Hansard

On behalf of the Scottish Conservatives, I support the bill. I thank all those who contributed to and supported the passage of the bill, including the witnesses and our loyal and hard-working clerks. I agree with the minister that work remains to be done. After spending two years and eight months as a member of the Health and Community Care Committee—I am one of the first members of the committee—I had not appreciated that that work would include the manuscript amendments that arrived at the last minute. However, we are at the beginning, not the end, of the process.

The bill is undoubtedly the most contentious to pass through the Parliament. Many considerations and principles underlie it, including financial considerations, which tended to get the most press. The bill should also be viewed from the perspective of equality of access to health care. If an elderly person is dying from cancer, a stroke or heart disease, all their health care costs are met, but old, frail people with Alzheimer's disease or Parkinson's disease are given limited support. The bill will ensure that elderly people will not be discriminated against on the grounds of their illness.

For me, visiting places such as the Western Isles was an incredible experience. Four members of the existing committee—Margaret Jamieson, Margaret Smith, Dorothy-Grace Elder and I—went on those visits. I suspect that the people that we met were shocked by the similarity of members' lines of questioning and that they felt some admiration and respect for us, as we were big enough to put health, and health of the elderly in particular, before politics.

The one or two points that I will make relate to our continuing work. Age Concern Scotland raised the issue of notional capital, although the committee probably did not spend as much time on that issue as it should have done. There is no doubt that that issue causes enormous distress, confusion and argument, as well as lengthy legal battles. Given the fact that the bill strives for equity, surely we need to set out guidance for families on that issue.

I make no specific proposal, but I draw members' attention to the fact that inheritance tax is not due on assets that are disposed of seven years prior to death. However, councils—at their discretion—can take into account a family home that was disposed of 20 years before care was accessed by claiming that the home was disposed of in order to deprive that person of capital. I am not saying that the period of 20 years is right or wrong, or that the period should be seven years. I am asking simply for clarity and, in particular, consistency in councils across Scotland.

I will quote from the Age Concern document:

"We do not wish to support the practice of giving away property with the sole intention of avoiding care fees, but we want to see an end to the draconian practice of including as notional capital the value of assets given away over a decade ago."

I am not saying that the period should be seven, 10 or 20 years. I am asking simply for clarity and consistency across health boards in Scotland.

Much of the free personal care will be delivered in the elderly person's own home. The recent Accounts Commission report talked about

"national policy focusing on care at home rather than institutional settings",

but the facts and the figures prove that the opposite is true. I raised that point in the Health and Community Care Committee and I make no apologies for raising it again. There will be tremendous demand for care at home on 1 July.

I will use the figures from the Accounts Commission's report. Between 1997 and 2000, the number of people that health visitors saw fell by 49,800. Between 1998 and 2000, the number of people who receive home care fell by 9,000. Between 1999 and 2000, the number of people that district nurses saw fell by 13,300. The numbers of people who attend day centres and who live in residential homes were also down. I hope that the provision of care to assist people in their own homes will be in place on 1 July, given the decline in those figures in recent years.

Although I am disappointed that we will still not have a single body for budget holding and planning and commissioning community care services, as was recommended by the Health and Community Care Committee, I accept that aligned and pooled budgets are undoubtedly a move in the right direction.

I note that where joint working does not deliver the outcomes that are expected—in other words, in cases of failure, in which the expected outcomes are not delivered—ministers can intervene to adopt key principles, such as single management and single budget. I am still not clear how the effectiveness of joint working will be measured. There needs to be some clarity about that. Quite honestly, 3,000 blocked beds represent proof that joint working is not as effective as it should be. There should be clarity about the outcomes that are expected from joint working—the outcomes on which joint working will be judged—and at what point the Executive will intervene.

There is also a concern about unmet need, which has emerged often in the Health and Community Care Committee. I spoke with my colleagues John Farquhar Munro and Rhoda Grant at a meeting with Highland Council and Highland NHS Board this week. Very little seems to be known about the unmet need for care in the community. Although we are clear about waiting times, waiting lists and all the procedures that are undertaken in the NHS, we are not clear about the unmet assessed need in the community. It is not always acknowledged that the care plans that people are given should reflect the provision of care—not a wish list.