Hansard

I begin by thanking the members of the Health and Community Care Committee for their work on the bill. I thank the members of all the other committees that have considered the bill and the Deputy Minister for Health and Community Care for his assistance on various points.

The Scottish Liberal Democrats and the Health and Community Care Committee—I can happily wear both hats during my speech—welcome the general principles of the bill. It is wide ranging and ambitious and it covers a number of different types and locations of care services.

The aims of improving the quality of care services for service users and their carers, and of providing registration and regulation of a properly trained professional work force—which cares for up to half a million Scots at any one time—will have universal support. The bill is a genuine attempt to improve standards and to protect the most vulnerable people in our society. The bill's key elements include the establishment of a Scottish commission for the regulation of care to provide for the regulation, inspection and registration of prescribed care services, including the setting of national care standards. The bill also includes provision for the setting up of a Scottish social services council.

I associate myself totally with the comments that have been made by colleagues to the effect that the quality of services that are delivered is fundamentally allied with the quality of the staff. We have a number of very high quality staff working in care—I hope that the bill will make their contribution even better. The bill will fulfil the recommendation of the Sutherland commission to take a strategic overview of care and will extend it beyond care of the elderly.

Why is the bill necessary? At present, we have a fragmented system, which includes different forms of registration and inspection in different settings. Not all care services are subject to statutory regulation and much of the legislation that governs care is out of date. Some services, such as residential care homes and day care for children, seem to be within the regulation of councils, although nursing homes are regulated by health boards. Add to that the fact that council-owned residential homes do not have to register, but are inspected, and we have a dog's breakfast of care. More and more people are being cared for at home, but as things stand, the services that are delivered there are neither registered nor inspected. I welcome the fact that the bill deals with the registration and inspection of day care and home care.

There has been concern about the lack of independence in the system, as local authorities are responsible for commissioning up to 80 per cent of services, regulating residential care homes and for providing some residential care home places. The bill introduces a purchaser-provider-regulator split that is welcomed by local authorities, as well as by everybody else. There have been claims of a lack of consistency throughout the country. The bill will introduce national care standards which, I hope, will bring consistency and fairness and improve services. Those standards will also provide clear guidelines on what is acceptable to those who provide services. Providers have told me that that will also be helpful to them.

There has been a lack of integration in the past, which meant that it was more difficult for residential and nursing home services to be provided in one establishment. That has led to elderly people in particular being moved when their need for nursing care increased. Such moves can be traumatic; I have been told by staff on several occasions that such moves have contributed to earlier mortality for certain service users.

Another area of concern was that there is no comprehensive regulation of the social services work force. With more and more Scots requiring care of one kind or another, it is crucial that we have a well trained work force that provides the best care.

Everyone agrees that the bill will tackle all the existing problems and that it represents a welcome step towards improving services. However, as colleagues have said, in taking evidence and in considering the bill, the committees has expressed some concerns. I hope that the ministers will take those concerns on board and address them at stage 2.

The bill is wide-ranging and ambitious, as I said. It seeks to close loopholes in care. However, we have been told in evidence that the scope of the bill is still not wide enough and that other areas should be added. The minister has said that adoption and fostering will be added. It has been difficult for us to conduct proper consultation on that issue, because we know that it is coming, but we do not have it in black and white in front of us. We are still concerned about nanny services and au pair services.

The British Association of Social Workers has mentioned fieldwork social work services, and other members have picked up on the point that Susan Deacon made about home care services, particularly those that are delivered in the homes of children who have disabilities. I was pleased to hear what the minister had to say about that; we will obviously get further clarification in due course. The role of hospices has also been mentioned in the Health and Community Care Committee. We feel that there is a need for greater clarification of some of the definitions of care services, and we would particularly welcome that in relation to support services, supported housing and some elements of independent health care.

The overall feeling that comes through from many organisations, particularly those that work with children, is that they want the added protection that the bill gives to be extended as widely as possible. The Health and Community Care Committee was also concerned about the amount of detail that was not contained in the bill, but which will be the subject of regulations. Our concern is about lack of scrutiny. Much of the work that will be done under those regulations concerns crucial elements of the bill, including transfer arrangements, location of staff and the number of offices, which will effect the efficacy of the legislation. The more information we have, the better we can scrutinise the bill. The committee also mentioned the need for continued parliamentary scrutiny of national care standards and of other important aspects of the bill.

One of the other key areas of concern that has been highlighted by members is the issue of funding and fees. The Health and Community Care Committee was certainly not convinced by the arguments that were put to us by the Deputy Minister for Health and Community Care on whether the proposed system would be the most effective one and whether it would be bureaucratic. The committee believes that it would be bureaucratic, and I certainly associate myself with the comments that were made by Shona Robison about that.

The Richmond Fellowship said in evidence to the committee:

"This convoluted approach with inherent additional time and administration costs does not represent a Best Value approach in dispensing the Community Care £."

The Health and Community Care Committee is good at giving ministers a number of ways to continue to spend even more money on community care. We are trying to be extremely helpful when we say that we think that the Executive could cut spending in the system by making it less bureaucratic. The Convention of Scottish Local Authorities and other organisations also told us that they believe that it is unrealistic to think in terms of the system being

"self-financing through fees from 2004-05."

That will have a major impact on local government, and I associate myself with the comments that have been made on that point.

Almost all the groups that we have spoken to across all sectors—public, voluntary and private—have expressed grave concerns about the impact of self-financing. Capability Scotland estimates that the extra fees, when coupled with the cost of the extra training that is required by the bill, will mean an extra £100,000 in costs to that organisation by 2004. Capability Scotland, Alzheimer Scotland—Action on Dementia, Age Concern Scotland and a host of other organisations have pointed out that the likely effect of the bill will be the loss of some services. The Health and Community Care Committee is sure that that is not the Executive's intention, and urges ministers to look again at the question of the level of fees and the means of funding.

Committee members were also concerned about a possible reduction in services if the minimum number of inspections was cut from the current two per year to one per year. We heard compelling evidence that that would be a mistake. In fact, on a visit to an inspection in Lundin Links, I heard from inspectors exactly what the difference is between announced and unannounced inspections. I learned that, during an announced inspection, they may look through people's books and see a lot of the preparation that has been done, which was relevant and necessary. However, I was told that an unannounced inspection involves a different set of issues for the inspectors to examine. We ask the Executive to reconsider the matter of inspections and to expect a minimum of two inspections a year in residential settings such as children's homes—one announced inspection and one unannounced.

A number of operational and organisational issues concerned the Health and Community Care Committee. We were largely persuaded about the argument for having two separate bodies—the commission and the council—but we feel that it is essential that those bodies communicate effectively. We are also interested in the lines of accountability to the minister from those bodies.

It is essential that service users are included in the new system as much as possible, both at local and national level. Several witnesses mentioned the need to listen to people who use the services; the case for the need to hear the voices of children in public care is especially compelling. We know from reports that we have all read that, in the past, we have too often failed some of those children. Announcements during the past few days about educational attainment show that, despite the best efforts of many good social service workers, we are still failing some children. It is essential that we listen to their voices.

The Health and Community Care Committee supports unanimously the establishment of the post of children's commissioner, but we agree with those who work in the sector who feel that to include that in the bill would restrict a commissioner's powers to help all our children. We look forward to the report of the Education, Culture and Sport Committee on the matter and we hope that the Executive will establish that post.

Whistleblowing is omitted from our report. We discussed the matter and thought that it was right to highlight the need for a robust complaints system, which worked in tandem with existing complaints procedures, but we also wanted to encourage and protect whistleblowers—whether they are members of staff or service users and carers. The nature of the services is such that people can hide abuse and poor service from the authorities and the general public; it is, however, much more difficult to hide it from colleagues.

Several witnesses said that they welcomed the bill's intention to allow for improvement notices to be followed through, rather than homes immediately being closed. That should allow members of staff greater freedom to report any service that they think is failing service users. We must protect them if they choose to do that.

We welcome the establishment of national care standards and the work that is being done by the national care standards committee. It is crucial that the standards are right—they are the standards against which the commission for the regulation of care will inspect services. The standards cover issues of quality of accommodation, quality of care and quality of life. They cover issues that range from nutrition and high staff turnover to complaints procedures, cultural considerations and privacy. However, health board chief executives and COSLA were critical of the draft standards and called for them to be "enforceable and measurable".

Everybody welcomed the proposal to set up a Scottish social services council to promote high standards of conduct and practice among social service workers through the publication of codes of practice; regulation of education; training of social workers; and the establishment of registers of relevant groups in the care work force. Several specific issues have been raised about the council, but the main point is that registration of staff must be done as quickly as possible; the Health and Community Care Committee endorses the Local Government Committee's call for a clear timetable.

Several witnesses expressed concern about the number and location of commission offices, and about the issue of staff working from home. It is essential that we strike the right balance between national standardisation of services and local interface with service users. We have asked the Executive to reconsider the number of offices and—specifically—to consider the possibility of linking that number to the number of health boards. That would link in with the new approach that is outlined in "Our National Health", and make use of existing offices.

I am running out of time, so I will not mention staff transfer. We will come back to that issue at stage 2, although I am sure that colleagues will mention it.

The Health and Community Care Committee looks forward to playing its full part, at stage 2, in taking forward a bill that is generally welcomed throughout Parliament and its committees. Work must still be done to improve the bill, but the bill will improve the lives of all Scots who receive care—wherever that care is delivered. I endorse the general principles of the bill.