Back to the Scottish Parliament Health Committee Report
Archive Home

Business Bulletin 1999-2011

Minutes of Proceedings 1999-2011

Journal of Parliamentary Proceedings Sessions 1 & 2

Committees Sessions 1, 2 & 3

Annual reports

SP Paper 594 HC/S2/06/R10
Volume 2     Next

10th Report, 2006 (Session 2)

Care Inquiry

CONTENTS - VOLUME 1

Remit and Membership

Summary of Conclusions and Recommendations

COMMITTEE REPORT

Introduction

A. Free Personal Care for the Elderly

Successes

Reception
Security and Dignity
Care at Home
Benefits to the NHS
The UK Context
Implementation
Conclusions and Recommendations

Problems with Implementation

Funding
Waiting Lists
Guidance
Up-rating Payments
Back-dating payments
Expectations of the Policy
Conclusions and Recommendations

Sustainability and Extension

Sustainability
Extension
Conclusion and Recommendations

B. The Regulation of Care for the Elderly

Successes

Conclusion and Recommendations

Problems with Implementation

Duplication and Overlap

‘Supporting People’

Registration

Small Providers
New Services
Online Registration

Financing the Care Commission
Handling Complaints
Conclusions and Recommendations

C. Direct Payments

Introduction
Research Findings
Committee Consideration
Conclusions and Recommendations

ANNEX A : FREE PERSONAL CARE – COUNCIL FOI RESPONSES

Table of responses from local authorities to the Committee’s Freedom of Information request regarding the costs of free personal care, and delays in provision.

ANNEX B: EXTRACT FROM MINUTES

7th February 2006 (4th Meeting, Session 2 (2006))
21st February 2006 (5th Meeting, Session 2 (2006))
7th March 2006 (6th Meeting, Session 2 (2006))
21st March 2006 (7th Meeting, Session 2 (2006))
28th March 2006 (8th Meeting, Session 2 (2006))
16th May 2006 (12th Meeting, Session 2 (2006))
23rd May 2006 (13th Meeting, Session 2 (2006))
30th May 2006 (14th Meeting, Session 2 (2006))

ANNEX C: RESEARCH REPORT ON THE IMPLEMENTATION OF DIRECT PAYMENTS FOR PEOPLE WHO USE CARE SERVICES

‘Implementation of Direct Payments for People Who use Care Services’ Report - Executive Summary

Volume 2

ANNEX D: ORAL EVIDENCE AND ASSOCIATED WRITTEN EVIDENCE

7th February 2006 (4th Meeting, Session 2 (2006))

Written Evidence

University of Stirling
Carers Scotland
Alzheimer Scotland
Age Concern Scotland
P³ - Patient Partnership in Practice

Oral Evidence

David Bell, University of Stirling
Fiona Collie, Carers Scotland
Alex Davidson, Association of Directors of Social Work
Ewan Findlay, Scottish Care
Paul Gray, Scottish Executive
Kate Higgins, Capability Scotland
Jim Jackson, Alzheimer Scotland
Alan McKeown, CoSLA
Stephen Moore, Fife Council
Willie Primrose, British Geriatric Society
Andy Sim, Age Concern Scotland
Pat Wells, RCGP Scotland, P3 - Patient Partnership in Practice

Supplementary Evidence

University of Stirling
Capability Scotland
Association of Directors of Social Work
CoSLA

21st February 2006 (5th Meeting, Session 2 (2006))

Written Evidence

Community Care Providers Scotland
North Lanarkshire Council
British Geriatric Society (Scotland)
Scottish Public Services Ombudsman
Royal College of Nursing Scotland
P3 - Patient Partnership in Practice

Oral Evidence

Lord Sutherland, Former Chair of The Royal Commission on Long Term Care of the Elderly
Aileen Anderson, Scottish Partnership for Palliative Care
David Bookbinder, Scottish Federation of Housing Associations
Alice Brown, Scottish Public Services Ombudsman
Fiona Cherry, Royal College of Nursing Scotland
Jim Dickie, North Lanarkshire Council
Ewan Findlay, Scottish Care
Annie Gunner, Community Care Providers Scotland
Will Mallinson, Edinburgh Advocacy & Representation Service
Alan McKeown, CoSLA
Adam Rennie, Scottish Executive
Hilda Smith, Association of Directors of Social Work
Pat Wells, RCGP Scotland, P3 - Patient Partnership in Practice

Supplementary Evidence

Lord Sutherland, Former Chair of The Royal Commission on Long Term Care of the Elderly
Scottish Public Services Ombudsman
Royal College of Nursing Scotland
P3 - Patient Partnership in Practice

7th March 2006 (6th Meeting, Session 2 (2006))

Written Evidence

Angus Council
Dundee City Council
Care Commission

Oral Evidence

Councillor Glennis Middleton, Angus Council
Robert Peat, Angus Council
Baillie Helen Wright, Dundee City Council
Alan Baird, Dundee City Council
Mary Hartnoll, Care Commission
Jacquie Roberts, Care Commission
David Wiseman, Care Commission

Supplementary Evidence

Angus Council
Dundee City Council

21st March 2006 (7th Meeting, Session 2 (2006))

Written Evidence

Anne Logue
Frank Bardgett
C I Thuillier
Anonymous
Scott Rae
Group of Families

Oral Evidence

Anne Logue
Frank Bardgett
Kate Thuillier
Sylvia Denton
Scott Rae
Alan Lawson

Supplementary Evidence

Frank Bardgett
Anonymous

28th March 2006 (8th Meeting, Session 2 (2006))

Oral Evidence

Lewis Macdonald MSP, Deputy Minister for Health & Community Care
Adam Rennie, Scottish Executive
Donald Carmichael, Scottish Executive

16th May 2006 (12th Meeting, Session 2 (2006))

Written Evidence

Glasgow Centre for Inclusive Living
Capability Scotland

Oral Evidence

Sheila Riddell, University of Edinburgh;
Charlotte Pearson, University of Glasgow;
Nick Watson, University of Glasgow
John Alexander, Fife Council
Etienne d'Aboville, Glasgow Centre for Inclusive Living
Elsie Normington, formerly of Direct Payments Scotland
Kate Higgins, Capability Scotland
Lewis Macdonald MSP, Deputy Minister for Health and Community Care
Jean MacLellan, Scottish Executive Health Department

Supplementary Written Evidence

Lewis Macdonald MSP, Deputy Minister for Health & Community Care (17th May 2006)
Lewis Macdonald MSP, Deputy Minister for Health & Community Care (25th May 2006)

ANNEX E: OTHER WRITTEN EVIDENCE

Organisations

Aberdeen City Council
Aberdeenshire Council
Clackmannanshire Council
Dumfries and Galloway Council
East Ayrshire Council
East Dunbartonshire Council
East Lothian Council
East Renfrewshire Community and Health & Care Partnership
Glasgow Centre for Inclusive Living
Highland Carers’ Strategy Steering Group
Highland Community Care Partnership
Marie Curie Cancer Care
The Moray Council/Moray Community Health & Social Care Partnership
NCH Scotland
New Craigs Carers Project
NHS Ayrshire and Arran
North Ayrshire Council Social Services
NUS Scotland Disabled Students Campaign
Orkney Islands Council
Alzheimer Scotland Polish and Ukrainian Support Service
Renfrewshire Council
Royal College of Physicians of Edinburgh
Scottish Borders Council
Scottish Hospice Forum
Skye and Lochalsh Community Care Forum
South Ayrshire Community Health Partnership
South Ayrshire Council
South Lanarkshire Council
UNISON Scottish Regulation of Care Branch
Voluntary Service Aberdeen Carers Centre
West Dunbartonshire Council
West Lothian Council

Individuals

Ms Hilda Black
Ms Pam Duncan
Ms Senga Jackson
Peter Johnston
Miss Margaret Lyth
Ms Angela Smillie
Mr W Hunter Watson
Mr John McIntosh

ANNEX F: FACT FINDING VISITS

Report of Visit to East Lothian
Report of Visit to Inverness
Report of Visit to Greenock/Rutherglen

‘The Implementation of Direct Payments For People Who Use Care Services: Report To The Scottish Parliament Health Committee.
Centre for Research in Education Inclusion and Diversity, University of Edinburgh, Department of Urban Studies, University of Glasgow and Strathclyde Centre for Disability Research, University of Glasgow

Remit and membership

Remit:

To consider and report on matters relating to health policy and the National Health Service in Scotland and such other matters as fall within the responsibility of the Minister for Health and Community Care.

Membership:

Roseanna Cunningham (Convener)
Helen Eadie
Janis Hughes (Deputy Convener)
Kate Maclean
Mr Duncan McNeil
Nanette Milne
Shona Robison
Euan Robson (from 25 April 2006)
Mike Rumbles (to 30 March 2006)
Dr Jean Turner

Committee Clerking Team:

Clerk to the Committee
Lynn Tullis
Simon Watkins

Senior Assistant Clerk
Graeme Elliott

Assistant Clerk
David Simpson

Committee Assistant
Lynn Devine

10th Report, 2006 (Session 2)

Care Inquiry

Summary of Conclusions and Recommendations

A. Free Personal Care

Successes

1. Conclusion: The Committee believes that the policy of free personal care for the elderly introduced by the Community Care and Health Act has been a success, and has been widely welcomed.

2. It has:

1) provided greater security and dignity to many elderly people

2) allowed them to be cared for more readily at home

3) assisted their carers

4) reduced delayed discharges, thus freeing up NHS resources

5) largely ended disputes between local authorities and health boards over the care of elderly people

6) led to fewer complaints being reported to the Ombudsman about care of the elderly in Scotland than in England and Wales

7) prompted consideration to be given to the development of elderly care policy in England and Wales

8) in the main, been introduced swiftly and comprehensively

3. Recommendation: The Committee proposes that the policy of providing free personal care for those over 65 continues to be pursued and developed.

Problems with Implementation

4. Conclusion: The Committee has heard evidence that would suggest that there have however been some major problems with the implementation of free personal care for the elderly. These could undermine the policy if not addressed.

5. The problems include:

1) questions about the funding formula put in place by the Scottish Executive

2) the operation of ‘waiting lists’ for free personal care by half of all local authorities

3) a failure by the Scottish Executive to enforce clear guidance on key aspects of eligibility, such as the preparation of meals

4) the level of free personal care funding, which is not increasing in line with inflation

5) a lack of clarity regarding the date from which payments are required to be made, which could create a financial incentive for local authorities to delay assessments

6) continuing confusion over what is covered by the policy.

6. Recommendations: The Committee supports the principle that everyone who has a right to free personal care under the legislation and is assessed as requiring it should have it provided without undue delay.

7. In order to address the implementation problems that have arisen a number of initiatives need to be undertaken:

1) the Scottish Executive should undertake a thorough review (based on the experience of the last 3 years) of the resources required by local authorities, collectively and individually, to adequately finance free personal care. This may require an increase in funding, or more equitable distribution amongst local authorities

2) loopholes that permit the use of mechanisms to effectively ‘ration’ free personal care should be closed, if necessary by changes to the legislation

3) the Scottish Executive should enforce the guidance on those aspects of eligibility which local authorities claim remain ambiguous. It should ensure that services such as assistance with meal preparation, where they are part of assessed need, are eligible for free personal care

4) the Scottish Executive should adopt a mechanism for determining the long-term level of financing of free personal care, i.e. whether to increase it in line with the rate of inflation or some other indicator, as decided by the Scottish Executive

5) the Scottish Executive should remove the financial incentive for local authorities to delay assessment by either: allowing claims for free personal care to be backdated from the point of eligibility rather than assessment: or introducing a mandatory deadline for assessments, e.g. within two weeks of application.

Sustainability and Extension

8. The Committee believes that the policy of free personal care will only truly be effective and equitable if it is sustainable in the longer-term.

9. The Committee recommends that the Scottish Executive carefully model the cost of free personal care in the medium-term to ensure its sustainability. In this exercise it should revalidate current costs based on demand.

10. The Committee believes that there is a logical and ethical case for extending for free personal care to those who require care who are under 65, but it recognises that this is financially difficult to achieve.

11. The Committee recommends that the Scottish Executive actively considers the extension of free personal care, in keeping with the commitment made at the time that the Community Care and Health Act was passed.

B. The Regulation of Care

Successes

12. The Committee believes that the Regulation of Care Act has achieved its primary purpose in creating, through the Care Commission, a comprehensive and independent regulatory regime which has provided increased protection for the elderly and other groups receiving care services.

13. The Committee recommends that the Scottish Executive should continue to develop the Care Commission as the primary agency for the regulation of care services for the elderly.

Problems with Implementation

14. The Committee has discovered that a number of problems have emerged in the Care Commission’s relationship with other agencies, particularly the increased regulation faced by some providers and services. There are also questions regarding the Commission’s funding basis and its handling of complaints.

15. The problems include:

1) duplication and overlap between the activities of the Care Commission and local authorities, particularly in the field of housing support services

2) poor co-operation between the Care Commission and local authorities, for instance in sharing information – currently only 8 of 32 local authorities have an agreement with the Commission

3) unnecessarily burdensome regulation in some areas, for instance in the need for multiple registrations for single services

4) the inflexibility of some systems which do not allow innovative services to be easily developed

5) the requirement from the Scottish Executive for the Care Commission to be self-financing in elderly care services (but not child care), which risks distorting its activity

6) some concerns about the process for registering and investigating complaints against care providers.

16. The Committee recommends that the following action be taken to address the difficulties that have emerged:       

         

The Scottish Executive should:

1) make it mandatory for local authorities and the Commission to have agreements over the inspection and monitoring of care services.

2) place a duty on local authorities and the Care Commission to share information collected from care services.

3) for the sake of clarity allocate responsibility for regulating housing support services to either local authorities or the Care Commission

4) remove the requirement for Care Commission services for elderly care to be self-financing

The Care Commission should:

1) streamline its registration systems so that the level of multiple registrations for single services is reduced

2) revise the way in which it handles new services so as not to hinder the development of innovations which could improve elderly care

3) review the way it regulates smaller voluntary providers, so as avoid the potential reduction in the provision of care services in more remote areas

4) publicise more widely the outcome of inquiries into complaints that have been upheld, for instance to other residents of care homes.

C. Direct Payments

Conclusions

17. The Committee welcomes the increase in the take-up of direct payments following the passing of the Community Care and Health Act in 2002. This has seen the numbers in receipt of payments increase from 207 in 2001 to 1,438 in 2005 and the value of payments increase from £2.1 to £13.7 million. On this basis the Act can be judged to have been a success.

18. However, these increases are from a low base and direct payments in Scotland are still running at half the level of England and Wales. There is also a wide variation in take-up across Scottish local authority areas.  There is significant scope for those local authorities that still exhibit low take-up rates to engage at the level of those with higher take-up rates.

19. The Committee supports the concept of direct payments as a means of increasing the autonomy of those who receive them as well as enabling care packages to be tailored more closely to their needs. Whilst not a solution for everyone, they have the potential to improve the care available to many and the committee wishes to encourage the increase in their take-up.

20. The Committee acknowledges that the choice of direct payments brings with it risks and responsibilities for the individual, and that these must be carefully weighed in advance by those concerned. In this, a balance may need to be struck between flexibility and standards of service.

21. The increasing take-up of direct payments does represent a challenge to local authorities and traditional methods of care provision. It may operate as a lever to improve these. The Committee welcomes this, and believes that it should not represent a threat to public sector provision, provided that the public sector meets people’s needs.

22. It is important for local authorities to meet their minimum statutory duties to protect the safety of the individual and to ensure that no fraud takes place, but beyond this the Committee welcomes a ‘light touch’ approach to monitoring. It does not support too prescriptive an approach by local authorities, which runs counter to the aim of direct payments in giving individuals autonomy over their care arrangements. 

Recommendations

23. The Committee wishes to see more pro-active promotion of the availability of direct payments by the Scottish Executive and local authorities. The aim should be that all those who are eligible should be fully aware of direct payments as an option and be able to access them.

24. The Committee recommends that the Scottish Executive commits itself to continuing to encourage the take-up of direct payments, particularly in those areas which appear to have lagged behind.

25. The research that the Committee has sponsored has identified a number of ‘success factors’ in promoting the take-up of direct payments within local authorities. The Committee recommends that the Scottish Executive restate (i) its commitment to direct payments, (ii) its intentions in pursuing its policy, and (iii) re-issues guidance which takes advantage of the Committee’s research.

26. The Committee recommends that the Executive guidance stresses:

1) the importance of working with user-led support services - to allow individuals to articulate their needs and manage their care packages

2) the need for a clear commitment at senior level within a local authority as a way of improving take-up

3) the need to ensure that staff receive proper training and are fully informed of their role vis a vis payments

4) the value of having a designated post to oversee direct payments and accumulate expertise

5) the importance of mainstreaming direct payments funding

6) the scope to publicise the availability of direct payments to potential beneficiaries

7) that direct payments may be suitable for those with complex needs, as well as those with more straight-forward care needs.

Volume 2     Next