Hansard

I welcome Malcolm Chisholm to his new job as Minister for Health and Community Care. As Nicola Sturgeon said, that is one of the most difficult jobs in Government in Scotland, but if anybody can do it well with charm and some ability, I am sure that that person is Malcolm. We trained him well on the Health and Community Care Committee, and he has continued to do great things since he ceased being a member of that committee.

I welcome the two new deputy health ministers—their positions reflect the importance of the health brief. The Labour party needs three people to do the job—or four if Margaret Jamieson, who is a member of the Health and Community Care Committee, is included—and the SNP needs two, while the poor old Tories and Liberal Democrats need only one each. I am not sure what that tells us about quantity and quality.

The experience of the three health ministers will be good not only for the health portfolio, but for the Parliament. Malcolm Chisholm has experience as a deputy convener and Mary Mulligan and Hugh Henry have experience as conveners of parliamentary committees. They will make use of that in performing their ministerial duties. I look forward to working with them in the future.

I must also pay tribute to, and bid farewell to, Susan Deacon. It would be fair to say that we did not always see eye to eye; we definitely did not see eye to eye on free personal care for the elderly. At no time, however, did we have anything other than respect for one another and the positions that we held. I was always very taken with the energy that Susan Deacon brought to her brief and with her hard work and commitment. Susan Deacon cared deeply about health care in Scotland and I wish her well for the future. For the past two and a half years, she has had her hands full, but she will have her hands full with something else in the year to come. I wish her well in that respect. If she finds herself on the Health and Community Care Committee, I recommend that to her—it is never dull. That would be fun, but I have no comment to make on what the former minister would make of it.

It is a privilege for me to stand in the chamber today as the Scottish Liberal Democrat spokesperson on health and as the convener of the Parliament's Health and Community Care Committee to acknowledge our wholehearted support for the general principles of the Community Care and Health (Scotland) Bill.

The bill will provide for the introduction of free personal nursing care for older people; the regulation of charging for home-care services, which have in the past been a postcode lottery; a legislative framework to permit greater joint working between the NHS and local authorities and others who provide care; and extensions of carers' rights. The bill will tackle inequities and bring diagnostic equality and equity to care of the elderly. The way in which we treat our older people is a crucial test of our society. The bill represents an opportunity for the Parliament and the Executive to send a clear signal that we are determined to treat our older people with respect and dignity. I am happy to support that.

The bill is the culmination of a hard-fought battle and of a great deal of work that has been undertaken over many years. I pay tribute again to Sir Stewart Sutherland's work and to the work of his commission. I thank the members of the Health and Community Care Committee for their work over several years. I also thank the joint future group and the members of the care development group, under the chairmanship of the new Minister for Health and Community Care, for the work that they have put into the development of the policy.

The bill will deliver free personal and nursing care for Scotland's elderly and I welcome that whole-heartedly. Free personal care has undoubtedly been one of the Scottish Parliament's most contentious issues. However, in accepting the Sutherland commission's findings, we have contributed to one of the new Parliament's finest hours. Free personal care has the unequivocal backing of my party, the considered backing of the Health and Community Care Committee and the backing of the majority of MSPs of all parties. I believe that the paraphrase "the settled will of the people of Scotland" applies to the bill, which should not, must not and will not be thwarted or deflected.

Let us not forget some of the reasons why the bill is necessary. The system of payment for care was a confusing, unfair muddle: care in hospital was free, but intimate personal care delivered in an older person's home was means-tested and charged. The amount that an older person paid depended not on their needs but—because of charging policies in Scotland's councils—on where they lived.

That system has treated badly in particular the 60,000 Scots who suffer from dementia, because it penalises them for the consequences of their illness in a way that is different from those who suffer from cancer, heart disease or strokes. Opponents of the policy say—and will continue to say—that the provisions of the bill affect only a few thousand Scots who could afford to pay anyway, but I disagree totally with that. The provisions of the bill are about fairness for all our pensioners. The issue affects everyone. It will benefit us all to take away the fear of paying for care in old age and of losing the home that one has worked for all his or her life. The provisions of the bill will benefit tens of thousands of Scots who currently pay for nursing care and personal care and who currently receive care in their own homes.

If people look to the bill to reflect some of that sense of principle and some of the rhetoric that we have heard pronounced so eloquently in the course of the past two years' debate on the issue, I am sad to say that they will be disappointed. The bill is dry and technical and much of it refers back to and amends the Social Work (Scotland) Act 1968. Perhaps that is the way that it must be.

The Health and Community Care Committee supports the view that was expressed by many witnesses—including community care providers in Scotland and Carers Scotland—that the bill's general principles on the provision of free nursing and personal care, the delivery of joint working and the position of carers as partners in the provision of care services should be made explicit in the bill. We hope, partly because of what we have heard today from the minister, that the Executive will think again about that. I appreciate the need for clarity and precision in the legislation, but I do not think that the task is beyond our new minister.

I am delighted with the minister's assurances that the definition of personal care will be included in the bill. The committee welcomes the care development group's definition of personal care, which covers personal hygiene, continence management, food and diet, problems with mobility, counselling, simple treatments and personal assistance. The committee heard evidence for and against the inclusion of a definition of personal care in the bill, but on balance decided that such a definition should be explicitly included. However, we know that there might be a need for flexibility to improve the definition and we therefore recommend that ministers should be able to amend the definition by subordinate legislation, as long as that amendment improves and adds to the definition. Controversy surrounding the cost of the policies rages on, with different economists crystal-ball gazing into the future. Last June, Angus MacKay announced £200 million to resource free personal care and other aspects of the bill in 2002 and 2003. That built on £100 million for community care services that was announced by Susan Deacon in October 2000 and January 2001.

The Health and Community Care Committee took evidence from Professor David Bell, professor of economics at Stirling University, who is a member of the care development group with responsibility for costing free personal care. He outlined the costing exercise, which took into account demographic change and the aging population, health expectancy—which is expected to improve—and changes in the unit cost of care at the level of a 2 per cent increase each year. Although Professor Bell undertook a rigorous examination of costs, the minister has stated that the figures are at best prediction. There remains a lack of certainty over costs. It is clear that there will be increases in years to come and the committee has called upon the Executive to monitor continually progress in that area.

The Scottish Liberal Democrats and the Health and Community Care Committee back the Executive in its attempt to secure continuing payment of attendance allowance by the Department for Work and Pensions. The committee noted that in England, nursing care was being extended to include—without any withdrawal of benefits—elements of what would in Scotland be primary care. We consider that any withdrawal of the £20 million in Scotland would therefore be discriminatory.

The committee welcomes the Executive's plans to ring-fence the resources that are distributed to local authorities for implementation of free personal care and the other provisions of the bill. The Sutherland commission, the committee's report and the care development group all noted the funding gap between the amount of grant-aided expenditure that is distributed to local authorities and the amount that is spent on services for care of the elderly. Executive figures that the committee received—which show only part of the picture—show that only one third of Scotland's councils spend to or above GAE on older persons services, while overall our councils spend £98 million above GAE on all social work services. It is essential at this stage that we ring-fence the money that needs to be put in place to deliver those policies and that we move as swiftly as possible towards outcome agreements following negotiations with local authorities.

The bill includes elements of choice in care services, including deferred payments, which will allow individuals to enter into agreements with councils to defer selling their homes to pay for care. Although we welcome that, the committee had sympathy for a view that was expressed by COSLA, the Association of Directors of Social Work and others to the effect that that would mean councils engaging in new activities, which would be paid for by increased borrowing. We think that there is at least a need to consider that nationally and to have it administrated nationally rather than at council level. However, if the Executive does not accept that, it could consider the possibility of phasing some of those extra duties on to local authorities over the course of the coming year.

The committee welcomes the bill's provisions to extend direct payments and the ability to tailor services to individual needs. We recommend that a duty be placed on local authorities to advise individuals that they have a right of access to direct payments. We hope that that work will be developed in order to cut the bureaucracy of the present system and to encourage more people to make use of that service.

The committee welcomes the Executive's plans to give carers an independent right of assessment, but there must be a positive duty to ensure that carers are informed of that right. We welcome the news that there will be an amendment to that effect. We called on the Executive to consider the possibility of imposing a duty on councils and the NHS—which deal with 620,000 unpaid carers in Scotland—to identify carers and to ensure that they are informed of all their rights.

For many, the Community Care and Health (Scotland) Bill is simply the free personal care bill. However, the bill also sets up a framework for joint working that will allow greater partnership and flexibility between key community care partners in the NHS and Scotland's local authorities by lifting legal impediments to closer working. It is true that the committee has been concerned about the lack of progress on joint working to date, and we welcome the possibility of ministers being able to exert pressure on local authorities and other partners to work together. We also welcome their ability to enforce the bill's powers if that is necessary. We feel that it is important that all partners in care, including the voluntary sector, service users and carers, have a say in the development of joint working models.

There is a real challenge to all the component bodies to work together. We understand that the role of those who deliver services is critical and we have some concerns on that front. We know that successful joint working relies on a motivated and integrated work force. That is why we support the removal of barriers through nationally agreed salary levels and conditions for all those who work in care.

I welcome the minister's comments. We hope that the bill will mark a sea-change improvement in the delivery of community care services. We hope also that it will provide a framework that delivers not only free personal care but greater resources, better integration, shared assessments, effective partnership and our ultimate goal, which is a better quality service for the people who rely on community care services in Scotland.