scottish social services council. Questions have been asked about whether the Transfer of Undertakings (Protection of Employment) Regulations are sufficient to deal with those concerns, which include the location of regional offices, the difficulties of homeworking, conditions of service, pension rights and employment alternatives. I know that some reassurances have been given: my colleagues from the Local Government Committee will deal with that in more detail.

Although we now know where the headquarters will be situated, the proposal for five regional offices has generated a lot of concern. We have yet to hear a coherent argument from the Executive on why that model should be followed. The Health and Community Care Committee is of the opinion that the model should be revisited and that there should be some correlation to existing administrative boundaries.

Without doubt, fees have been the most contentious issue. The Executive proposes to fund the start-up costs but expects both bodies to be self-financing by 2004-05 through the registration fees of care providers and staff. That has been condemned as unrealistic by organisation after organisation. I quote NAIRO again:

"We as both providers and purchasers of services are very concerned about the belief that the commission can achieve self-financing through fees: we do not think that is achievable. It is clear that the imposition of fees on local authorities will draw on community care moneys. We pose the question whether that is the best use of the community care pound".

Existing registration and inspection units raise less than one fifth of their cost through income that is generated by the units, but that is expected to become 100 per cent within three years. That can be achieved only through massive increases in the level of fees. As we have heard, there is an intention to increase the fees from the current £10 to £95 by 2003 and possibly to as much as £180 by 2004. That is quite a jump. All the bodies that gave evidence to the Health and Community Care Committee roundly condemned that hike. The committee asked the deputy minister to think again about the issue. I hope that when he sums up, he will indicate that he has done so, although the Minister for Health and Community Care's opening speech and the letter that I received this morning do not suggest that that will be the case.

I will move on to another related problem that NAIRO highlights. It is inevitable that the bulk of the increase in fees will be passed on, in the charge for the care home place, to the client. As we know, local authorities' community care budgets fund about 80 per cent of the places that private and voluntary care providers supply. Therefore, all that will happen is that community care budgets will bear the brunt of the increase in fees. The Minister for Health and Community Care looks puzzled. If she wants to ask for clarification, I will explain the position differently.

Does the minister think that it is sensible for money from one pot of public money—the community care budget—to go through a convoluted route to pay to run the commission and the council, which are public bodies? The value of the community care pound becomes less each time it is moved, because of administration costs. Do ministers think that that is best value? No doubt we will hear at the end of the debate.

In the Health and Community Care Committee and today, ministers have argued that the increased charges would be covered by increases in the total revenue grant funding to local authorities. When the deputy minister said that to the committee, everyone laughed, because we know that local authorities remain cash-strapped. More important, the money is not ring-fenced. We heard some honest evidence from social work managers, who admitted that they often use community care money for other priorities, if needs must.

Voluntary organisations fear that local authorities will not increase their funding, leaving them to find the money for registration fees by cutting staff or services. They are not reassured. The Health and Community Care Committee did not buy the deputy minister's reasoning on funding. I hope that ministers will listen to the overwhelming opposition to the self-funding model. The structure must be revisited to devise a fairer, more workable and more realistic system.

The general principle of people paying a fee to register with the council has been accepted, but the fee should be based on a person's ability to pay. It may not be fair to expect a childminder or social work student to pay the same as someone who is in well-paid employment.

Many organisations that gave evidence to the Health and Community Care Committee backed the introduction of a children's rights commissioner. Some believed that proposals should be in the bill. I have sympathy with the argument that Children 1st, Barnardos Scotland and NCH Scotland made in evidence: that they would prefer separate legislation to create the post of children's commissioner rather than risk the role being curtailed by the bill's scope. I am relaxed about how the post is introduced—whether in the bill or through the Education, Culture and Sport Committee—but the Executive must make progress on its establishment, to afford Scotland's children the same level of protection as Welsh children will receive under the Care Standards Act 2000.

The bill is an opportunity to improve the delivery and monitoring of care for some of the most vulnerable people in society. We are all behind that aim. The committee has invested much time and energy in hearing a great deal of evidence. There is much agreement and consensus across the parties on what needs to change in the bill. I hope that when the minister meets the key stakeholder groups next week he will listen to what they have to say about the changes that are required—the bill will be all the better for them.