Chamber
Plenary, 20 Sep 2006
20 Sep 2006 · S2 · Plenary
Item of business
Care Inquiry
Yes. The committee concluded that there are discrepancies in interpretation of the guidance. We raised the matter with the Executive and included it in our report—I will talk more about it. I hope that the minister will tell us what progress has been made in addressing the issue.
During our inquiry, two common misconceptions emerged about what free personal care will deliver. First, there is a misconception that under the 2002 act all care costs will be met by the state. Secondly, there is a belief that eligibility is universal and does not depend on assessment. The committee thinks that the Executive needs to issue clearer guidance on how the policy works.
The committee acknowledges the successes of free personal care, but we consider that measures should be taken to address the implementation problems that have arisen. First, we recommended that the Executive undertake a thorough review of the resources that local authorities—collectively and individually—require if they are adequately to finance free personal care. An increase in funding or more equitable distribution among local authorities might be required. We are pleased that such a review is under way and we look forward to hearing its conclusions.
The loopholes that, in effect, permit the use of mechanisms to ration free personal care should be closed through changes to the legislation, if necessary. The Executive has noted that suggestion and will consider it in its policy evaluation. However, that is disappointing for the committee, so I would welcome further comments from the minister on that.
The Executive should enforce the guidance on the aspects of eligibility that local authorities claim remain ambiguous and it should ensure that services such as assistance with meal preparation—if they are part of assessed need—fall under the free personal care scheme. I am aware that the Executive has made many attempts to resolve the situation, but the committee remains concerned that, overall, it is still unresolved.
The Executive should also adopt a mechanism for determining the long-term level of financing for free personal care—it should decide, for example, whether to increase the financing in line with inflation or some other indicator. The Executive has noted that suggestion, but the committee hopes that it will be considered in the review. I ask the minister to elaborate on that today.
The Executive should also remove the financial incentive for local authorities to delay assessment, either by allowing claims for free personal care to be backdated from the point of eligibility rather than from assessment, or by introducing a mandatory deadline for assessments, which could perhaps be two weeks after application.
Free personal care can be effective only if it is sustainable in the long term, which is an issue that the Executive must address. The committee recommended that the Executive should model carefully the cost of free personal care in the medium term to ensure its sustainability and, in so doing, revalidate the current costs based on demand. As I said, we welcome the Executive's acceptance of that recommendation. Although clear financial obstacles to the extension of the policy exist, a logical and ethical argument can be made for extending free personal care to people under 65 who require care. We encourage the Executive actively to consider extension of the policy, in line with the commitment that was given when the legislation was passed.
Our inquiry focused on more than just free personal care. We believe that the Regulation of Care (Scotland) Act 2001 has achieved its primary purpose of creating, through the Scottish Commission for the Regulation of Care, a comprehensive and independent regulatory regime that has provided increased protection for elderly people and other groups who receive care services. Nonetheless, as with free personal care, we found that the care commission has encountered teething problems: its duplication of local authorities' work; poor co-operation between it and some councils; unnecessarily burdensome regulation in some areas; inflexible systems that do not allow innovative services to be developed easily; and the Executive's requirement for the commission's elderly care services, but not its child care services, to be self-financing, which risks distorting its activity.
The committee therefore made several recommendations to the Executive and the care commission. We recommended that agreements between local authorities and the commission should be mandatory and that the care commission's elderly services should be funded in the same way as child care services are funded. We are disappointed that the Executive's response to those suggestions was not positive, but we look forward to hearing from the minister whether the issues will be considered further. However, the committee welcomes the fact that the Executive has accepted our recommendation that the care commission's registration system should be simplified to avoid multiple registrations.
The committee welcomes the increase in the take-up of direct payments since 2002. The number of people who are in receipt of such payments has increased from 207 in 2001 to 1,438 in 2005. On that basis, the legislation has been a success. However, we would like the Executive to do more to promote the availability of direct payments, particularly as we continue to lag far behind England and Wales in take-up. The Executive broadly supports our view, so we encourage it to back up that support with action in the coming months.
It is often said that the quality of a civilisation is defined by how it cares for its elderly people. I believe that Scotland has a good story to tell in that regard. The committee believes that, despite some problems, free personal care has been a great success, but we call on the Executive to act to ensure that the policy continues to deliver for Scotland's elderly people for many years to come. I commend the report to Parliament.
I move,
During our inquiry, two common misconceptions emerged about what free personal care will deliver. First, there is a misconception that under the 2002 act all care costs will be met by the state. Secondly, there is a belief that eligibility is universal and does not depend on assessment. The committee thinks that the Executive needs to issue clearer guidance on how the policy works.
The committee acknowledges the successes of free personal care, but we consider that measures should be taken to address the implementation problems that have arisen. First, we recommended that the Executive undertake a thorough review of the resources that local authorities—collectively and individually—require if they are adequately to finance free personal care. An increase in funding or more equitable distribution among local authorities might be required. We are pleased that such a review is under way and we look forward to hearing its conclusions.
The loopholes that, in effect, permit the use of mechanisms to ration free personal care should be closed through changes to the legislation, if necessary. The Executive has noted that suggestion and will consider it in its policy evaluation. However, that is disappointing for the committee, so I would welcome further comments from the minister on that.
The Executive should enforce the guidance on the aspects of eligibility that local authorities claim remain ambiguous and it should ensure that services such as assistance with meal preparation—if they are part of assessed need—fall under the free personal care scheme. I am aware that the Executive has made many attempts to resolve the situation, but the committee remains concerned that, overall, it is still unresolved.
The Executive should also adopt a mechanism for determining the long-term level of financing for free personal care—it should decide, for example, whether to increase the financing in line with inflation or some other indicator. The Executive has noted that suggestion, but the committee hopes that it will be considered in the review. I ask the minister to elaborate on that today.
The Executive should also remove the financial incentive for local authorities to delay assessment, either by allowing claims for free personal care to be backdated from the point of eligibility rather than from assessment, or by introducing a mandatory deadline for assessments, which could perhaps be two weeks after application.
Free personal care can be effective only if it is sustainable in the long term, which is an issue that the Executive must address. The committee recommended that the Executive should model carefully the cost of free personal care in the medium term to ensure its sustainability and, in so doing, revalidate the current costs based on demand. As I said, we welcome the Executive's acceptance of that recommendation. Although clear financial obstacles to the extension of the policy exist, a logical and ethical argument can be made for extending free personal care to people under 65 who require care. We encourage the Executive actively to consider extension of the policy, in line with the commitment that was given when the legislation was passed.
Our inquiry focused on more than just free personal care. We believe that the Regulation of Care (Scotland) Act 2001 has achieved its primary purpose of creating, through the Scottish Commission for the Regulation of Care, a comprehensive and independent regulatory regime that has provided increased protection for elderly people and other groups who receive care services. Nonetheless, as with free personal care, we found that the care commission has encountered teething problems: its duplication of local authorities' work; poor co-operation between it and some councils; unnecessarily burdensome regulation in some areas; inflexible systems that do not allow innovative services to be developed easily; and the Executive's requirement for the commission's elderly care services, but not its child care services, to be self-financing, which risks distorting its activity.
The committee therefore made several recommendations to the Executive and the care commission. We recommended that agreements between local authorities and the commission should be mandatory and that the care commission's elderly services should be funded in the same way as child care services are funded. We are disappointed that the Executive's response to those suggestions was not positive, but we look forward to hearing from the minister whether the issues will be considered further. However, the committee welcomes the fact that the Executive has accepted our recommendation that the care commission's registration system should be simplified to avoid multiple registrations.
The committee welcomes the increase in the take-up of direct payments since 2002. The number of people who are in receipt of such payments has increased from 207 in 2001 to 1,438 in 2005. On that basis, the legislation has been a success. However, we would like the Executive to do more to promote the availability of direct payments, particularly as we continue to lag far behind England and Wales in take-up. The Executive broadly supports our view, so we encourage it to back up that support with action in the coming months.
It is often said that the quality of a civilisation is defined by how it cares for its elderly people. I believe that Scotland has a good story to tell in that regard. The committee believes that, despite some problems, free personal care has been a great success, but we call on the Executive to act to ensure that the policy continues to deliver for Scotland's elderly people for many years to come. I commend the report to Parliament.
I move,
In the same item of business
The Presiding Officer (Mr George Reid):
NPA
The next item of business is a debate on motion S2M-4795, in the name of Roseanna Cunningham, on the Health Committee's 10th report of 2006, which is on the ...
Janis Hughes (Glasgow Rutherglen) (Lab):
Lab
There can be little doubt that Parliament is proud of the introduction of free personal care for all of Scotland's elderly population. The Community Care and...
Alex Fergusson (Galloway and Upper Nithsdale) (Con):
Con
I have often raised that issue locally—it is of considerable concern to me. Does the Health Committee agree that local authorities' different approaches to i...
Janis Hughes:
Lab
Yes. The committee concluded that there are discrepancies in interpretation of the guidance. We raised the matter with the Executive and included it in our r...
That the Parliament notes the conclusions and recommendations contained in the Health Committee’s 10th Report, 2006 (Session 2):
Care Inquiry (SP Paper 594).
The Deputy Minister for Health and Community Care (Lewis Macdonald):
Lab
I very much welcome this debate and the Health Committee's initiative in conducting the first major post-legislative review by a Scottish parliamentary commi...
Mike Rumbles (West Aberdeenshire and Kincardine) (LD):
LD
Will the minister confirm whether that review will include consideration of uprating the allowance? The allowance was set four years ago, and the minister wi...
Lewis Macdonald:
Lab
I am certainly happy to confirm that we will look at that matter; indeed, we are already doing so in order to establish whether the figure that was set a num...
Mr Kenneth Macintosh (Eastwood) (Lab):
Lab
Does the minister acknowledge the difficulties that are faced by authorities such as East Renfrewshire Council, where older people enjoy the benefits of a lo...
Lewis Macdonald:
Lab
The formula for distribution among local authorities is a matter in which local authorities themselves have an interest. We deal with them as partners in tha...
Shona Robison (Dundee East) (SNP):
SNP
Will the minister clarify the timescale for the review that the Executive is going to carry out? When will it be concluded?
Lewis Macdonald:
Lab
The review is under way and we look to come to conclusions in the course of the current calendar year.We do not ring fence or hypothecate the money that goes...
Mr John Swinney (North Tayside) (SNP):
SNP
Does the minister acknowledge that some local authorities are having to dip into wider resources for older people services, beyond what the Government has es...
Lewis Macdonald:
Lab
We will be happy to discuss distribution issues with local government, through COSLA, in the usual way. On the adequacy of resources, it is worth noting that...
Mr Jamie Stone (Caithness, Sutherland and Easter Ross) (LD) rose—
LD
Mr David Davidson (North East Scotland) (Con) rose—
Con
The Presiding Officer:
NPA
I call Jamie Stone—sorry, it is David Davidson.
Mr Davidson:
Con
I thought that the minister looked at me. I beg your pardon. What is your guidance, Presiding Officer?
The Presiding Officer:
NPA
You are up, so carry on.
Mr Davidson:
Con
Thank you. I am grateful.The minister talked about implementation. At the end of the first year of the policy, four councils wrote to me to illustrate their ...
Lewis Macdonald:
Lab
It sounds as if David Davidson has already delivered his speech. We are keen to ensure that local authorities understand and implement the policy consistentl...
Mr Stone:
LD
When we are discussing this or any other element of local government expenditure, it is often hard for back benchers to understand the figures and get to the...
Lewis Macdonald:
Lab
That reflects the question that Mr Rumbles asked about inflation proofing or changing the level of fees that are made available. The review will consider tho...
Christine Grahame (South of Scotland) (SNP):
SNP
Does the minister share my concern that many of the costs are engendered by the care commission's being self financing? That concern was expressed to me many...
Lewis Macdonald:
Lab
We believe that it is right that the costs of regulation should be open and transparent. That means that it is right that those who are regulated should be c...
Shona Robison (Dundee East) (SNP):
SNP
We should remember that, despite the difficulties with implementation, the policy of free personal care has been widely welcomed and judged to be a success. ...
Mike Rumbles:
LD
The Health Committee found that the Executive says that it is fully funding free personal care. The Executive negotiates with COSLA, which also says that the...
Shona Robison:
SNP
Frankly, the issue is that there is buck-passing between all levels of government. That has to end because vulnerable elderly people are caught in the middle...
Mr Stone rose—
LD
The Deputy Presiding Officer (Trish Godman):
Lab
The member is winding up.